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1.
Clare J. Lee Todd T. Brown Michael Schweitzer Thomas Magnuson Jeanne M. Clark 《Surgery for obesity and related diseases》2018,14(6):797-802
Background
Hypoglycemia after bariatric surgery is an increasingly recognized metabolic complication associated with exaggerated secretion of insulin and gut hormones.Objective
We sought to determine the incidence of hypoglycemic symptoms (hypo-sx) after bariatric surgery and characteristics of those affected compared with those unaffected.Setting
University hospital.Methods
We collected retrospective survey data from the patients who underwent bariatric surgery at a single center. Based on number and severity of postprandial hypo-sx in Edinburgh hypoglycemia questionnaire postoperatively, patients without preoperative hypo-sx were grouped into high versus low suspicion for hypoglycemia. We used multivariable logistic regression to examine potential baseline and operative risk factors for the development of hypo-sx after surgery.Results
Among the 1119 patients who had undergone bariatric surgery who received the questionnaire, 464 (40.6%) responded. Among the 341 respondents without preexisting hypo-sx, 29% (n = 99) had new-onset hypo-sx, and most were severe cases (n = 92) with neuroglycopenic symptoms. Compared with the low suspicion group, the high suspicion group consisted of more female patients, younger patients, patients without diabetes, and those who underwent Roux-en-Y gastric bypass with a longer time since surgery and more weight loss. In multivariate analysis, factors independently associated with incidence of hypo-sx after bariatric surgery were female sex (P = .003), Roux-en-Y gastric bypass (P = .001), and absence of preexisting diabetes (P = .011).Conclusions
New onset postprandial hypoglycemic symptoms after bariatric surgery are common, affecting up to a third of those who underwent bariatric surgery. Many affected individuals reported neuroglycopenic symptoms and were more likely to be female and nondiabetic and to have undergone Roux-en-Y gastric bypass. 相似文献2.
Charles J. Keith Lauren E. Goss Camille D. Blackledge Richard D. Stahl Jayleen Grams 《Surgery for obesity and related diseases》2018,14(5):631-636
Background
Despite a lack of demonstrated patient benefit, many insurance providers mandate a physician-supervised diet before financial coverage for bariatric surgery.Objectives
To compare weight loss between patients with versus without insurance mandating a preoperative diet.Setting
University hospital, United States.Methods
Retrospective study of all patients who underwent laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy over a 5-year period, stratified based on whether an insurance-mandated physician-supervised diet was required. Weight loss outcomes at 6, 12, and 24 months postoperation were compared. Linear mixed-models and backward-stepwise selection were used. P<0.05 was considered significant.Results
Of 284 patients, 225 (79%) were required and 59 (21%) were not required to complete a preoperative diet by their insurance provider. Patients without the requirement had a shorter time to operation from initial consultation (P = .04), were older (P<.01), and were more likely to have government-sponsored insurance (P<.01). There was no difference in preoperative weight or body mass index or co-morbidities. In unadjusted models, percent excess weight loss was superior in the group without an insurance-mandated diet at 12 (P = .050) and 24 (P = .045) months. In adjusted analyses, this group also had greater percent excess weight loss at 6 (P<.001), 12 (P<.001), and 24 (P<.001) months; percent total weight loss at 24 months (P = .004); and change in body mass index at 6 (P = .032) and 24 (P = .007) months. There was no difference in length of stay or complication rates.Conclusions
Insurance-mandated preoperative diets delay treatment and may lead to inferior weight loss. 相似文献3.
Gautam Sharma Andrew T. Strong Chao Tu Stacy A. Brethauer Philip R. Schauer Ali Aminian 《Surgery for obesity and related diseases》2018,14(3):304-310
Background
The current literature comparing robot-assisted Roux-en-Y gastric bypass (RA-RYGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) is limited to single center retrospective series.Objectives
This study aims to compare perioperative outcomes of patients who underwent RA-RYGB with those who underwent LRYGB.Setting
National database.Methods
Data on patients who underwent RA-RYGB and LRYGB were extracted from the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participant use file. A 1:8 propensity score matching (RA-RYGB:LRYGB) was performed, and the 30-day outcomes of the propensity-matched cohorts were compared.Results
In total, 36,158 patients met inclusion criteria, including 2660 RA-RYGB (7.4%) cases, which were propensity matched (1:8) with 21,280 LRYGB cases having similar preoperative characteristics. RA-RYGB was associated with longer median operative time (136 versus 107 min; P<.001) and a higher 30-day readmission rate (7.3% versus 6.2%; P = .03). There were no statistical differences between the RA-RYGB and LRYGB cohorts with respect to all-cause morbidity (10.6% versus 10.7%; P = .8), serious morbidity (1.2% versus 1.7%; P = .07), mortality (0.1% versus .2%; P = .2), unplanned intensive care unit admission (1.1% versus 1.3%; P = .3), reoperation (2.4% versus 2.4%; P = .97), or reintervention (3.0% versus 2.5%; P = .2) within 30 days after surgery.Conclusion
Based on available national data, RA-RYGB appears safe compared with a conventional laparoscopic approach for gastric bypass. However, RA-RYGB was associated with longer operative time and higher readmission rate, indicating greater resource use. Further studies are needed to better delineate the role of robotic platforms in bariatric surgery. 相似文献4.
