Bariatric Surgery Following Total Shoulder Arthroplasty Increases the Risk for Mechanical Complications Including Instability and Prosthetic Loosening

Background

While extensive literature has been published on the risks and benefits of bariatric surgery (BS) prior to and following lower-extremity arthroplasty, no similar investigations have been performed on the impact of BS prior to total shoulder arthroplasty (TSA).

Purpose

The objective of the present study was to compare the incidence of mechanical complications in morbidly obese patients who undergo TSA: those who undergo BS following TSA compared with those who do not undergo BS, and those who undergo BS after TSA compared with those who undergo BS prior to TSA.

Methods

A Medicare database was queried for morbidly obese patients who underwent BS either before or after TSA, as well as those who underwent TSA but no BS. Of 12,277 morbidly obese patients who underwent TSA between 2005 and 2014, 304 underwent BS (165 of them prior to TSA and 139 following TSA) and 11,923 did not undergo BS. Rates of mechanical complications were then compared between groups using a logistic regression analysis.

Results

Patients who underwent BS after TSA had significantly higher rates of mechanical complications (12.9%) compared to controls (8.8%) or patients who underwent prior BS (7.9%). Patients who underwent BS after TSA had higher rates of both instability (7.9%) and loosening (8.6%) than did controls (5.1 and 4.9%, respectively) or patients who underwent BS before TSA (4.8 and 4.2%, respectively).

Conclusions

BS following TSA is associated with increased rates of mechanical complications, including instability and loosening, compared to BS prior to TSA. These findings suggest that it may be prudent to consider performing BS prior to TSA in morbidly obese patients, rather than waiting until after TSA is performed.

     

Vitamin D Deficiency Before Bariatric Surgery: Should Supplement Intake Be Routinely Prescribed?

Background

Before bariatric surgery, we demonstrate a 96% rate of vitamin D deficiency in morbidly obese French patients: should supplement intake be routinely prescribed? We conducted a prospective observational study to demonstrate the prevalence of vitamin D deficiency in morbidly obese patients awaiting bariatric surgery.

Methods

Clinical and biological data were collected on 50 successive patients.

Results

Data showed vitamin D deficiency in 96% (25-OH vitamin D = 31 ± 13 nmol/l), with a cut-point of 50 nmol/l. Secondary hyperparathyroidism was found in 44% of patients with hypovitaminosis D (parathyroid hormone (PTH), 59?±?24 pg/ml). Impaired PTH level concerned 89% of this group, considering the cut-point at 30 pg/ml. No significant correlation appeared between vitamin D and calcium or phosphate levels.

Conclusions

Before surgery, we demonstrated a higher incidence of vitamin D deficiency in morbidly obese French patients as compared to the general population. The incidence was also higher than previous American studies. Screening for hypovitaminosis D may routinely be considered in morbid obesity. Long-term observation is, however, needed to assess the advantages and potential side effects of systematic vitamin D supplements.

     

Laparoscopic Sleeve Gastrectomy Improves Olfaction Sensitivity in Morbidly Obese Patients

Background

Olfactory abilities of the patients are known to be altered by eating and metabolic disorders, including obesity. There are only a number of studies investigating the effect of obesity on olfaction, and there is limited data on the changes in olfactory abilities of morbidly obese patients after surgical treatment. Here we investigated the changes in olfactory abilities of 54 morbidly obese patients (M/F, 22/32; age range 19–57 years; body mass index (BMI) range 30.5–63.0 kg/m²) after laparoscopic sleeve gastrectomy.

Method

A laparoscopic sleeve gastrectomy was performed by the same surgeon using five-port technique. Olfactory abilities were tested preoperatively and 1, 3, and 6 months after the surgery using a standardized Sniffin’ Sticks Extended Test kit.

Results

Analyses of variance indicated statistically significant improvement in T, D, and I scores of morbidly obese patients within time factors (preoperative vs. 1, 3, and 6 months; 1 vs. 3 and 6 months; and 3 vs. 6 months; p?<?0.001 for all). There was a statistically significant improvement in overall TDI scores with an increase from 25 to 41 during the 6 months follow-up period (p?<?0.001 for all).

Conclusions

Here, for the first time in literature, we were able to show the significant improvement in olfactory abilities of morbidly obese patients after laparoscopic sleeve gastrectomy.

