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1.
Background The prevalence of obstructive sleep apnea syndrome (OSAS) is high in obese patients. Certain components of metabolic syndrome
are linked to OSAS, but there is no information on their association in morbidly obese patients. Our aim was to ascertain
the prevalence of respiratory disturbances during sleep in candidates for bariatric surgery and to study their association
with metabolic syndrome.
Methods We examined the preoperative records (history, physical examination and laboratory findings, spirometry, and overnight pulse
oximetry [arterial oxygen saturation by pulse oximetry, [SpO2]]) of patients scheduled for gastric bypass surgery for 1 year in our hospital; an overnight sleep study was performed if
SpO2 readings or symptoms suggested sleep disturbance. Metabolic syndrome was defined according to the criteria of the National
Cholesterol Education Program’s Adult Treatment Panel III.
Results Of the 31 patients studied, 19 (61.3%) had OSAS, including 15 newly diagnosed cases with a mean ± standard deviation apnea–hypopnea
index of 49 ± 36. OSAS patients had higher fasting plasma glucose and triglyceride levels and a higher prevalence of diabetes.
Metabolic syndrome was also more frequent in subjects with previously untreated OSAS (13/14, 92%) than in those without sleep
disturbance (six of 11, 55%; p = 0.033). Conversely, the prevalence of OSAS in patients with metabolic syndrome was higher (13/19, 68%) than in subjects
without metabolic syndrome (one of six, 17%; p = 0.026) even though the two groups had similar body mass index.
Conclusions Sleep disordered breathing is very prevalent in obese patients who are candidates for bariatric surgery and its presence is
related to metabolic syndrome.
An erratum to this article can be found at 相似文献
2.
Jean J. Bao Vikas Desai Katherine Kaufer Christoffel Patrick Smith-Ray Alex P. Nagle 《Obesity surgery》2009,19(7):833-839
Background Clinical experience suggests that some adults who undergo bariatric surgery have children who are obese. Childhood obesity
is associated with increased morbidity and mortality in later life. This study examined the prevalence of obesity among children
and grandchildren (≤12 years of age) of adult bariatric surgery patients.
Methods Patients in a prospective database of morbidly obese patients who underwent bariatric surgery between January 2004 and May
2007 were recruited by phone and in clinic. Patient demographics, body mass index (BMI) at surgery, and survey data were collected.
The survey included questions regarding their child/grandchild's body habitus, weight, and height. Child obesity was defined
as BMI percentile ≥95. Statistical significance was set at p < 0.05.
Results One hundred twenty-two patients were enrolled in this study (77% women, mean BMI 49 kg/m2). One hundred thirty-four out of 233 children/grandchildren identified had complete data; 41% had a BMI percentile ≥95. Only
29% of these obese children were so identified by the adult respondents. Significantly more biological children/grandchildren
were obese than nonbiological (p = 0.013), and significantly more biological children were obese than biological grandchildren (p = 0.027).
Conclusions This sample of bariatric surgery patients had a high proportion of obese preteen children/grandchildren. Obesity was most
prevalent among biological children (vs. biological grandchildren and nonbiological children). Patients often did not recognize
the degree of overweight in their children/grandchildren. Because families of bariatric surgery patients often include obese
children, interventions aimed at all family members merit consideration. 相似文献
3.
Background Obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators
including C-reactive protein (CRP) and white blood cell count (WBC). Recent studies have shown elevated CRP or WBC is a significant
risk factor for cardiac events and stroke but the clinical significance of CRP and WBC has not been clearly studied in morbidly
obese patients. This study is aimed at the clinical significance of WBC and CRP in morbidly obese patients and the change
after bariatric surgery.
Methods The study was a prospectively controlled clinical study. From December 1, 2001 to January 31, 2006, of 640 (442 females and
198 males) consecutive morbid obese patients enrolled in a surgically supervised weight loss program with at least 1 year’s
follow-up were examined.