Piotr Major Jakub Droś Artur Kacprzyk Michał Pędziwiatr Piotr Małczak Michał Wysocki Michał Janik Maciej Walędziak Krzysztof Paśnik Hady Razak Hady Jacek Dadan Monika Proczko-Stepaniak Łukasz Kaska Paweł Lech Maciej Michalik Michał Duchnik Krzysztof Kaseja Maciej Pastuszka Andrzej Budzyński 《Surgery for obesity and related diseases》2018,14(7):997-1004
Background
Global experiences in general surgery suggest that previous abdominal surgery may negatively influence different aspects of perioperative care. As the incidence of bariatric procedures has recently increased, it is essential to assess such correlations in bariatric surgery.Objectives
To assess whether previous abdominal surgery influences the course and outcomes of laparoscopic bariatric surgery.Setting
Seven referral bariatric centers in Poland.Methods
We conducted a retrospective analysis of 2413 patients; 1706 patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) matched the inclusion criteria. Patients with no history of abdominal surgery were included as group 1, while those who had undergone at least 1 abdominal surgery were included as group 2.Results
Group 2 had a significantly prolonged median operation time for RYGB (P = .012), and the longest operation time was observed in patients who had previously undergone surgeries in both the upper and lower abdomen (P = .002). Such a correlation was not found in SG cases (P = .396). Groups 1 and 2 had similar rates of intraoperative adverse events and postoperative complications (P = .562 and P = .466, respectively). Group 2 had a longer median duration of hospitalization than group 1 (P = .034), while the readmission rate was similar between groups (P = .079). There was no significant difference between groups regarding the influence of the long-term effects of bariatric treatment on weight loss (percentage of follow-up was 55%).Conclusions
Previous abdominal surgery prolongs the operative time of RYGB and the duration of postoperative hospitalization, but does not affect the long-term outcomes of bariatric treatment. 相似文献5.
Amihai Rottenstreich Ram Elazary Yossef Ezra Geffen Kleinstern Nahum Beglaibter Uriel Elchalal 《Surgery for obesity and related diseases》2018,14(3):347-353
Background
While hypoglycemia during an oral glucose tolerance test (OGTT) has been shown to occur in a considerable portion of nonpregnant post–bariatric surgery (BS) patients, its incidence among pregnant post-BS patients evaluated for gestational diabetes has only been sparsely studied.Objectives
We investigated OGTT results and pregnancy outcomes in pregnant women who underwent 3 types of bariatric procedures before pregnancy.Setting
A university hospital.Methods
From medical records, data were collected on glucose measurements during a 100-g, 3-hour OGTT, as well as maternal and fetal outcomes.Results
Of 119 post-BS pregnant patients included in the study, 55 underwent laparoscopic sleeve gastrectomy, 34 laparoscopic adjustable gastric banding, and 30 laparoscopic Roux-en-Y gastric bypass surgery. Hypoglycemia (<55 mg/dL) was encountered in 59 (49.6%) patients during the OGTT. Among them, the nadir plasma glucose levels occurred 2 hours after glucose ingestion in 25 (42.4%) and after 3 hours in 34 (57.6%), with a median value of 47 (44–52) mg/dL. The risk of hypoglycemia was higher among women with prior laparoscopic Roux-en-Y gastric bypass surgery (83.3%) than among those with prior laparoscopic sleeve gastrectomy (54.5%; P = .009) or laparoscopic adjustable gastric banding (11.8%; P<.0001). Time from surgery to conception was significantly shorter among women with evidence of hypoglycemia during OGTT (median 711 versus 1246 days, P = .002). Compared with patients without evidence of hypoglycemia, patients who experienced hypoglycemia had lower rates of gestational diabetes (P = .03) but higher proportions of low birth weight (P = .01) and small for gestational age infants (P = .03).Conclusions
Because hypoglycemia is common during OGTT among post-BS parturients, other diagnostic methods should be considered in this setting. The association found between hypoglycemia and poor fetal growth warrants investigation as to whether interventions to prevent hypoglycemia will improve fetal outcome. 相似文献6.
