Bariatric Surgery and Effects on Calcium and Bone Metabolism

With the increasing epidemic of obesity in the United States as well as abroad, bariatric surgery has emerged as the most effective and sustained treatment for reduction. This treatment modality has been well recognized to diminish the risk of cardiovascular morbidity and mortality and ameliorate diabetes mellitus. However, with time, derangement in mineral metabolism has emerged as a major complication in this population. Population-based study has shown increased prevalence of bone fractures and kidney stone formation following bariatric surgery. The risk appears to be more specific after Roux-en-Y gastric bypass procedures, the most common surgical approach among this population. Over the past decade, there have been advances in the understanding of pathophysiologic mechanisms of both bone loss and kidney stone disease in these patients. The understanding of these underlying pathophysiologic mechanisms may lead to the development of drug therapies that ameliorate this complication. Unfortunately, at the present time, there is no hard data on any specific treatment showing decreased incidence of fragility fractures or kidney stone passage. However, some studies suggest that calcium and vitamin D supplementation may decrease bone loss and bone turnover, and as a result, increase bone mineral density in this population. However, there is concern with the development of kidney stone formation following such an approach. A novel treatment approach would be the use of effervescent potassium calcium citrate that not only prevents complications of bone loss but may diminish the risk of kidney stone formation. Despite preliminary results showing the effectiveness of this drug in the reduction in the parathyroid hormone, bone turnover, and improvement in the urinary saturation marker showing effectiveness against calcium oxalate and uric acid stones, there is no hard data available to support the effectiveness of this treatment in the reduction in fragility fractures or kidney stone incidence. Such studies to explore this effect must be considered in the future.     

Bariatric Surgery: Effects on the Metabolic Complications of Obesity

Bariatric surgery is increasing at an enormous rate in all countries but the indications for the operation on the basis of metabolic derangements are not clear, as only one controlled randomized trial specifically for a comorbidity has been performed. Thus, it is not clear if bariatric surgery should be offered to all obese patients with long standing type 2 diabetes or poorly controlled hypertension or hypertriglyceridemia, even though these conditions clearly respond in most patients to bariatric surgery and weight loss. It would appear that patients with early type 2 diabetes with reasonable control and a greater body mass index gain more benefit from the operation. More randomized trials are required.     

Long-term Reflux-Related Symptoms After Bariatric Surgery: Comparison of Sleeve Gastrectomy Versus Laparoscopic Adjustable Gastric Banding

Background

Long-term pulmonary reflux-related symptoms following laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) have not been reported.

Methods

We designed a retrospective analysis of consecutive patients who underwent LAGB or LSG between January 2000 and December 2010. All patients provided detailed history and physical examination. We assessed both early and late reflux-related symptoms. All patients underwent spirometry and chest X-ray (CXR).

Results

The analysis included 307 patients who underwent either LAGB (n = 193) or LSG (n = 114). Mean age was 43 ± 12 and 46 ± 11 years, respectively; 144 (76.6 %) and 83 (73 %) were female, respectively. Similar rates of previous pulmonary disease were noted in both LAGB and LSG groups (10.9 vs. 10.5 %, respectively). However, more patients with sleep apnea were in the LSG group (13.2 vs. 6.2 %, p = 0.03). The mean interval between surgery and the onset of pulmonary symptoms was longer in patients who underwent LAGB (72 ± 22 months) than for those who had LSG (36 ± 24 months; p = 0.03). The overall complication rate was higher in the LAGB (7.3 %) than in LSG (4.4 %) group. LSG patients had significantly lower rates of morning cough (12.3 vs. 59.6 %, p = 0.001) and postprandial cough (10.5 vs. 58 %, p = 0.001) compared to the LAGB patients. Two cases of pneumonia occurred in each group. The mortality rate was zero in both groups.

Conclusion

Both surgeries are considered safe and without major reflux-related symptoms. There is a lower incidence of cough with LSG than with LAGB.     

Bariatric Surgery: Impact on Pregnancy Outcomes

The dramatic increase in the prevalence of obesity in women of reproductive age has resulted in approximately 1 in 5 women being obese when they conceive. Bariatric surgery has been shown to be the most effective long-term weight loss strategy in obese women in this age group. Clinicians should be aware of the effects of bariatric surgery on fertility and future pregnancies. Regarding certain complications, pregnancy after bariatric surgery appears to be safer than pregnancy in the obese. In patients where nutrition is properly maintained and monitored, the risks for obesity-related obstetric complications, such as gestational diabetes mellitus and hypertension, are significantly reduced, but possibly at the expense of an increase in neonates born small-for-gestational-age. At the present, definitive conclusions cannot be drawn concerning the risk for Caesarian delivery, differences in type of bariatric procedure, or the optimal surgery-to-conception interval.     

Thirty-Day Readmission After Bariatric Surgery: Causes,Effects on Outcomes,and Predictors

Digestive Diseases and Sciences - Bariatric surgery (BSx) is one of the most common surgical procedures in North America. Readmissions may be associated with a high burden to the healthcare system....     

The Quality of Bowel Preparation After Bariatric Surgery: Diverse Effects of Diversion

Digestive Diseases and Sciences -     

The Impact of Bariatric Surgery on Depression: a Review

More than half of patients with obesity who present for medical or surgical management meet the criteria for a psychiatric illness, commonly a mood disorder. Bariatric surgery leads to significant improvement in depression symptomology and a reduction in the overall prevalence of depression. Studies generally report short-term overall reduction in depression rates between approximately 55 to 65 % within the first two years following surgery. It appears that there is a dose response relationship between weight loss and resolution of depression. There are some conflicting reports in the literature as to the maintenance of depression outcomes following bariatric surgery, with newer, long-term studies reporting the attenuation of depression symptomology improvements. While generally, bariatric surgery is beneficial for depression, there exists a cohort of patients who might actually worsen following surgery. A likely multifactorial consequence of weight regain, unrealistic expectations or other life stresses, this group needs to be monitored closely, as postoperative bariatric surgery patients surgery appear to be at an increased risk of suicide. Overall, a multidisciplinary team including psychiatrists, psychologists and other mental health professionals are vital to optimize patient care in the depressed, obese bariatric surgery patient.