Results Of the patients, 476 (74.4%) had elevated CRP and 100 (15.6%) had elevated WBC at preoperative study. CRP and WBC were significantly
related and both increased with increasing body mass index (BMI). CRP is also increased with increasing waist, glucose level,
hemoglobin, albumin, Ca, insulin, C-peptide, and metabolic syndrome while WBC is increased with metabolic syndrome but decreased
with increasing age. Multivariate analysis confirmed fasting glucose level and hemoglobin are independent predictors of the
elevation of CRP while age is the only independent predictor for elevated WBC. Both WBC and CRP levels decreased rapidly after
obesity surgery. These improvements resulted in a 69.8% reduction of CRP and 26.4% reduction of WBC 1 year after surgery.
Although individuals who underwent laparoscopic gastric bypass lost significantly more weight (36.8 ± 11.7 kg vs. 17.3 ± 10.8 kg;
p = 0.000) and achieved a lower BMI (27.8 ± 4.6 vs. 35.0 ± 5.5; p = 0.000) than individuals who underwent laparoscopic gastric banding, there was no difference in the resolution of elevated
CRP 1 year after surgery (95.9% vs. 84.5%; p = 0.169) and WBC (99.4% vs. 98.3%; p = 0.323).
Conclusions Both baseline WBC and CRP are elevated in morbid obese patients but CRP has a better clinical significance. Significant weight
reduction 1 year after surgery markedly reduced CRP and WBC with a resolution rate of 93.9% and 98.2% separately. Obesity
surgery performed by laparoscopic surgery is recommended for obese patients with elevated CRP or WBC. 相似文献
4.
Nugent C Bai C Elariny H Gopalakrishnan P Quigley C Garone M Afendy M Chan O Wheeler A Afendy A Younossi ZM 《Obesity surgery》2008,18(10):1278-1286
Background Metabolic syndrome (MS) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study was to
assess the impact and predictors of bariatric surgery on the resolution of MS.
Methods Subjects included 286 patients [age 44.0 ± 11.5, female 78.2%, BMI 48.7 ± 9.4, waist circumference 139 ± 20 cm, AST 23.5 ± 14.9,
ALT 30.0 ± 20.1, type 2 diabetes mellitus (DM) 30.1% and MS 39.2%] who underwent bariatric surgery.
Results Of the entire cohort, 27.3% underwent malabsorptive surgery, 55.9% underwent restrictive surgery, and 16.8% had combination
restrictive–malabsorptive surgery. Mean weight loss was 33.7 ± 20.1 kg after restrictive surgery (follow up period 298 ± 271 days),
39.4 ± 22.9 kg after malabsorptive surgery (follow-up period 306 ± 290 days), and 28.3 ± 14.1 kg after combination surgery
(follow-up period 281 ± 239 days). Regardless of the type of bariatric surgery, significant improvements were noted in MS
(p values from <0.0001–0.01) as well as its components such as DM (p values from <0.0001–0.0005), waist circumference (p values <0.0001), BMI (p values <0.0001), fasting serum triglycerides (p values <0.0001 to 0.001), and fasting serum glucose (p values <0.0001). Additionally, a significant improvement in AST/ALT ratio (p value = 0.0002) was noted in those undergoing restrictive surgery. Multivariate analysis showed that patients who underwent
malabsorptive bariatric procedures experienced a significantly greater percent excess weight loss than patients who underwent
restrictive procedures (p value = 0.0451). Percent excess weight loss increased with longer postoperative follow-up (p value <0.0001).
Conclusions Weight loss after bariatric surgery is associated with a significant improvement in MS and other metabolic factors. 相似文献
5.
Background Roux-en-Y gastric bypass (RYGBP) has become a common surgical procedure to treat morbid obesity. Furthermore, it strongly
reduces the incidence of type 2 diabetes and mortality. However, there is scant information on how magnesium status is affected
by RYGBP surgery. Previous bariatric surgery methods, like jejunoileal bypass, are associated with hypomagnesemia.
Methods Twenty-one non-diabetic morbidly obese patients who underwent RYGBP were evaluated before and 1 year after surgery and compared
to a matched morbidly obese control group regarding serum magnesium. Groups were matched regarding weight, BMI, abdominal
sagittal diameter and fasting glucose, blood pressure, and serum magnesium concentrations before surgery in the RYGBP group.
