Shortened sleep duration causes hormonal and metabolic changes that favor fat accumulation and weight gain. Obesity, in turn, may reduce sleep quality and contribute to sleep loss. The purpose of this study was to evaluate the sleep durations of individuals with morbid obesity, compared to their nonobese counterparts, and to determine the effects of surgical weight reduction on sleep duration and sleep quality.
Methods
The study population included 45 bariatric (BA) surgical patients (mean body mass index [BMI]?=?49) and 45 gender-matched nonobese controls (NC; BMI?=?24). Self-reported sleep durations were obtained and overall sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
Results
The data show that average sleep durations of the preoperative BA patients were significantly (p?p?p?Conclusions Individuals with extreme obesity, compared to the nonobese, obtain less sleep and experience poorer sleep quality. Bariatric surgery improves sleep duration and quality. 相似文献
Obesity is a risk factor for female pelvic floor disorders. The study objective was to determine whether there was a difference in the subjective reporting of pelvic symptoms before and after bariatric surgery.
Methods
This was a prospective cohort study of female patients that underwent bariatric surgery. Patients completed a demographic questionnaire, the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) before surgery and at 6 and 12?months following surgery. Body mass index (BMI) was compared between time points using Student??s t tests (P?P?Results At 12?months after surgery, 63 patients had completed the study. Even with significant weight loss (BMI, 43.7?kg/m2 to BMI, 29?kg/m2; P?P?=?0.2). Prevalence of pelvic floor symptom impact on quality of life did significantly decrease after surgery (56% to 30%; P?=?0.004). Baseline PFDI-20 and PFIQ-7 scores were low; however, there was still a significant reduction in PFDI-20 and PFIQ-7 scores after surgery (P?Conclusions Prevalence of pelvic floor symptoms did not vary greatly after surgery; however, significant weight reduction did improve the degree of bother and quality of life related to these symptoms. 相似文献
Background: Surgical treatment is the most effective method for weight reduction in morbid obesity. The most common operations
are gastric banding and gastric bypass. The effect of these interventions on esophageal function and gastroesophageal reflux
symptoms has not been adequately investigated. Methods: Patients undergoing obesity surgery were prospectively included in
an observational study. Before surgery, each of the 53 patients underwent pulmonary function tests, esophageal manometry,
and gastroscopy. Drug medication and esophageal symptoms were recorded. "Non-sweet eater" patients with good compliance underwent
laparoscopic adjustable gastric banding (LAGB). In "sweet-eating" or non-compliant patients, gastric bypass (GBP) was carried
out. Results: Between July 1997 and April 2000, 53 patients (9 males and 44 females) were consecutively operated on. 32 patients
(median BMI 46.4 kg/m2 ±5.4 SD) received LAGB, and 21 patients (BMI 54.0 kg/m2 ±10.7) GBP. Median follow-up was 22 months, and only 3 patients were lost to yearly follow-up. Preoperatively, 6 LAGB patients
had reflux symptoms, which postoperatively resolved in 3 of them, while the other 3 noted no change. Three patients who had
no preoperative reflux symptoms developed them after LAGB. In the GBP group, no patient had esophageal dysmotility or incompetent
esophageal sphincter function pre- or postoperatively. The incidence of postoperative esophageal symptoms was independent
of operative technique (Wilcoxon U-Test: p= 0.75). Conclusion: The present results do not show any effect of gastric reduction
surgery on postoperative esophageal function or gastroesophageal reflux symptoms. 相似文献
Micronutrient deficiencies are key concerns after bariatric surgery. We describe the prevalence of perioperative testing and diagnosis of micronutrient deficiencies among a cohort of insured bariatric surgery patients.
Methods
We used claims data from seven health insurers to identify bariatric surgery patients from 2002–2008. Our outcomes were perioperative claims for vitamin D, B12, folate, and iron testing and diagnosed deficiencies. We analyzed results by bariatric surgery type: Roux-en-Y gastric bypass (RYGB), restrictive, and malabsorptive. We calculated the prevalence of testing and deficiency diagnosis, and performed multivariate logistic regression to determine the association with surgery type.