     

Prevalence and Prediction of Obstructive Sleep Apnea Prior to Bariatric Surgery—Gender-Specific Performance of Four Sleep Questionnaires

Purpose

Bariatric surgery (BS) is a treatment option for morbid obesity leading to substantial and sustained weight loss in adults. As obstructive sleep apnea (OSA) is highly prevalent in obese subjects and may increase the perioperative risk, screening for OSA is recommended prior to BS. In clinical routine, BS is performed more frequently in women. Therefore, we sought to assess the gender-specific performance of four sleep questionnaires (Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), STOPBang, and NoSAS) to predict moderate to severe OSA in the morbidly obese population.

Material and Methods

We applied all four questionnaires to patients scheduled for BS with polygraphic OSA screening at our institution between 2012 and 2015 and performed gender-specific sensitivity analyses.

Results

We included 251 bariatric patients (76% female, median age 39 years, median BMI 42.0 kg/m²). OSA (AHI >?5/h; AHI >?15/h) was present in 43% (females 35%, males 68%; p?<?0.001) and 21% (females 13%, males 45%; p?<?0.001). STOPBang and NoSAS performed markedly better than ESS and FSS. With the exception of the ESS, all sleep questionnaires allowed better OSA prediction in women than in men.

Conclusion

In obese patients scheduled for BS, a gender-specific difference was observed in the performance of the evaluated OSA screening questionnaires. This needs to be considered when these questionnaires are used. Our results underline the need for better gender-specific OSA screening algorithms in morbidly obese patients.

     

Ultrasound-guided popliteal sciatic nerve blockade in the severely and morbidly obese: a prospective and randomized study

Purpose

Limited research data exist regarding optimal block techniques in the severely and morbidly obese patient population. We compared two approaches to sciatic nerve blockade at the popliteal fossa in severely and morbidly obese patients. The purpose of this study was to identify differences in pain scores, block onset characteristics, and adverse events between the proximal (prebifurcation) and the distal (postbifurcation) sites.

Methods

Patients with a body mass index ≥35 scheduled for unilateral foot surgery with a popliteal block were randomized to receive an ultrasound-guided popliteal block proximal or distal to the bifurcation of the sciatic nerve. The primary endpoint was numerical rating scale (NRS) scores in the post anesthesia care unit (PACU).

Results

Thirty patients were enrolled in each group for a total of 60 participants. Patients in the distal group had lower NRS scores upon entry into the PACU (0.70 ± 1.91) compared with the proximal group (2.17 ± 3.37), had a faster onset of sensorimotor blockade, and were less likely to require a repeat block procedure, conversion to general anesthesia, or local anesthetic supplementation by the surgical team. There was no difference in block procedure times or incidence of nerve injury between the two groups.

Conclusions

The distal approach to the popliteal block provided several intraoperative and analgesic benefits without a difference in block procedural times in the severely and morbidly obese. It is a cost-free intervention that results in a higher likelihood of a successful block in a population where avoidance of opioids is desirable.

     

A 4-Week Preoperative Ketogenic Micronutrient-Enriched Diet Is Effective in Reducing Body Weight,Left Hepatic Lobe Volume,and Micronutrient Deficiencies in Patients Undergoing Bariatric Surgery: a Prospective Pilot Study

Background

Before bariatric surgery (BS), moderate weight loss, left hepatic lobe volume reduction, and micronutrient deficiency (MD) identification and correction are desirable.

Objectives

The objective of this study was to assess the safety and the effectiveness of a 4-week preoperative ketogenic micronutrient-enriched diet (KMED) in reducing body weight (BW), left hepatic lobe volume, and correcting MD in patients scheduled for BS.

Materials and Methods

In this prospective pilot study, a cohort of morbidly obese patients (n?=?27, 17 females, 10 males) with a mean body mass index (BMI) of 45.2 kg/m² scheduled for BS underwent a 4-week preoperative KMED. Their BW, BMI, fat mass (FM), fat-free mass (FFM), resting metabolic rate (RMR), left hepatic lobe volume, micronutrient status, and biochemical and metabolic patterns were measured before and after the 4-week KMED. Patient compliance was assessed by validated questionnaires (3-day estimated food records and 72-h recall). Qualitative methods (5-point Likert questionnaire) were used to measure diet acceptability and side effects.