Results The serum magnesium concentrations increased by 6% from 0.80 to 0.85 mmol/l (p = 0.019) in the RYGBP group while a decrease by 4% (p = 0.132) was observed in the control group. The increase in magnesium concentration at the 1-year follow-up in the RYGBP
group was accompanied by a decreased abdominal sagittal diameter (r
2 = 0.32, p = 0.009), a lowered BMI (r
2 = 0.28, p = 0.0214), a lowered glucose concentration (r
2 = 0.28, p = 0.027) but not by a lowered insulin concentration (p = 0.242), a lowered systolic (p = 0.789) or a lowered diastolic (p = 0.785) blood pressure.
Conclusion RYGBP surgery in morbidly obese subjects is characterized by reduced visceral adiposity, lowered plasma glucose, and increased
circulating magnesium concentrations. The inverse association between lowered central obesity, lowered plasma glucose and
increased magnesium concentrations, needs further detailed studies to identify underlying mechanisms. 相似文献
6.
Ekaterina Tiktinsky Leonid Lantsberg Sophie Lantsberg Solly Mizrahi Svetlana Agranotvich Michael Friger Boris Kirshtein 《Obesity surgery》2009,19(9):1270-1273
Background Laparoscopic adjustable gastric banding (LAGB) has been popularized as an effective, safe, minimally invasive surgical technique
for the treatment of morbid obesity. We performed a pilot study to evaluate gastric emptying of semisolid meals and antral
motility following LAGB.
Methods Gastric emptying half-time was compared in normal volunteers and morbidly obese patients before and 6–12 months after LAGB
using sulfur colloid-labeled semisolid meals.
Results There was no difference in mean age between groups. Women were prevalent in the group of obese patients. BMI was higher in
patients before surgery (p < 0.001). Patients following LAGB demonstrated prolonged gastric pouch emptying (T1/2 = 36.6 ± 9.8 min) compared to subjects
without surgery (23.8 ± 4.7 min) and healthy volunteers (22.8 ± 6.8 min; p < 0.001). Similar gastric contractility was found all groups (3.3 ± 0.4; p = 0.968). No cases of band slippage or pouch dilatation were observed during mean follow-up of 11.4 months.
Conclusions A standard normal gastric pouch emptying rate of semisolids in asymptomatic patients after LAGB was established. Postoperative
prolongation of gastric emptying is a matter of mechanical delay without gastric pouch denervation. This study provides a
first step of future functional evaluation of complications following this type of bariatric surgery. 相似文献
7.
Reinehr T Roth CL Schernthaner GH Kopp HP Kriwanek S Schernthaner G 《Obesity surgery》2007,17(12):1571-1577
Background Peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) are cosecreted in the same enteroendocrine L-cells of the gut and reported
to inhibit food intake additively. However, findings in human studies regarding these peptides are controversial. The aim
of this study was to analyze the relationships between fasting PYY, GLP-1, and weight status in morbidly obese patients before
and after surgically induced weight loss.
Methods Fasting GLP-1, PYY, glucose, and insulin concentrations; blood pressure; and body-mass index (BMI) were determined in 30 morbidly
obese adults (mean BMI 45.8, mean age 40 years) before bariatric surgery [Roux-en-Y gastric bypass (RYGB): n = 19; gastric banding (GB): n = 11] and after weight loss (mean 50% excess weight loss) in the course of mean 2 years.
Results GLP-1 concentrations decreased (mean −20 pg/ml; mean −38%; p = 0.001) and PYY concentrations increased (mean +19 pg/ml; mean +19%, p = 0.036) after bariatric surgery. The weight loss and changes of GLP-1 were significantly (p < 0.05) more pronounced after RYGB as compared to GB, whereas the changes of PYY did not differ significantly between the
patients who had undergone RYGB or GB.
Conclusions In morbidly obese adults reducing their weight by bariatric surgery, fasting PYY levels increased and GLP-1 concentrations
decreased independently of each other. Therefore, the relationship between PYY and GLP-1 seems more complicated than might
be anticipated from animal and in vitro studies.
T. Reinehr and C. L. Roth contributed equally to this work. 相似文献
8.