Results
Of 21,345 eligible patients, 84 % underwent RYGB. The pre-surgical testing prevalence for all micronutrients was <25 %. The testing prevalence during the first 12 months after surgery varied: vitamin D (12 %), vitamin B12 (60 %), folate (47 %) and iron (49 %), and declined during 13–24 and 25–36 months. The deficiency prevalence during 0–12 months post-survey varied: vitamin D (34 %), vitamin B12 (20 %), folate (13 %), and iron (10 %). The odds of vitamin B12, folate, and iron deficiency during 0–12 months were significantly lower for restrictive as compared to RYGB, but were not different during 13–24 and 25–36 months post-surgery. The odds of vitamin D deficiency were significantly greater for malabsorptive as compared to RYGB during all post-surgical periods.
Conclusion
Many patients did not receive micronutrient testing pre- or post-surgery, yet deficiencies were relatively common among those tested. These results highlight the need for surgeons and primary care providers to test all bariatric surgery patients for micronutrient deficiencies. 相似文献
The prevalence of obesity is increasing worldwide and has lately reached epidemic proportions in western countries. Several epidemiological studies have consistently shown that both overweight and obesity are important risk factors for the development of various functional defaecatory disorders (DDs), including faecal incontinence and constipation. However, data on their prevalence as well as effectiveness of bariatric surgery on their correction are scant. The primary objective of this study was to estimate the effect of morbid obesity on DDs in a cohort of patients listed for bariatric surgery. We also evaluated preliminary results of the effects of sleeve gastrectomy on these disorders.
Patients and methods
A questionnaire-based study was proposed to morbidly obese patients having bariatric surgery. Data included demographics, past medical, surgical and obstetrics histories, as well as obesity related co-morbidities. Wexner Constipation Score (WCS) and the Faecal Incontinence Severity Index (FISI) questionnaires were used to evaluate constipation and incontinence. For the purpose of this study, we considered clinically relevant a WCS ??5 and a FISI score ??10. The same questionnaires were completed at 3 and 6?months follow-up after surgery.
Results
A total of 139 patients accepted the study and 68 underwent sleeve gastrectomy and fully satisfied our inclusion criteria with a minimum follow-up of 6?months. Overall, mean body mass index (BMI) at listing was 47?±?7?kg/m2 (range 35?C67?kg/m2). Mean WCS was 4.1?±?4 (range 0?C17), while mean FISI score (expressed as mean±standard deviation) was 9.5?±?9 (range 0?C38). Overall, 58.9% of the patients reported DDs according to the above-mentioned scores. Twenty-eight patients (20%) had WCS ??5. Thirty-five patients (25%) had a FISI ??10 while 19 patients (13.7%) reported combined abnormal scores. Overall, DDs were more evident with the increase of obesity grade: Mean BMI decreased significantly from 47?±?7 to 36?±?6 and to 29?±?4?kg/m2 respectively at 3 and 6?months after surgery (p?p?=?0.02). Similarly, the FISI score decreased from 10?±?8 to 3?±?4 and to 1?±?2 respectively at 3 and 6?months (p?=?0.0001).
Conclusions
Defaecatory disorders are common in morbidly obese patients. The risk of DDs increases with BMI. Bariatric surgery reduces DDs, mainly faecal incontinence, and these findings correlated with BMI reduction. 相似文献
This study aims to evaluate the effect of weight loss on the physical capacity and the structure and function of the heart
after bariatric surgery. 相似文献
Bariatric surgery (BS) may help transplant patients by improving their comorbidities and graft function and reducing the recurrence of the disease that led to the transplant. Different timings for BS have been proposed. This study aims to describe the outcomes of BS before, during, and after solid organ transplantation.
Methods
We identified patients with history of solid organ transplantation that underwent BS between January 1, 2012, and April 31, 2022, at our hospital site. We analyzed patients’ demographics, obesity-related comorbidities, and transplant history. Measured outcomes included post-operative morbidity; readmission; comorbidity management; weight loss at 6-, 12-, and 24-month follow-up; and survival.
Results
Seventy-eight patients were included in our analysis, with a median age of 57 (28–75) years and a median BMI of 40.91 (28.9–61) kg/m2. The most transplanted organ was the liver (53.6%), followed by the kidney (31.9%). Ten patients underwent BS before the transplant, 11 had simultaneous BS and liver transplant, and 57 underwent BS after the transplant. The median operative time, ICU requirement, length of hospital stay, and early post-operative complications were significantly higher in the simultaneous group. The median EBWL% at 6-, 12-, and 24-month follow-up was 47.51%, 57.89%, and 64.22%, respectively, with no significant difference between the three groups. Thirty-four (44.3%) and 40 (50.8%) patients reduced their HTN and DM medication dosage, respectively. One- and five-year survival rates were 98.2% and 87.4%.