Results

All patients completed the study. We observed highly significant decreases in BW (??10.3%, p?<?0.001, in males; ??8.2%, p?<?0.001, in females), left hepatic lobe volume (??19.8%, p?<?0.001), and an amelioration of patient micronutrient status. All patients showed a high frequency of acceptability and compliance in following the diet. No adverse side effect was reported.

Conclusion

This study demonstrates that a 4-week preoperative KMED is safe and effective in reducing BW, left hepatic lobe volume, and correcting MD in obese patients scheduled for BS.

     

Bariatric Surgery Promising in Migraine Control: a Controlled Trial on Weight Loss and Its Effect on Migraine Headache

Introduction

There is evidence that substantial weight loss through bariatric surgery (BS) may result in short-term improvement of migraine severity. However, it still remains to be seen whether smaller amounts of weight loss have a similar effect on migraine headache. This study has been designed to compare the effects of weight reduction through BS and non-surgical modifications.

Materials and Methods

Migraine characteristics were assessed at 1 month before (T0), 1 month (T1), and 6 months (T2) after BS (vertical sleeve gastrectomy (VSG) (n = 25) or behavioral therapy (BT) (n = 26) in obese women (aged 18–60 years) with migraine headache. Migraine was diagnosed using the International Classification of Headache Disorders (ICHDIIβ) criteria.

Results

There was significant reduction in the visual analog scale (VAS) from the baseline to T1 and T2 in both groups. The number of migraine-free days showed a significant increase within each group (p < 0.001). The BS group had a significant reduction in attack duration (p < 0.001) while there were no changes observed within the BT group. Following the adjustment of ANCOVA models for baseline values of migraine characteristics, age, changes in weight, BMI, body fat, and fat-free mass from T0 to T2, the BS group showed statistically significant lower VAS and duration of migraine attacks and a significantly higher number of migraine-free days than the BT group at T1 and T2 (p ≤ 0.028).

Conclusion

Our results indicated that far before significant weight reduction after BS (VSG), there was marked alleviation in the severity and duration of migraine and a significant increase in the number of migraine-free days in obese female migraineurs. However, the effects in the BT group were not comparable with the effects in the BS group.

     

Surgical treatment of medically refractory gastroparesis in the morbidly obese

Introduction

Surgical management of medically refractory gastroparesis remains a challenge. Case series and small retrospective studies describe clinical benefits from surgical intervention; however, no study reports the efficacy of gastric electrical stimulation (GES) or Roux-en-Y gastrojejunostomy with or without near-total gastrectomy (RYGJ) in morbidly obese patients with severe gastroparesis.

Methods

A chart review was performed on all morbidly obese patients (BMI > 35 kg/m²) who underwent GES or RYGJ for medically refractory gastroparesis from March 2002 to December 2012 at the Cleveland Clinic. The main outcomes examined were symptom improvement, postoperative complications, and change in BMI.

Results

A total of 20 morbidly obese patients underwent GES placement. Seven morbidly obese patients had RYGJ with or without resection of the remnant stomach surgery. All operations were completed laparoscopically. In GES group, 18 patients had initial symptom improvement (90 %) and 11 (55 %) rated their symptom improved at the last follow-up. During the average 23 months’ follow-up, 9 patients (45 %) experienced at least one readmission for gastrointestinal reasons. Early complications included two infections at a simultaneously placed J-tube site and one seroma. In the RYGJ group, all patients, including 4 patients who failed GES and subsequently converted to RYGJ, experienced short-term symptom improvement and 5 patients (71 %) rated their symptoms as improved at last follow-up. One duodenal stump leak happened in the RYGJ group. There were no 30-day mortalities in either group. The BMI change after GES implantation was 0.6 ± 4 kg/m² versus ?7.7 ± 4 kg/m² after RYGJ (p < 0.01).

Conclusion

GES implantation and RYGJ are both effective in terms of symptom control for medically refractory gastroparesis in morbidly obese. Both options can be performed in a minimally invasive fashion with low morbidity. Patients who have no improvement of symptoms for refractory gastroparesis after GES implantation can be successfully converted laparoscopically to RYGJ.