Daniel Eriksson Hogling Mikael Rydén Jesper Bäckdahl Anders Thorell Peter Arner Daniel P. Andersson 《Surgery for obesity and related diseases》2018,14(7):936-942
Background
Bariatric surgery such as Roux-en-Y gastric bypass (RYGB) remains the most effective treatment of obesity and associated co-morbidities. Body fat distribution associates with metabolic function.Objective
To investigate if preoperative body fat mass and distribution measured by dual-energy x-ray absorptiometry (DXA) predict weight loss and metabolic outcome after RYGB, and to compare predictive value of DXA with simple anthropometric measures.Setting
Four Swedish hospitals within the Stockholm area.Methods
Two hundred fifteen women scheduled for RYGB were included. Evaluations before and 2 years after RYGB included determination of insulin sensitivity by the homeostatic model assessment of insulin resistance, blood pressure, plasma lipids, and anthropometric measures, such as waist-to-hip-ratio and fat percentage estimated by formula. Body fat mass and distribution were determined by DXA.Results
Follow-up rate was 77.2% (n = 166). All clinical, anthropometric, and DXA measures were improved/reduced postsurgery (all P<.0001). Android/gynoid fat mass ratio and waist-to-hip-ratio predicted improved homeostatic model assessment of insulin resistance (P = .0028 and .0014), independently of body mass index and age. Body fat percentage, measured by DXA or estimated by formula, predicted percent weight loss (P<.0001 and .0083). Body mass index predicted percent weight loss and percent excess body mass index lost (P = .0022 and<.0001). DXA and anthropometric measures performed equally as predictors, except for DXA measured fat percentage that was slightly better than formula estimated.Conclusion
DXA provided predictive values similar to those by basic anthropometric measures, suggesting a limited additional value of preoperative DXA to predict metabolic improvement and weight loss after RYGB in women. 相似文献7.
Everton Cazzo Helena Paes de Almeida de Saito José Carlos Pareja Elinton Adami Chaim Francisco Callejas-Neto João de Souza Coelho-Neto 《Surgery for obesity and related diseases》2018,14(1):23-28
Background
Occurrences of mesenchymal tumors have been more recognized in recent years, and the incidental diagnosis of these lesions during bariatric surgery has been previously reported.Objective
To describe the cases of incidentally diagnosed mesenchymal tumors during consecutive bariatric surgeries.Setting
Private health-providing service, Brazil.Methods
A retrospective population-based study, which enrolled individuals who consecutively underwent Roux-en-Y gastric bypass at a single center from January 2006 through July 2016.Results
Of 1502 individuals, there were 16 cases (1.1%) of confirmed mesenchymal tumors. Of these 16 cases, 14 (87.5%) were gastrointestinal stromal tumors and 2 (12.5%) were leiomyomas. The affected individuals were significantly older (aged 46.2 ± 6.3 versus 35.4 ± 7.2 yr; P = .00031), presented a lower body mass index (38.2 ± 5.1 versus 45.3 ± 8.1 kg/m2; P<.00001), and had a lower weight (102.1 ± 17.9 versus 121.1 ± 7.4 kg; P = .00321). None of the individuals presented reported relapses of the mesenchymal tumors.Conclusion
The possibility of incidental gastric mesenchymal tumors during bariatric surgery should not be neglected; a careful inventory of the stomach at the beginning of the procedure and resection of lesions found are mandatory. (Surg Obes Relat Dis 2017;X:XXX–XXX.) © 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved. 相似文献8.