The use of prosthetic material to prevent incisional hernia in clean-contaminated procedures as bariatric surgery remains
controversial. We present our experience on 45 consecutive morbidly obese patients undergoing biliopancreatic diversion that
was closed using a polypropylene mesh. Moreover, we reviewed the outcome of the 50 previous consecutive obese patients who
underwent biliopancreatic diversion and conventional closure of the abdomen in order to compare the outcome between the two
groups after a minimum follow-up of 2 years. Between January 2006 and February 2010, 95 morbidly obese patients underwent
open biliopancreatic diversion at our department. During the first 2 years of our experience, there were 50 obese patients
whose open biliopancreatic diversion was closed conventionally (without mesh). Starting on February 2008 and until February
2010, 45 patients received prophylactic midline reinforcement by the positioning of retrorectal muscle polypropylene mesh.
The outcome at 3, 6, 12, and 24 months was analyzed comparing the two groups of patients. No mesh infection occurred. Minor
local complications occurred similarly in both groups. The incidence of postoperative hernia was significantly higher in the
group conventionally closed (30%) than in the mesh group (4.4%) at 2-year follow-up (p < 0.05). The prophylactic use of mesh in open bariatric surgery is safe and effective at 2-year follow-up. 相似文献
9.
Background Although still controversial, upper endoscopy is frequently performed before bariatric surgery. This study investigated the
hypothesis that morbidly obese patients would prefer anesthesiologist-monitored sedation (AMS) compared to surgeon-monitored
sedation (SMS) during preoperative endoscopy.
Methods All patients who underwent endoscopy before their bariatric surgery were given a post-procedure survey regarding their experience
with the preoperative endoscopy. The survey inquired about issues during and after the procedure. We compared patients who
had AMS with IV propofol versus SMS IV narcotics and benzodiazepines.
Results There were 100 patients (SMS = 49 and AMS = 51). Few patients complained of pain in the abdomen or throat during the procedure
(AMS vs. SMS = 2 vs. 8% and 2 vs. 10%, respectively; p = NS). More patients complained about throat pain after the procedure (AMS vs. SMS = 37 vs. 45%; p = NS). More patients in the SMS group remembered the scope being placed in the mouth versus AMS (33 vs. 10%; p < 0.02). More patients remembered gagging during the procedure in the SMS group versus the AMS group, but this did not reach
statistical significance (24 vs. 10%; p = 0.06). There was a trend that more patients in the AMS group felt they recovered in less than 1 h (53%) compared to the
SMS group (37%; p = 0.1).
Conclusion Patients who undergo upper endoscopy with either AMS or SMS seem to tolerate the procedure well. The preliminary benefits
seen with AMS need to be further explored. AMS should be considered for patients undergoing preoperative upper endoscopy before
bariatric surgery.
Presented at the International Federation for the Surgery of Obesity annual meeting; August 2006; Sydney, Australia. 相似文献
10.
E. Pardina A. Lecube R. Llamas R. Catalán R. Galard J. M. Fort H. Allende V. Vargas J. A. Baena-Fustegueras J. Peinado-Onsurbe 《Obesity surgery》2009,19(8):1150-1158
Background Although bariatric surgery is currently the most common practice for inducing weight loss in morbidly obese patients (BMI > 40 kg/m2), its effect on the lipid content of adipose tissue and its lipases (lipoprotein lipase [LPL] and hormone-sensitive lipase
[HSL]) are controversial.
Methods We analyzed LPL and HSL activities and lipid content from plasma as well as subcutaneous (SAT) and visceral (VAT) adipose
tissue of 34 morbidly obese patients (MO) before and after (6 and 12 months) Roux-en-Y gastric bypass surgery and compare
the values with those of normal weight (control) patients.
Results LPL activity was significantly higher in MO (SAT = 32.9 ± 1.0 vs VAT = 36.4 ± 3.3 mU/g tissue; p < 0.001) than in control subjects (SAT = 8.2 ± 1.4 vs VAT = 6.8 ± 1.0 mU/g tissue) in both adipose depots. HSL activity had
similar values in both types of tissue (SAT = 32.8 ± 1.6 and VAT = 32.9 ± 1.6 mU/g) of MO. In the control group, we found
similar results but with lower values (SAT = 11.9 ± 1.4 vs VAT = 12.1 ± 1.4 mU/g tissue). Twelve months after surgery, SAT
LPL activity diminished (9.8 ± 1.4 mU/g tissue, p < 0.001 vs morbidly obese), while HSL (46.6 ± 3.7 mU/g tissue) remained high. All lipids in tissue and plasma diminished
after bariatric surgery except plasma nonesterified fatty acids, which maintained higher levels than controls (16 ± 3 vs 9 ± 0 mg/dL;
p < 0.001, respectively).