     

Concomitant Bariatric Surgery with Laparoscopic Intra-peritoneal Onlay Mesh Repair for Recurrent Ventral Hernias in Morbidly Obese Patients: an Evolving Standard of Care

Background and Aims

Repair of recurrent ventral hernias (RVHs) has a high failure rate more so in the presence of obesity. The chronic increase in intra-abdominal pressure (IAP) associated with obesity might, in part, be an important implicating factor that needs to be addressed in these patients. Laparoscopic ventral hernia repair (LVHR) done with concomitant bariatric surgery in morbidly obese patients with RVHs may avoid multiple failures.We report our preliminary experience in treating RVHs in morbidly obese patients with laparoscopic intra-peritoneal onlay mesh (IPOM) repair and concomitant bariatric surgery.

Methods

A retrospective review of all patients with a RVH who underwent concomitant bariatric surgery and laparoscopic IPOM repair at our institution from 2009 to 2013 was performed. Demographic, operative, postoperative, and follow-up data were collected.

Results

There were 23 patients included in the study. The mean BMI was 43.24. Fifteen patients had a previous open mesh repair, and eight had a laparoscopic IPOM repair. The patients had a median of 2 previous repairs (range 1–5 repairs). A laparoscopic sleeve gastrectomy was performed in 22 patients, and a laparoscopic Roux-en-Y gastric bypass was performed in one. The mean operating time was 112 min (65–220 min). The mean hospital stay was 3.3 days (2–8 days). A seroma was noted in four patients. No mesh infection or recurrence was noted at a median follow-up of 3.3 years (9 months to 5.5 years).

Conclusion

Laparoscopic IPOM repair done with concomitant bariatric surgery in morbidly obese patients with RVHs seems promising with a low rate of early recurrence.

     

Goal-Directed Fluid Therapy on Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients

Background

In bariatric surgery, there are no guidelines available for intraoperative fluid administration. Goal-directed fluid therapy (GDFT) is a new concept of perioperative fluid management that has been shown to improve the prognosis of patients undergoing abdominal surgery. The aim of our study is to assess the impact of the implementation of a GDFT protocol in morbidly obese patients who underwent laparoscopic sleeve gastrectomy (LSG).

Methods

A before-after intervention study, in morbidly obese patients who underwent LSG, was conducted at the Obesity Unit of the General University Hospital Elche. Data from the GDFT implementation group (January 2014 to December 2015) were prospectively collected and compared with a preimplementation group (January 2012 to December 2013).

Results

Baseline demographic and comorbidity data between the two groups of patients were similar. The length of stay in the hospital was significantly shortened in GDFT group from 4.5 to 3.44 days (p?<?0.001). Intraoperative fluid administration was significantly lower in the GDFT group (1002.4 vs 1687.2 ml in preimplementation group, p?<?0.001). In the postoperative period, there was a statistically significant reduction in postoperative nausea and vomiting (PONV) after GDFT implementation (48 to 14.3 %, p?<?0.001).

Conclusions

Implementation of GDFT protocols can prevent intraoperative fluid overload in patients undergoing bariatric surgery. It could improve outcomes, for example decreasing PONV or even hospital stay.

     

The Effects of Bariatric Surgery on Cardiac Structure and Function: a Systematic Review of Cardiac Imaging Outcomes

Background

Obesity is associated with cardiac dysfunction, atherosclerosis, and increased cardiovascular risk. It can be lead to obesity cardiomyopathy and severe heart failure, which in turn raise morbidity and mortality while carrying a negative impact on quality of life. There is increasing clinical and mechanistic evidence on the metabolic and weight loss effects of bariatric surgery on improving cardiac structure and function in obese patients.

Objectives

The objective of this study was to quantify the effects of bariatric surgery on cardiac structure and function by appraising cardiac imaging changes before and after metabolic operations.

Methods

This is a comprehensive systematic review of studies reporting pre-operative and post-operative echocardiographic or magnetic resonance cardiac indices in obese patients undergoing bariatric surgery. Studies were quality scored, and data were meta-analyzed using random effects modeling.