Zubaidah Nor Hanipah Elie C. Nasr Emre Bucak Philip R. Schauer Ali Aminian Stacy A. Brethauer Derrick Cetin 《Surgery for obesity and related diseases》2018,14(1):93-98
Background
Some patients do not achieve optimal weight loss or regain weight after bariatric surgery. In this study, we aimed to determine the effectiveness of adjuvant weight loss medications after surgery for this group of patients.Setting
An academic medical center.Methods
Weight changes of patients who received weight loss medications after bariatric surgery from 2012 to 2015 at a single center were studied.Results
Weight loss medications prescribed for 209 patients were phentermine (n = 156, 74.6%), phentermine/topiramate extended release (n = 25, 12%), lorcaserin (n = 18, 8.6%), and naltrexone slow-release/bupropion slow-release (n = 10, 4.8%). Of patients, 37% lost>5% of their total weight 1 year after pharmacotherapy was prescribed. There were significant differences in weight loss at 1 year in gastric banding versus sleeve gastrectomy patients (4.6% versus .3%, P = .02) and Roux-en-Y gastric bypass versus sleeve gastrectomy patients (2.8% versus .3%, P = .01).There was a significant positive correlation between body mass index at the start of adjuvant pharmacotherapy and total weight loss at 1 year (P = .025).Conclusion
Adjuvant weight loss medications halted weight regain in patients who underwent bariatric surgery. More than one third achieved>5% weight loss with the addition of weight loss medication. The observed response was significantly better in gastric bypass and gastric banding patients compared with sleeve gastrectomy patients. Furthermore, adjuvant pharmacotherapy was more effective in patients with higher body mass index. Given the low risk of medications compared with revisional surgery, it can be a reasonable option in the appropriate patients. Further studies are necessary to determine the optimal medication and timing of adjuvant pharmacotherapy after bariatric surgery. 相似文献9.
Adam B. King Matthew D. Spann Patrick Jablonski Jonathan P. Wanderer Warren S. Sandberg Matthew D. McEvoy 《Surgery for obesity and related diseases》2018,14(6):849-856
Background
Patients frequently remain in the hospital after bariatric surgery due to pain, nausea, and inability to tolerate oral intake. Enhanced recovery after surgery (ERAS) concepts address these perioperative complications and therefore improve length of stay for bariatric surgery patients.Objectives
To determine if ERAS concepts increase the proportion of patients discharged on postoperative day 1. Secondary objectives included mean length of stay, perioperative opioid use, emergency department visits, and readmissions.Setting
A large metropolitan university tertiary hospital.Methods
A quantitative before and after study was conducted for patients undergoing bariatric surgical patients. Data were collected surrounding length of stay, perioperative opioid consumption, antiemetic therapy requirements postoperatively, multimodal analgesia compliance, emergency department visits, and hospital readmission rates. Wilcoxon rank-sum and χ2 test were used to compare continuous and categorical variables, respectively. A secondary analysis was performed using Aligned Rank Transformation and Cochran-Mantel-Haenszel χ2 tests to account for an increase in sleeve gastrectomies in the intervention group.Results
The 2 groups had clinically similar baseline characteristics. Comparison group (N = 366) and ERAS group (N = 715) patients underwent a primary bariatric surgery procedure. There was an increase in the number of patients undergoing a laparoscopic sleeve gastrectomy in the intervention group. After accounting for this increase, the percentage of patients discharged on postoperative day 1 was unchanged (79.8% non-ERAS versus 83.1% ERAS, P = .52). ERAS length of stay was statistically significantly lower for gastric bypass (P<.001) and robotic gastric bypass (P = .01). Perioperative opioid consumption was reduced (41.0 versus 16.2 morphine equivalents, P<0.001), and fewer ERAS patients required postoperative antiemetics (68.8% versus 46.2%, P<.001). Emergency department visits at 7 days were reduced (6.0% versus 3.2%, P = .04), but hospital readmission rates were unchanged.Conclusions
Implementing ERAS did not reduce the percentage of patients discharged on postoperative day 1 in a bariatric surgery program with historically low length of stay, but it led to significant reductions in perioperative opioid use, decreases in postoperative nausea, and early emergency room visits. 相似文献10.