Conclusions When obese patients lose weight, they lose not only part of the lipid content of the cells but also the capacity to store
triacylglycerides in SAT depots.
E. Pardina and A. Lecube contributed equally to this study.
J.A. Baena-Fustegueras and J. Peinado-Onsurbe share senior authorship. 相似文献
11.
H. Scheidbach H. Ptok D. Schubert D. Kose O. Hügel I. Gastinger F. K?ckerling H. Lippert 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(2):371-374
Background The creation of a stoma is an established therapeutic concept for the palliation of non-resectable rectal carcinomas and advanced
tumours infiltrating the pelvis.
Materials and methods In two prospective country-wide multicentre studies, each conducted over a similar period of time, the peri-operative course
and postoperative short-term outcomes of laparoscopic vs laparotomy-based stoma construction were compared.
Results A total of 90 patients underwent palliative laparoscopic construction; 550 patients received a stoma via a laparotomy. The
intra-operative complication rate was lower after open surgery than after laparoscopic surgery (2.7 vs 5.6%; p = 0.15), although the difference was not significant. With regard to general (30.9 vs 15.6%; p = 0.003) and also specific postoperative complications (13.8 vs 5.6%; p = 0.029), however, a significant advantage of the laparoscopic approach was seen. Furthermore, mortality in the laparoscopic
group was also significantly lower (4.4 vs 14.0%; p = 0.011).
Conclusion Palliative stoma done via laparoscopy had significantly better outcomes in terms of postoperative morbidity and mortality
in comparison with the open surgical procedure. 相似文献
12.
Antonio Iannelli Rodolphe Anty Thierry Piche Moucef Dahman Philippe Gual Albert Tran Jean Gugenheim 《Obesity surgery》2009,19(5):577-582
Background Although Roux-en-Y gastric bypass (RYGBP) is one of the preferred bariatric procedures in obese individuals, the efficacy
of this procedure in the setting of super-obesity [body mass index (BMI) ≥50] is unclear. The aim of this study was to compare
the efficacy of laparoscopic (L) RYGBP to reverse metabolic syndrome, inflammation, and insulin resistance in super-obese
women compared to morbidly obese women.
Methods Seventy-three consecutive women were enrolled in this prospective study. Anthropometric, metabolic, and inflammatory biological
parameters were assessed in 18 super-obese and 55 morbidly obese women before LRYGBP and 1 year after surgery. Metabolic syndrome
was diagnosed according to the International Diabetes Federation definition.
Results Before surgery, super-obese women had a higher BMI, fat mass, blood insulin, and HOMA1-IR than morbidly obese women. Both
groups had similar serum levels of C-reactive protein and orosomucoid. The incidence of metabolic syndrome, type 2 diabetes,
and increased liver enzymes was comparable in the two groups. One year after LRYGBP, metabolic syndrome, type 2 diabetes,
metabolic and inflammatory biological parameters were improved in the whole study population. A similar degree of improvement
was observed in super-obese and morbidly obese women, although BMI and fat mass were persistently higher in super-obese patients.
Conclusions One year after surgery, LRYGBP was equally effective at reversing metabolic syndrome, inflammation, and insulin resistance
in morbidly obese and super-obese women. 相似文献
13.
Jouët P Sabaté JM Maillard D Msika S Mechler C Ledoux S Harnois F Coffin B 《Obesity surgery》2007,17(4):478-485
Background Morbid obesity is a risk factor of nonalcoholic steatohepatitis (NASH). Obstructive sleep apnea (OSA) could also be an independent
risk factor for elevated liver enzymes and NASH. The relationships between liver injuries and OSA in morbidly obese patients
requiring bariatric surgery were studied prospectively.