Results

Bariatric surgery is associated with significant improvements in the weighted incidence of a number of cardiac indices including a decrease in left ventricular mass index (11.2 %, 95 % confidence intervals (CI) 8.2–14.1 %), left ventricular end-diastolic volume (13.28 ml, 95 % CI 5.22–21.34 ml), and left atrium diameter (1.967 mm, 95 % CI 0.980–2.954). There were beneficial increases in left ventricular ejection fraction (1.198 %, 95 %CI ?0.050–2.347) and E/A ratio (0.189 %, 95 %CI ?0.113–0.265).

Conclusions

Bariatric surgery offers beneficial cardiac effects on diastolic function, systolic function, and myocardial structure in obese patients. These may derive from surgical modulation of an enterocardiac axis. Future studies must focus on higher evidence levels to better identify the most successful bariatric approaches in preventing and treating the broad spectrum of obesity-associated heart disease while also enhancing treatment strategies in the management of obesity cardiomyopathy.

     

Complications of pelvic and acetabular fractures in 1331 morbidly obese patients (BMI ≥ 40): a retrospective observational study from the National Trauma Data Bank

Background

There have been no large-scale epidemiological studies of outcomes and perioperative complications in morbidly obese trauma patients who have sustained closed pelvic ring or acetabular fractures. We examined this population and compared their rate of inpatient complications with that of control patients.

Methods

We retrospectively reviewed the records of patients treated for closed pelvic ring or acetabular fracture, aged 16–85 years, with Injury Severity Scores ≤15 from the National Trauma Data Bank Research Dataset for the years 2007 through 2010. The primary outcome of interest was rate of in-hospital complications. Secondary outcomes were length of hospital stay and discharge disposition. Unadjusted differences in complication rates were evaluated using Student t tests and Chi-squared analyses. Multiple logistic and Poisson regression were used to analyze binary outcomes and length of hospital stay, respectively, adjusting for several variables. Statistical significance was defined as p?<?0.05.

Results

We included 46,450 patients in our study. Of these patients, 1331 (3%) were morbidly obese (body mass index ≥40) and 45,119 (97%) were used as controls. Morbidly obese patients had significantly higher odds of complication and longer hospital stay in all groups considered except those with pelvic fractures that were treated operatively. In all groups, morbidly obese patients were more likely to be discharged to a skilled nursing/rehabilitation facility compared with control patients.

Conclusions

Morbidly obese patients had higher rates of complications and longer hospital stays and were more likely to be discharged to rehabilitation facilities compared with control patients after pelvic ring or acetabular fracture.

     

Bariatric Surgery Provides a “Bridge to Transplant” for Morbidly Obese Patients with Advanced Heart Failure and May Obviate the Need for Transplantation

Background

In patients with advanced heart failure, morbid obesity is a relative contraindication to heart transplantation due to higher morbidity and mortality in these patients.

Methods

We performed a retrospective analysis of consecutive morbidly obese patients with advanced heart failure who underwent bariatric surgery for durable weight loss in order to meet eligibility criteria for cardiac transplantation.

Results

Seven patients (4 M/3 F, age range 31–56 years) with left ventricular ejection fraction (LVEF) ≤25 % underwent laparoscopic bariatric surgery. Median preoperative body mass index (BMI) was 42.8 kg/m² (range 37.5–50.8). There were no major perioperative complications in six of seven patients. Median length of hospital stay was 5 days. There was no mortality recorded during complete patient follow-up. At a median follow-up of 406 days, median BMI reduction was 12.9 kg/m² (p?=?0.017). Postoperative LVEF improved to a median of 30 % (interquartile range (IQR) 25–53 %; p?=?0.039). Two patients underwent successful cardiac transplantation. Two patients reported symptomatic improvement with little change in LV function and now successfully meet listing criteria. Three patients showed marked improvement of their LVEF and functional status, thus removing the requirement for transplantation.

Conclusions

Bariatric surgery can achieve successful weight loss in morbidly obese patients with advanced cardiac failure, enabling successful heart transplantation. In some patients, cardiac transplantation can be avoided through surgical weight loss.

     

Increased Metabolic Benefit for Obese,Elderly Patients Undergoing Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Purpose

We sought to assess outcomes of laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB) in a cohort of morbidly obese, elderly patients.

Materials and Methods

Retrospective review was conducted of all patients age 60 years or greater undergoing LSG or LRYGB at our institution between 2007 and 2014.

