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1.
《Journal of pediatric surgery》2019,54(5):1049-1053
PurposeAn interdisciplinary obesity management program was established in 2007 at our quaternary hospital, including bariatric surgery for selected adolescent patients. We report the evolution of surgical management within the program and outcomes following bariatric surgery.MethodsThis was a retrospective review of adolescents who underwent bariatric surgery between 2007 and 2017. All cases were performed by a pediatric surgeon and an adult bariatric surgeon. Baseline demographics, BMI, co-morbidities, and post-operative outcomes were recorded.ResultsThirty-eight patients underwent bariatric surgery. Median age at entrance into the program was 16.5 (range, 12.1–17.4) years and at time of surgery was 17.4 (range, 13.6–18.8) years. Eight patients had laparoscopic adjustable gastric banding (LAGB) from 2007 to 10. Between 2011 and 2017, 18 had laparoscopic sleeve gastrectomy (LSG), and 12 had laparoscopic Roux-en-Y gastric bypass (RYGB). There were no intraoperative complications or conversions. Postoperative complications included wound infection, bleeding requiring transfusion and re-exploration, and internal hernia. Of patients who had LAGB, 2 required surgical revision, and 3 underwent subsequent removal.ConclusionsAdolescent bariatric surgery in the context of a multidisciplinary obesity management program is safe and effective. RYGB and sleeve gastrectomy are associated with superior weight loss in the immediate post-operative period and at most recent follow-up and lower reoperation rates than gastric banding.Level of EvidenceIII. 相似文献
2.
Background: Motivation for seeking obesity surgery has not been studied. The authors explored the patient's motivation for selecting
surgery and examined for a relationship between primary motivating factors and weight outcomes. Methods: 208 (177F: 31M) unselected participants followed at least 1 year after Lap-Band? placement completed a short questionnaire.
6 statements were scored 1-6 from the most important through to the least important. Statements included appearance, embarrassment,
medical conditions, health concerns, physical fitness and physical limitation. Any additional factors were also sought. Results: Mean age, weight and BMI before surgery were 41±10 years, 129±16 kg and 46±8 kg/m2 respectively. Responses to appearance and embarrassment correlated strongly and were grouped together. Medical conditions
and health concerns account for 52%, appearance and embarrassment for 32%, and poor physical fitness and physical limitation
for 16% of first choices. Those who scored 1 for appearance or embarrassment (n=67) had a lower presenting BMI (44 kg/m2, P=0.03) and all but 1 were female (P<0.001). This group reported more depressive symptoms, poorer mental quality of life and poorer body image preoperatively.
Men were more likely than women to be motivated by medical problems (P=0.007). Subjects motivated by a medical condition were more likely to have hypertension or diabetes and less likely to smoke.
This group tended to be older. Weight history did not influence motivation. The first choice of motivating factor was not
associated with weight outcomes at 1-3 years following surgery. Conclusion: Health issues dominate the motivation for seeking surgery. Weight outcomes do not appear to be affected by the patient's
primary motivating factor. 相似文献
3.
Stephen C. Benoit Tina D. Hunter Diane M. Francis Nestor De La Cruz-Munoz 《Obesity surgery》2014,24(6):936-943
Background
This study was conducted to determine the contributions of various predictors to the large variations in absolute weight loss and percent body mass index (BMI) loss after bariatric surgery.Methods
The data source was the Bariatric Outcomes Longitudinal DatabaseSM by the Surgical Review Corporation. Eligibility criteria included a first bariatric surgery for adjustable gastric band (AGB), Roux-en-Y gastric bypass (RYBG), or sleeve gastrectomy (SG) between January 2007 and February 2010; age 21 years or older; presurgery BMI?>?30 kg/m2; and at least one preoperative visit within 6 months and at least one postoperative visit 30 days or more after surgery. Potential predictor variables included procedural details, patient demographics, comorbidities, and prior surgical history. Linear regression models of absolute weight loss and %BMI loss were fitted at 12, 18, and 24 months. The 12-month absolute weight loss endpoint was then chosen for a more in-depth analysis of variability through variable transformations and separate models by procedure.Results
A total of 31,443 AGB, 40,352 RYGB, and 2,194 SG patients met all inclusion criteria. Regression models explained 37 to 55 % of the variability in %BMI loss and 52 to 65 % of variability in absolute weight loss. The key predictors for absolute weight loss at 12 months were procedure (44.8 %) and baseline weight (18.5 %), with 34.2 % of the variability unexplained. Other significant predictors, each of which accounted for <1 % of variability, included age, race, and diabetes.Conclusions
Research on additional sources of variability is still needed to help explain the remaining differences in outcomes after bariatric surgery. 相似文献4.