Conclusion
BS before, during, or after solid organ transplant is safe, leads to a significant weight loss and improvement of obesity-related comorbidities, and improves patient’s survival.
Readmissions are an important quality metric for surgery. Here, we compare characteristics of readmissions across laparoscopic Rouxen-Y gastric bypass (LRYGB), sleeve gastrectomy (LSG), and adjustable gastric band (LAGB).
Methods
Demographic, intraoperative, anthropometric, and laboratory data were prospectively obtained for 1775 patients at a single academic institution. All instances of readmissions within 1 year were recorded. Data were analyzed using STATA, release 12.
Results
For the 1775 patients, 113 (6.37 %) were readmitted. Mean time to readmission was 52.1 days. Of all the readmissions, 64.6 % were within 30 days, 22.1 % from 30 to 90 days, 1.77 % from 90 to 180 days, and 11.5 % from 180 to 365 days. Incidence of 30-day readmissions varied across surgeries (LRYGB: 7.17 %; LAGB: 3.05 %; LSG: 4.25 %, p?=?0.04). Time to readmission varied as well, with 90.0 % of LSG and 80.0 % of LABG patients within the first 30 days, versus 60.8 % of LRYGB (p?=?0.02). The most common causes of readmissions were gastrointestinal issues related to index procedure (34.5 %) and did not vary across surgeries. In multivariable logistic regression, index hospital length of stay (LOS) was associated with readmission (OR?=?1.07, 95 % CI 1.02–1.13, p?=?0.01).
Conclusions
Readmissions after bariatric surgery are associated with high index hospital LOS, and a measureable proportion of procedure-related readmissions can occur up to 1 year, especially for LRYGB.
Background: Obstructive sleep apnea (OSA) is common in morbidly obese patients, with a reported prevalence from 12 to 40%.
Preoperative diagnosis of OSA is important for both perioperative airway management and the prevention of postoperative pulmonary
complications. BMI has been reported to be an independent risk factor, and has been used recently in scoring systems to help
predict OSA. Our hypothesis was that OSA is highly prevalent in patients presenting for bariatric surgery, and that BMI alone
is not a good predictor of the presence or absence of sleep apnea. Methods: A cross-sectional study was undertaken of the
last 170 consecutive patients presenting for bariatric surgery in a single surgeon's practice. Clinical and demographic data
were available from our prospective database, and polysomnography results were reviewed retrospectively. Sleep apnea was noted
as present or absent, and graded from mild to severe. The patient population was stratified by BMI into severely obese (BMI
35-39.9), morbidly obese (BMI 40-49.9), super-obese (BMI 50-59.9), and super-super-obese (BMI ≥ 60). Results: OSA had been
diagnosed before surgical consultation in 26 of the 170 patients (15.3%). Sleep studies were not available in 7 patients (4.1%).
The remaining 137 patients (80.6%) had sleep data available, and 105 (76.6%) had sleep apnea (based on American Board of Sleep
Medicine criteria).There was no correlation of sleep apnea with BMI. The overall prevalence of OSA in this cohort was 77%
(131/170). Conclusions: In this large patient cohort, sleep apnea was prevalent (77%) independent of BMI, and most cases were
not diagnosed before bariatric surgical consultation.These data support the use of routine screening polysomnography before
bariatric surgery. 相似文献
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
Periodically, the state of bariatric surgery worldwide should be assessed; the most recent prior evaluation was in 2003. An
email survey was sent to the leadership of the 36 International Federation for the Surgery of Obesity and Metabolic Disorders
nations or national groupings, as well as Denmark, Norway, and Sweden. Responses were tabulated; calculation of relative prevalence
of specific procedures was done by weighted averages. Out of a potential 39, 36 nations or national groupings responded. In
2008, 344,221 bariatric surgery operations were performed by 4,680 bariatric surgeons; 220,000 of these operations were performed
in USA/Canada by 1,625 surgeons. The most commonlyperformed procedures were laparoscopic adjustable gastric banding (AGB;
42.3%), laparoscopic standard Roux-Y gastric bypass (RYGB; 39.7%), and total sleeve gastrectomies 4.5%. Over 90% of procedures
were performed laparoscopically. Comparing the 5-year trend from 2003 to 2008, all categories of procedures, with the exception
of biliopancreatic diversion/duodenal switch, increased in absolute numbers performed. However, the relative percent of all