Results

A total of 134 patients who underwent LSG (n = 65) or LRYGB (n = 69) were identified. Groups were similar with respect to age (64 years, range 60–75 years), BMI (44.0 ± 6.1), and ASA score (91% ≥ ASA 3). There were no differences in major post-operative complications (3, 4.7% LSG vs 4, 5.8% LRYGB, p = 0.75). Median follow-up was 39 months (IQR 14–64 months) with no patients lost to follow-up. Patients undergoing LRYGB had improvement in each of diabetes mellitus 2 (DM2), hypertension (HTN), hyperlipidemia (HL), and gastroesophageal reflux disease (GERD) as well as a significant decrease in insulin use (16/47, 34.0% pre-operatively vs 7/47, 15.2% post-operatively; p = 0.03). Patients undergoing LSG had improvement in DM2 and HTN but not in HL or GERD; there was no reduction in insulin dependence. Weight loss was not significantly different between groups; mean percent total weight loss at 36 months was 26.9 ± 9.0% in the LSG group and 23.9 ± 9.3% in the LRYGB group, p = 0.24.

Conclusions

Both LSG and RYGB can be safely performed on morbidly obese, elderly adults. At intermediate follow-up, there is an increased metabolic benefit for elderly patients undergoing LRYGB over LSG.

     

Pressure-controlled Ventilation Does Not Improve Gas Exchange in Morbidly Obese Patients Undergoing Abdominal Surgery

Background

Morbid obesity results in marked respiratory pathophysiologic changes that may lead to impaired intraoperative gas exchange. The decelerating inspiratory flow and constant inspiratory airway pressure resulting from pressure-controlled ventilation (PCV) may be more adapted to these changes and improve gas exchanges compared with volume-controlled ventilation (VCV).

Methods

Forty morbidly obese patients scheduled for gastric bypass were included in this study. Total intravenous anesthesia was given using the target-controlled infusion technique. During the first intraoperative hour, VCV was used and the tidal volume was adjusted to keep end-tidal PCO₂ around 35 mmHg. After 1 h, patients were randomly allocated to 30-min VCV followed by 30-min PCV or the opposite sequence using a Siemens® Servo 300. FiO₂ was 0.6. During PCV, airway pressure was adjusted to provide the same tidal volume as during VCV. Arterial blood was sampled for gas analysis every 15 min. Ventilatory parameters were also recorded.

Results

Peak inspiratory airway pressures were significantly lower during PCV than during VCV (P? <?0.0001). The other ventilatory parameters were similar during the two periods of ventilation. PaO₂ and PaCO₂ were not significantly different during PCV and VCV.

Conclusion

PCV does not improve gas exchange in morbidly obese patients undergoing gastric bypass compared to VCV.

     

Effect of Contemporary Bariatric Surgical Procedures on Type 2 Diabetes Remission. A Population-Based Matched Cohort Study

Objective

The objective of the study is to evaluate the effect of gastric banding, gastric bypass and sleeve gastrectomy on medium to long-term diabetes control in obese participants with type 2 diabetes mellitus.

Research Design and Methods

Matched cohort study using primary care electronic health records from the UK Clinical Practice Research Datalink. Obese participants with type 2 diabetes who received bariatric surgery from 2002 to 2014 were compared with matched control participants who did not receive BS. Remission was defined for each year of follow-up as HbA1c <6.5 % and no antidiabetic drugs prescribed.

Results

There were 826 obese participants with T2DM who received bariatric surgery including adjustable gastric banding (LAGB) 220; gastric bypass (GBP) 449; or sleeve gastrectomy (SG) 153; with four procedures undefined. Mean HbA1c declined from 8.0 % before BS to 6.5 % in the second postoperative year; proportion with HbA1c <6.5 % (<48 mmol/mol) increased from 17 to 47 %. The proportion of patients in remission was 30 % in the second year, being 20 % for LAGB, 34 % for GBP and 38 % for SG. The adjusted relative rate of remission over the first six postoperative years was 5.97 (4.86 to 7.33, P?<?0.001) overall; for LAGB 3.32 (2.27 to 4.86); GBP 7.16 (5.64 to 9.08); and SG 6.82 (5.05 to 9.19). Rates of remission were maintained into the sixth year of follow-up.