Methods Every consecutive morbidly obese patient (BMI ≥40 kg/m2 or ≥35 kg/m2 with severe comorbidities) requiring bariatric surgery was included between January 2003 and October 2004. Polygraphic recording,
serum aminotransferases (ALT, AST), γ-glutamyltransferase (GGT) and liver biopsy were systematically performed. OSA was present
when the apnea–hypopnea index (AHI) was >10/h.
Results 62 patients (54 F; age 38.5 ± 11.0 (SD) yrs; BMI 47.8 ± 8.4 kg/m2) were included. Liver enzymes (AST, ALT or GGT) were increased in 46.6%. NASH was present in 34.4% and OSA in 84.7%. Patients
with OSA were significantly older (P = 0.015) and had a higher BMI (P = 0.003). In multivariate analysis, risk factors for elevated liver enzymes were the presence of OSA and male sex.The presence
of NASH was similar in patients with or without OSA (32.7% vs 44.4% of patients, P = 0.76).
Conclusion In this cohort of morbidly obese patients requiring bariatric surgery, one-third of patients had NASH, a prevalence similar
to previous studies. OSA was found to be a risk factor for elevated liver enzymes but not for NASH. 相似文献
14.
Background The ghrelin and leptin levels have been reported to be correlated with weight loss after bariatric surgery. However, the serial
changes of ghrelin and leptin levels after laparoscopic minigastric bypass surgery (LMGBP) have not been reported yet. Therefore,
we aimed to evaluate their serial changes and to analyze their relations to weight reduction after LMGBP.
Methods Serial fasting serum leptin and ghrelin concentrations were measured in 68 morbidly obese patients before (M0) and 1 (M1),
3 (M3), 6 (M6), and 12 (M12) months after LMGBP surgery. The correlations between ghrelin, insulin, and leptin concentrations
and weight reduction were analyzed.
Results Leptin levels were significantly reduced at 1, 3, 6, and 12 months after surgery, respectively (vs M0, p < 0.001), whereas the ghrelin concentrations were not significantly changed after surgery. The percent of excess BMI lost
(%EBL) 12 months after surgery was negatively correlated with higher preoperative ghrelin concentrations (p = 0.004) and larger preoperative BMI (p = 0.002) in the multivariate analysis.
Conclusion Higher preoperative ghrelin concentrations and larger BMI are predictive of less %EBL at 12 months after LMGBP surgery. 相似文献
15.
Rossi M Barretto Fereira da Silva R Chaves Alcântara G Regina PF Martin Bianco Rossi F Serpa Neto A Zimberg Chehter E 《Obesity surgery》2008,18(5):601-606
Background Metabolic Syndrome (MS) is a complex disorder characterized by a number of cardiovascular risk factors usually associated
with central fat deposition and insulin resistance. Nowadays, there are many different medical treatments to MS, including
bariatric surgery, which improves all risk factors. The present study aims to evaluate the influence of gastric bypass in
the improvement of risk factors associated with MS, during the postoperative (6 months).
Methods This was a retrospective study of 140 patients submitted to gastric bypass. The sample was comprised of a female majority
(79.3 %). The mean body mass index (BMI) was 44.17 kg/m2. We evaluated the weight of the subjects, the presence of diabetes mellitus and hypertension as comorbidities, as well as
plasma levels of triglycerides (TG), total cholesterol and its fractions, and glycemia, in both preoperative and postoperative.
Results The percentage of excess weight loss (%EWL) was similar in men and women, with an average of 67.82 ± 13.21%. Concerning impaired
fasting glucose (≥100 mg/dl), 41 patients (95.3%) presented normal postoperative glycemia. There has been an improvement of
every appraised parameter. The mean decrease in TG level was 66.33 mg/dl (p < 0.0001). Before the surgery, 47.1% were hypertensive; after it, only 15% continued in antihypertensive drug therapy (p < 0.0001). Otherwise, the only dissimilar variable between sexes was the high-density lipoprotein (HDL) level.
Conclusion Gastric bypass is an effective method to improve the risk factors of metabolic syndrome in the morbidly obese. 相似文献
16.