5.
Background
Sarcopenic obesity is the combination of low muscle mass and strength with increased fat mass. This condition is associated with negative health outcomes. We hypothesized that sarcopenia could be a pejorative factor on surgical weight loss.Objective
The objectives of the study are to determine the influence of sarcopenic obesity on gastric bypass and sleeve gastrectomy results regarding weight loss and comorbidities resolution at 3, 6, and 12 months.Setting
The study was conducted at the University Hospital.Methods
Sixty-nine obese patients who benefited from bariatric surgery were included. Skeletal muscle mass was determined by the Janssen’s equation. Physical performance and muscle strength were determined using the 6-min walk test and the wall sit test. Obese subjects from the lowest tertile of the Skeletal Muscle mass Index (SMI) of Baumgartner were set as sarcopenic.Results
Weight loss outcomes and rate of weight loss failure were not influenced by sarcopenia. At 1 year, mean EBMIL% was 75.4 %?±?5 in sarcopenic subjects vs 67.8 % ±4 in the non-sarcopenic subjects (p?=?0.242). Improvement rates of co-morbidities were similar between groups. Skeletal muscle mass was no more different between groups at 1 year after surgery. There was no patient lost to follow-up.Conclusions
Bariatric surgery remains effective in achieving weight loss target in sarcopenic patients, with similar remission rates of main comorbidities and similar safety profile than in the non-sarcopenic group. Whether bariatric surgery could result in improvement or deterioration of daily living activities disabilities and functional autonomy in sarcopenic obese patients still have to be evaluated.6.
7.
Katherine D. Gray Maureen D. Moore Adham Elmously Omar Bellorin Rasa Zarnegar Gregory Dakin Alfons Pomp Cheguevara Afaneh 《Obesity surgery》2018,28(7):1852-1859
Background
Utilization of the robotic platform has become more common in bariatric applications. We aim to show that robotic revisional bariatric surgery (RRBS) can be safely performed in a complex patient population with perioperative outcomes equivalent to laparoscopic revisional bariatric surgery (LRBS).Methods
Retrospective review was conducted of adult patients undergoing laparoscopic revisional bariatric surgery (LRBS) or robotic revisional bariatric surgery (RRBS) at our institution from September 2007 to December 2016. Patients undergoing planned two-stage bariatric procedures were excluded.Results
A total of 84 patients who underwent LRBS (n?=?66) or RRBS (n?=?18) were included. The index operation was adjustable gastric banding (AGB) in 39/84 (46%), sleeve gastrectomy (VSG) in 23/84 (27%), Roux-en-Y gastric bypass (RYGB) in 13/84 (16%), and vertical banded gastroplasty (VBG) in 9/84 (11%). For patients undergoing conversion from AGB (n?=?39), there was no difference in operative time, length of stay, or complications by surgical approach. For patients undergoing conversion from a stapled procedure (n?=?45), the robotic approach was associated with a shorter length of stay (5.8?±?3.3 vs 3.7?±?1.7 days, p?=?0.04) with equivalent operative time and post-operative complications. There were three leaks in the LRBS group and none in the RRBS group (p?=?0.36). Major complications occurred in 3/39 (8%) of patients undergoing conversion from AGB and 2/45 (4%) of patients undergoing conversion from a stapled procedure (p?=?0.53) with no difference by surgical approach.Conclusions
RRBS is associated with a shorter length of stay than LRBS in complex procedures and has at least an equivalent safety profile. Long-term follow-up data is needed.8.
9.
Zambon S Romanato G Sartore G Marin R Busetto L Zanoni S Favretti F Sergi G Fioretto P Manzato E 《Obesity surgery》2009,19(2):190-195
Background Small dense low-density lipoprotein (LDL) are atherogenic particles frequently observed in obese patients. Fatty acids modulate
LDL. Objective of this study was to determine the relations between plasma phospholipid fatty acid composition and the presence
of small dense LDL particles in morbidly obese patients treated with laparoscopic gastric banding (LAGB).
Methods Small dense LDL, plasma lipids, lipoproteins, apoproteins, and phospholipid fatty acid composition (a marker of dietary fatty
acid intake) were quantified before and 12 months after surgery in four men and 11 women who were morbidly obese and (BMI > 40 kg/m2) eligible for surgery, consecutively treated with LAGB at the Department of Medical and Surgical Sciences of the University
of Padova.