RYGBs decreased from 65.1% to 49.0%; whereas, AGB increased from 24.4% to 42.3%. Markedly, different trends were found for
Europe and USA/Canada: in Europe, AGB decreased from 63.7% to 43.2% and RYGB increased from 11.1% to 39.0%; whereas, in USA/Canada,
AGB increased from 9.0% to 44.0% and RYGB decreased from 85.0% to 51.0%. The absolute growth rate of bariatric surgery decreased
over the past 5 years (135% increase), in comparison to the preceding 5 years (266% increase). Bariatric surgery continues
to grow worldwide, but less so than in the past. The types of procedures are in flux; trends in Europe vs USA/Canada are diametrically
opposed. 相似文献
Weight loss continues for extended time post-bariatric surgery; thus, discharge destination is an important factor to consider when examining outcomes of surgery. The Agency for Healthcare Research and Quality State Inpatient Database was utilized to identify patients with bariatric surgery and to determine factors associated with and predictive of home discharge. Patients that were discharged home had shorter length of stays, lower total hospital costs, fewer chronic conditions, and lower readmission rates. Factors predictive of discharge were identified. Being discharged home could be associated with characteristics vital to patient’s long-term weight loss. It is imperative to focus on factors predictive of home discharge in order to reap the most beneficial outcomes of surgery. 相似文献
Secondary hyperparathyroidism (SHPT) is linked to obesity. Bariatric surgery may be associated with calcium and vitamin D deficiencies leading to SHPT. This study aimed to detect the prevalence of SHPT before and after bariatric surgery.
Methods
This prospective study assessed the prevalence of SHPT after sleeve gastrectomy (SG, n = 38) compared to one-anastomosis gastric bypass (OAGB, n = 86). All patients were followed up for 2 years. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry.
Results
Of the 124 patients, 71 (57.3%) were females, and 53 (42.7%) were males, with a mean age of 37.5 ± 8.8 years. Before surgery, 23 patients (18.5%) suffered from SHPT, and 40 (32.3%) had vitamin D deficiency. The prevalence of SHPT increased to 29.8% after 1 year and 36.3% after 2 years. SHPT was associated with lower levels of vitamin D and calcium and higher reduction of BMD in the hip but not in the spine. After 2 years, SHPT was associated with a significantly lower T-score in the hip. SHPT and vitamin D deficiency were significantly more common in patients subjected to OAGB compared to SG (p = 0.003, and p < 0.001, respectively). There is a strong negative correlation between vitamin D levels and parathormone levels before and after surgery.
Conclusion
Prevalence of SHPT is high in obese patients seeking bariatric surgery, especially with lower vitamin D levels. Bariatric surgery increases the prevalence of SHPT up to 2 years. Gastric bypass is associated with a higher risk of developing SHPT compared to SG.
Metabolic/bariatric procedures for the treatment of morbid obesity, as well as for type 2 diabetes, are among the most commonly performed gastrointestinal operations today, justifying periodic assessment of the numerical status of metabolic/bariatric surgery and its relative distribution of procedures.
Methods
An email questionnaire was sent to the leadership of the 50 nations or national groupings in the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Outcome measurements were numbers of metabolic/bariatric operations and surgeons, types of procedures performed, and trends from 2003 to 2008 to 2011 worldwide and in the regional groupings of Europe, USA/Canada, Latin/South America, and Asia/Pacific.
Results
Response rate was 84 %. The global total number of procedures in 2011 was 340,768; the global total number of metabolic/bariatric surgeons was 6,705. The most commonly performed procedures were Roux-en-Y gastric bypass (RYGB) 46.6 %; sleeve gastrectomy (SG) 27.8 %; adjustable gastric banding (AGB) 17.8 %; and biliopancreatic diversion/duodenal switch (BPD/DS) 2.2 %. The global trends from 2003 to 2008 to 2011 showed a decrease in RYGB: 65.1 to 49.0 to 46.6 %; an increase, followed by a steep decline, in AGB: 24.4 to 42.3 to 17.8 %; and a marked increase in SG: 0.0 to 5.3 to 27.89 %. BPD/DS declined: 6.1 to 4.9 to 2.1 %. The trends from the four IFSO regions differed, except for the universal increase in SG.
Conclusions
Periodic metabolic/bariatric surgery surveys add to the knowledge and understanding of all physicians caring for morbidly obese patients. The salient message of the 2011 assessment is that SG (0.0 % in 2008) has markedly increased in prevalence. 相似文献