Urs Zingg Alexander McQuinn Dennis DiValentino Steven Kinsey-Trotman Philip Game David Watson 《Obesity surgery》2010,20(12):1627-1632
With the increase in bariatric procedures performed, revisional surgery is now required more frequently. Roux-en-Y gastric
bypass (RYGB) is considered to be the gold standard revision procedure. However, data comparing revisional vs. primary RYGB
is scarce, and no study has compared non-resectional primary and revisional RYGB in a matched control setting. Analysis of
61 revisional RYGB that were matched one to one with 61 primary RYGB was done. Matching criteria were preoperative body mass
index, age, gender, comorbidities and choice of technique (laparoscopic vs. open). After matching, the groups did not differ
significantly. Previous bariatric procedures were 13 gastric bands, 36 vertical banded gastroplasties, 10 RYGB and two sleeve
gastrectomies. The indication for revisional surgery was insufficient weight loss in 55 and reflux in 6. Intraoperative and
surgical morbidity was not different, but medical morbidity was significantly higher in revisional procedures (9.8% vs. 0%,
p = 0.031). Patients undergoing revisional RYGB lost less weight in the first two postoperative years compared with patients
with primary RYGB (1 month, 14.9% vs. 29.7%, p = 0.004; 3 months, 27.4% vs. 51.9%, p = 0.002; 6 months, 39.4 vs. 70.4%, p < 0.001; 12 months, 58.5% vs. 85.9%, p < 0.001; 24 months, 60.7% vs. 90.0%, p = 0.003). Although revisional RYGB is safe and effective, excess weight loss after revisional RYGB is significantly less
than following primary RYGB surgery. Weight loss plateaus after 12 months follow-up. 相似文献
17.
Johansson Hans-Erik Haenni Arvo Öhrvall Margareta Sundbom Magnus Zethelius Björn 《Obesity surgery》2009,19(5):601-607
Background Roux-en-Y gastric bypass (RYGBP) powerfully reduces type 2 diabetes (T2DM) incidence. Proinsulin predicts development of T2DM.
Adjustable gastric banding is associated with lowered proinsulin but after RYGBP information is scant.
Methods Twenty-one non-diabetic morbidly obese patients who underwent RYGBP surgery were evaluated before (baseline), at 12 months
(first follow-up), and at 42 months, range 36–50 (second follow-up), after surgery and compared to a control group, matched
at baseline regarding fasting glucose, insulin, proinsulin, alanine aminotransferase (ALT), high-density lipoprotein (HDL)
cholesterol, and body mass index (BMI).
Results In the RYGBP group, fasting serum proinsulin concentrations were markedly lowered from 13.5 to 3.5 pmol/l at first follow-up
and to 4.9 pmol/l at second follow-up (p < 0.001, respectively). Fasting insulin concentrations were reduced from 83.4 to 24.6 pmol/l at first follow-up (p < 0.001) and to 36.4 pmol/l at second follow-up (p < 0.01). ALT was lowered from 0.62 to 0.34 μkatal/l at first follow-up and continued to lower to 0.24 μkatal/l at second
follow-up (p < 0.001, respectively). The further decrease between first and second follow-up was also significant (p = 0.002). HDL cholesterol increased from 1.16 to 1.45 mmol/l at the first follow-up and continued to increase at second follow-up
to 1.58 mmol/l (p < 0.001, respectively). The further increase between first and second follow-up was also significant (p = 0.006). The differences between groups at first follow-up were significant for BMI, proinsulin, insulin, ALT, and HDL cholesterol
(p = 0.04–0.001).
Conclusion RYGBP surgery in morbidly obese patients is not only characterized by markedly and sustained lowered BMI but also lowered
concentrations of proinsulin, insulin, and ALT and increased HDL cholesterol.
An erratum to this article can be found at 相似文献
18.
Escalona A Boza C Muñoz R Pérez G Rayo S Crovari F Ibáñez L Guzmán S 《Obesity surgery》2008,18(1):47-51
Background Preoperative evaluation and treatment of biliary lithiasis in morbid obese patients who are candidates to bariatric surgery
raise a series of questions which to date has no clear consensus. The aim of this study was to evaluate the results of routine
preoperative abdominal ultrasonography and selective cholecystectomy comparing patients who underwent laparoscopic Roux-en-Y
gastric bypass (RYGBP) with and without simultaneous cholecystectomy.
Methods The prospective database of all the patients who underwent laparoscopic RYGBP in our institution was reviewed. The demographic
characteristics, comorbidities, operative time, hospital stay, and postoperative complications were analyzed.