Results BMI was 48.3 ± 4.8 kg/m2 before and 36.1 ± 5.5 kg/m2 after LAGB. Plasma triglycerides and apoprotein E levels significantly decreased, while HDL cholesterol significantly increased
after LAGB. A reduction of small dense LDL with an increase of LDL relative flotation (0.34 ± 0.04 before vs 0.38 ± 0.03 after
LAGB, p < 0.001) was also observed. These modifications were neither related to weight reduction nor to changes in phospholipid fatty
acid composition, but they were associated to triglyceride reduction, which explained 76.7% of the LDL relative flotation
variation.
Conclusion Weight loss obtained by LAGB in morbidly obese subjects was accompanied by triglyceride reduction, high-density lipoprotein
increase, and an improvement of the atherogenic LDL profile. Triglyceride reduction, but not the extent of weight loss or
dietary fatty acid modifications, is the determinant of modifications of LDL physical properties in these patients. 相似文献
10.
Meyerowitz BR 《Obesity surgery》2004,14(4):563-564
11.
12.
Obesity has been associated with poor graft and patient survival after kidney transplantation, requiring functional increase
of anti-rejection drugs. Weight loss surgery may be a good alternative in this clinical scenario. The aim of this report is
to describe the outcomes of bariatric procedures performed in patients after kidney transplantation at our institution. A
retrospective chart review of a prospectively collected database was conducted to analyze the outcomes of morbidly obese patients
after kidney transplantation who underwent laparoscopic bariatric procedures between November 2004 and October 2007. Our series
included five patients who underwent a bariatric procedure following kidney transplantation. All patients were females, with
a mean age of 40.8 years (range 30–48) and mean body mass index (BMI) of 52.2 (range 48–69). Percent of excess weight loss
(%EWL) at 2 years was over 50% for all patients; other comorbidities that might affect postoperative renal function were diabetes
mellitus in 2/5 patients, hypertension in 5/5 patients, and chronic heart failure in 1/5 patients. Four patients had laparoscopic
Roux-en-Y gastric bypass and one had laparoscopic sleeve gastrectomy. There were no postoperative complications in any patients,
and no alteration to the dosages of the immunosuppressant drugs were recorded after bariatric surgery. Laparoscopic bariatric
surgical techniques may be used safely and effectively to control obesity in renal transplant patients. 相似文献
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14.
Lisa R. Miller-Matero Kelly Bryce Caroline K. Saulino Kate E. Dykhuis Jeffrey Genaw Arthur M. Carlin 《Obesity surgery》2018,28(7):1910-1915
Background
There are no clear psychosocial predictors of weight loss following bariatric surgery. The purpose of this study was to investigate whether preoperative problematic eating behaviors predict weight loss outcomes following bariatric surgery.Methods
Clinical records were utilized to examine outcomes of 101 patients who completed a pre-surgical psychosocial evaluation and underwent gastric bypass or sleeve gastrectomy. Information analyzed included binge eating history and scores from the Hospital Anxiety and Depression Scale, Yale Food Addiction Scale, and Emotional Eating Scale. Measures of weight loss 1 year post-surgery were compared to pre-surgical assessments.Results
One-year follow-up data were available for 60 patients. Patients with higher levels of eating in response to anger/frustration (p?=?.02), anxiety (p?=?.01), or depression (p?=?.05) were more likely to miss the 1-year follow-up appointment. Eating in response to anger/frustration and depression were related to poorer weight loss outcomes. There was a trend for binge eating to predict greater %EWL (p?=?.06). A higher number of food addiction symptoms increased the likelihood that patients would experience less weight loss (p?=?.01). Psychiatric symptoms were not related to weight loss outcomes.Conclusions
Patients who endorsed higher levels of pre-surgical emotional eating and food addiction symptoms had poorer weight loss 1 year post-surgery. Providers should consider screening patients for these behaviors during the pre-surgical psychosocial evaluation which would allow opportunities for psychotherapy and potential improvement in weight loss outcomes. Future research should examine which interventions are successful at improving problematic eating behaviors.15.
Background: Many patients rely on the Internet for gathering medical information. Bariatric patients appear to explore the
Internet for information regarding weight loss surgery. This investigation studied the hypothesis that Internet use is common
among the bariatric population. Methods: From Oct 1 to Dec 31, 2003, every patient who visited our bariatric clinic was asked
to fill out a questionnaire. This survey contained questions concerning use of the Internet and E-mail. Results: Of the 127
respondents, 89% owned a computer, had Internet access, and had an E-mail address. 85% of the patients had searched the Internet
for bariatric information, and 98% of these patients (91/93) found the information useful. Of the patients who had access
to the Internet, 36% searched for information about the hospital, 40% about the clinic, and 54% about the surgeon. Most of
the patients believed that all doctors and all clinics should be available via E-mail (88% and 92% respectively). Conclusions:
Most patients who come to a bariatric clinic are Internet savvy. It is helpful for bariatric surgeons and clinics to post
information about themselves on the Internet and to be available via E-mail. 相似文献
16.