Conclusions

Remission of diabetes may continue for up to 6 years after bariatric surgical procedures. Diabetes outcomes are generally more favourable after gastric bypass or sleeve gastrectomy than LAGB.

     

Effects of Laparoscopic Roux-en-Y Gastric Bypass on Chinese Type 2 Diabetes Mellitus Patients with Different Levels of Obesity: Outcomes After 3 Years’ Follow-Up

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been proven to be effective on treating type 2 diabetes mellitus (T2DM) in severely obese patients, but whether LRYGB surgery should be performed in obese class I patients is controversial.

Materials and Methods

A retrospective study of 3-year bariatric and metabolic outcomes in different obese class T2DM patients who underwent LRYGB was conducted to compare the effectiveness of LRYGB in obese class I patients with that in obese class II/III patients in a Chinese T2DM population.

Results

Totally, 58 patients with class I obesity and 45 patients with class II/III obesity were enrolled in this study. Major complications included two cases of incomplete intestinal obstructions and one anastomotic leak. The remission rates of T2DM were 70.6% in obese class I group and 77.8% in obese class II/III group at 1 year after surgery and 55.6 versus 64.3% at 3 years (all P > 0.05). Logistic regression analysis showed that higher waist circumference, lower fasting plasma glucose, and higher FCP at 2 h of OGTT were independently associated with diabetes remission at 1 year after surgery. At 1 year and thereafter, the percentage of excess weight loss was significantly greater in obese class II/III patients. At 3 years, body mass index was not significantly different between the two groups, and the obese class I patients had high recurrence rates of hypertension and hyperuricemia.

Conclusions

LRYGB surgery is feasible, safe, and effective in Chinese obese class I patients with T2DM.

     

Effects of a Pre-surgery Supervised Exercise Training 1 Year After Bariatric Surgery: a Randomized Controlled Study

Background

We have previously reported on the benefits of Pre-Surgical Exercise Training (PreSET) on physical fitness and social interactions in subjects awaiting bariatric surgery (BS). However, data are needed to know whether these benefits are maintained post-BS.

Objectives

The purpose of this paper was to evaluate the effect of PreSET on physical activity (PA) level, physical fitness, PA barriers, and quality of life (QoL) 1 year (1-Y) after BS.

Methods

Of the 30 participants randomized into two groups (PreSET and usual care), 25 were included in the final analysis. One year after BS, time spent in different PA intensities and number of steps were assessed with an accelerometer. Before BS and until 1-Y after BS, physical fitness was assessed with symptom-limited cardiac exercise test, 6-min walk test (6MWT), and sit-to-stand, half-squat, and arm curl tests. QoL, PA barriers, and PA level were evaluated with questionnaires.

Results

The number of steps (7460 vs 4287) and time spent in light (3.2 vs 2.2 h/day) and moderate (0.6 vs 0.3 h/day) PA were higher in the PreSET group 1-Y after BS. The changes in 6MWT heart cost (1.3 vs 0.6 m/beats/min), half-squat test (38.8 vs 10.3 s), and BMI (? 16.8 vs ? 13.5 kg/m²) were significantly greater in the PreSET group compared to those in the usual care group. No other significant difference between groups was observed.

Conclusion

The addition of the PreSET to individual lifestyle counseling seems effective to improve PA level and submaximal physical fitness 1-Y after BS. Studies with larger cohorts are now required to confirm these results.The trial was registered at clinicaltrials.gov (NCT01452230).

     

The Role of Attachment in Body Weight and Weight Loss in Bariatric Patients

Purpose

The aim of this study is to explore the role of attachment styles in obesity.

Material and Methods

The present study explored differences in insecure attachment styles between an obese sample waiting for bariatric surgery (n = 195) and an age, sex and height matched normal weight control group (n = 195). It then explored the role of attachment styles in predicting change in BMI 1 year post bariatric surgery (n = 143).

Results

The bariatric group reported significantly higher levels of anxious attachment and lower levels of avoidant attachment than the control non-obese group. Baseline attachment styles did not, however, predict change in BMI post surgery.

Conclusion

Attachment style is different in those that are already obese from those who are not. Attachment was not related to weight loss post surgery.