Results From August 2001 to December 2006, 1,311 patients underwent laparoscopic RYGBP, 137 (10.4%) of them were excluded due to previous
cholecystectomy. In 128 (10.9%) of the remaining 1,174 patients, a cholecystectomy associated to laparoscopic RYGBP was performed.
The mean age was 38.5 ± 10.1 years, and 106 (82.8%) were women. The mean operative time in patients with and without simultaneous
cholecystectomy was 129.8 ± 45 and 108.5 ± 43 min, respectively (p < 0.001). The hospital stay was 3.6 ± 0.8 days in patients with simultaneous cholecystectomy and 4 ± 3 days in patients without
simultaneous cholecystectomy (p = 0.003). There were no deaths. Postoperative complications were observed in 9 (7%) and 73 (6.9%) patients with and without
simultaneous cholecystectomy respectively (p = NS). Postoperative complications were not related to the cholecystectomy.
Conclusion Cholecystectomy associated to laparoscopic RYGBP should be considered in all patients with preoperative ultrasound diagnosis
of cholelithiasis. 相似文献
19.
Eva Pardina Juan A. Baena-Fustegueras Rafael Llamas Roberto Catalán Rosa Galard Albert Lecube Jose M. Fort Miquel Llobera Helena Allende Víctor Vargas Julia Peinado-Onsurbe 《Obesity surgery》2009,19(5):608-616
Background Most patients with morbid obesity develop non-alcoholic fatty liver disease (NAFLD). The origins of lipid deposition in the
liver and the effects of bariatric surgery in the obese with NAFLD are controversial.
Methods We analyzed lipids and lipoprotein lipase (LPL) in both plasma and liver biopsies performed before and 12–18 months after
Roux-en-Y gastric bypass surgery in 26 patients.
Results In the livers of morbidly obese patients, the levels of LPL messenger RNA (mRNA) were higher (4.5-fold) before surgery than
afterwards than control livers. In these patients, LPL activity was also significantly higher (91 ± 7 mU/g) than in controls
(51 ± 3 mU/g, p = 0.0026) and correlated with the severity of the liver damage. All hepatic lipids were significantly increased in obese
patients; however, after bariatric surgery, these lipids, with the exception of NEFA, tended to recover to normal levels.
Conclusions The liver of obese patients presented higher LPL activity than controls, and unlike the controls, this enzyme could be synthesized
in the liver because it also present LPL mRNA. The presence of the LPL activity could enable the liver to capture circulating
triacylglycerides, thus favoring the typical steatosis observed in these patients. 相似文献
20.
Chih-Kun Huang Sheng-Fa Yao Chi-Hsien Lo Jer-Yiing Houng Yaw-Sen Chen Po-Huang Lee 《Obesity surgery》2010,20(10):1429-1435
Conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) is a gold standard for bariatric surgery, but the procedure requires
five to seven incisions for placement of multiple trocars and thus may produce less-than-ideal cosmetic results. We have developed
a new approach, single-incision transumbilical LRYGB (SITU-LRYGB) to treat morbid obesity. We compared the surgical results
and patient satisfaction in a study of five-port LRYGB and SITU-LRYGB. Fifty morbidly obese patients (14 males, 36 females)
underwent either Roux-en-Y gastric bypass with five-port LRYGB or the SITU-LRYGB approach. During the operation, we used a
novel intraoperative liver traction method with a “liver suspension tape” that we specifically designed for SITU-LRYGB. Compared
to five-port surgery with SITU-LRYGB, there were no intraoperative complications, wound healing was excellent, and there was
no abdominal scarring. SITU surgical time was longer than that with five-port LRYGB (99.8 vs. 67.6 min, P < 0.001). Patients treated with the five-port method were more obese than those in the SITU group (127.9 vs. 112.4 kg, P = 0.016). After the bariatric surgery, no difference in comorbidity was found in both groups. Patient satisfaction was greater
with SITU than with the five-port method (4.48 vs. 3.96, P = 0.006). Roux-en-Y gastric bypass can be successfully achieved via a single umbilical incision, a method that provides a
short operative time and good recovery and eliminates abdominal scarring. 相似文献