17.
Eric Edison Martin Whyte Jeremy van Vlymen Simon Jones Piers Gatenby Simon de Lusignan Jill Shawe 《Obesity surgery》2016,26(12):2837-2842
Background
The aims of this study are the following: to describe the female population of reproductive age having bariatric surgery in the UK, to assess the age and ethnicity of women accessing surgery, and to assess the effect of bariatric surgery on factors that underlie fertility and pregnancy outcomes.Methods
Demographic details, comorbidities, and operative type of women aged 18–45 years were extracted from the National Bariatric Surgery Registry (NBSR). A comparison was made with non-operative cases (aged 18–45 and BMI ≥40 kg/m2) from the Health Survey for England (HSE, 2007–2013). Analyses were performed using “R” software.Results
Data were extracted on 15,222 women from NBSR and 1073 from HSE. Women aged 18–45 comprised 53 % of operations. Non-Caucasians were under-represented in NBSR compared to HSE (10 vs 16 % respectively, p?<?0.0001). The NBSR group was older than the HSE group—median 38 (IQR 32–42) vs 36 (IQR 30–41) years (Wilcoxon test p?<?0.0001). Almost one third of women in NBSR had menstrual dysfunction at baseline (33.0 %). BMI fell in the first year postoperatively from 48.2?±?8.3 to 37.4?±?7.5 kg/m2 (t test, p?<?0.001). From NBSR, in the postoperative period, the prevalence of type 2 diabetes fell by 54 %, polycystic ovarian syndrome by 15 %, and any menstrual dysfunction by 12 %.Conclusions
Over half of all bariatric procedures are carried out on women of reproductive age. More work is required to provide prompt and equal access across ethnic groups. At least one in three women suffers from menstrual dysfunction at baseline. Bariatric surgery improves factors that underlie fertility and pregnancy outcomes. A prospective study is required to verify these effects.18.
19.
Background Morbidly obese individuals may have impaired alveolar-membrane diffusing capacity (DmCO). The purpose of this study was to
measure pulmonary diffusing capacity for NO (DLNO) as an index of DmCO pre- and postbariatric surgery in the morbidly obese.
Methods Twenty-one patients [age = 40 ± 9 years, body mass index (BMI) = 48.5 ± 7.2 kg/m2] with an excess weight of 72 ± 17 kg scheduled for bariatric surgery were recruited. Pulmonary function and arterial blood-gases
were measured pre- and postsurgery.
Results DmCO was 88 ± 23% of predicted before surgery (p < 0.05). There was loss in BMI and excess weight of 7.7 ± 2.0 kg/m2 and 31 ± 8%, respectively. Because DmCO = DLNO/2.42, the increase in DLNO postsurgery resulted in a normalization of the
predicted DmCO to 97 ± 29% predicted, or an improvement of DLNO by 11 ± 18 (95% CI = 3.5, 19.1; p = 0.01) milliliters per minute per millimeter of mercury without any improvement in DLCO. The DLNO/DLCO ratio and alveolar
volume both increased, respectively (p < 0.05), and pulmonary capillary blood volume to DmCO ratio decreased postsurgery (p < 0.01). Multiple linear regression revealed that the change in DLNO was most strongly associated with changes in alveolar
volume and the waist-to-hip ratio (adjusted r
2 = 0.76; p < 0.001) and was not related to the reduction in the alveolar-to-arterial PO2 difference.
Conclusion Alveolar-membrane diffusion normalizes within 10 weeks after bariatric surgery. This is likely due to the increase in alveolar
volume from the reduction in the waist-to-hip ratio.
G.S. Zavorsky is the recipient of the 2005 Baxter Corporation Award in Anesthesia from the Canadian Anesthesiologist’s Society.
G.S. Zavorsky was a previous Research Scholar – Junior 1 from the Quebec Health Research Foundation (Fonds de la Recherche en Santé du Québec, FRSQ). N.V. Christou is a consultant for Ethicon Endo-Surgery and has stock ownership in Weight Loss Surgery. 相似文献
20.
Dietric L. Hennings Maria Baimas-George Zaid Al-Quarayshi Rachel Moore Emad Kandil Christopher G. DuCoin 《Obesity surgery》2018,28(1):44-51