Thomas R McCarty Justin B. Echouffo-Tcheugui Andrew Lange Lamia Haque Basile Njei 《Surgery for obesity and related diseases》2018,14(1):74-80
Background
Bariatric surgery in eligible morbidly obese individuals may improve liver steatosis, inflammation, and fibrosis; however, population-based data on the clinical benefits of bariatric surgery in patients with nonalcoholic fatty liver disease (NAFLD) are lacking.Objectives
To assess the relationship between bariatric surgery and clinical outcomes in hospitalized patients with NAFLD.Setting
United States inpatient care database.Methods
The Nationwide Inpatient Sample database was queried from 2004 to 2012 with co-diagnoses of NAFLD and morbid obesity. Hospitalizations with a history of prior bariatric surgery (Roux-en-Y gastric bypass, gastric band, and sleeve gastrectomy) were also identified. The primary outcome was in-hospital mortality. Secondary outcomes included cirrhosis, myocardial infarction, stroke, and renal failure. Poisson regression was used to derive adjusted incidence risk ratios for clinical outcomes in patients with prior bariatric surgery compared with those without bariatric surgery.Results
Among 45,462 patients with a discharge diagnosis of NAFLD and morbid obesity, 18,618 patients (41.0%) had prior bariatric surgery. There was a downward trend in bariatric surgery procedures (percent annual change of ?5.94% from 2004 to 2012). In a multivariable analysis, prior bariatric surgery was associated with decreased inpatient mortality compared with no bariatric surgery (incidence risk ratios = .08; 95% confidence interval, .03–.20, P<.001). Prior bariatric surgery was also associated with decreased incidence risk ratios for cirrhosis, myocardial infarction, stroke, and renal failure (all P<.001).Conclusions
Prior bariatric surgery is associated with decreased in-hospital morbidity and mortality in morbidly obese NAFLD patients. Despite this, the proportion of NAFLD patients with bariatric surgery has declined from 2004 to 2012. 相似文献11.
Introduction
Acute care surgeons care for the entire breadth of the American adult population, including obese patients. As the population gets heavier, more patients will present to acute case surgeons with nonbariatric surgical emergencies. Do these surgeons need bariatric training to properly care for obese population?Objectives
To evaluate our experience in obese population requiring acute surgery and compare outcomes based on surgeon expertise in bariatric surgery.Setting
Community teaching hospital, United States.Methods
Retrospective review of obese patients requiring acute surgical intervention. Surgeons were classified as bariatric surgeons (B, n = 2) versus nonbariatric surgeons (NB, n = 4). Demographic characteristics, co-morbidities, and outcomes based on surgeon training were compared.Results
Two hundred three patients comprised the cohort. The mean body mass index was 37 ±6 kg/m2. The majority of procedures were laparoscopic (cholecystectomies n = 75, appendectomies n = 45). The remaining nonroutine laparoscopic cases were intestinal obstructions (n = 9), incarcerated hernias (n = 17), traumatic injuries (n = 48), and intestinal ischemia or perforation (n = 9). Bariatric surgeons performed 35% of cases, and risk profiles were similar between groups. Operative times were similar for cholecystectomies and appendectomies. Bariatric surgeons performed more nonroutine cases laparoscopically (7% B versus 2% NB, P = .001). Surgical site infections were low (2% B versus 4% NB, P = .4). Hospital length of stay was higher in the NB group at 9 ± 9 days versus 5 ± 4 days for B (P = .05). Mortality was 5%.Conclusions
Acute surgical procedures were performed in obese patients. Bariatric expertise favorably affected length of stay and the application of laparoscopy. Bariatric expertise may improve outcomes in nonbariatric emergencies, but further study is warranted. 相似文献12.
Uzma Rahman Salvatore Docimo Aurora D. Pryor Andrew Bates Nabeel R. Obeid Konstantinos Spaniolas 《Surgery for obesity and related diseases》2018,14(4):517-520
Background
Although multiple studies demonstrate that routine postoperative contrast studies have a low yield in diagnosing patients with early gastrointestinal (GI) leak after bariatric surgery, the practice pattern is unknown. Additionally, routine imaging may hinder procedural pathways that lead to accelerated postoperative discharge.Objectives
To report on the nationwide use of routine upper GI studies (UGI) and evaluate the effect on hospital resource utilization.Setting
Nationwide analysis of accredited centers.Methods
The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program public use file for 2015 was used to identify patients who underwent routine UGI after nonrevisional Roux-en-Y gastric bypass or sleeve gastrectomy. Multivariable logistic regression models were developed to identify risk factors for early hospital discharge.Results
Bariatric surgery was performed on 130,686 patients. Routine UGI was performed in 30.9% of Roux-en-Y gastric bypass and 43% of sleeve gastrectomy patients (P<.0001). Patients undergoing routine UGI were less likely to be discharged by postoperative day 1 (odds ratio .7, 95%; confidence interval .69–0.72). There was no difference in postoperative leak rate between the routine UGI versus nonroutine UGI group (.7% versus .8%, P = .208). Among patients who developed a GI leak, there was no significant difference in the rate of reoperation, readmission, and reintervention between the 2 groups. The time interval between index operation and any further management for the leak was longer in the routine UGI group.Conclusions
Routine UGI evaluation after bariatric surgery remains a common practice in accredited centers. This practice is associated with prolonged hospital length of stay, with no effect on the diagnosis of leak rate. 相似文献13.
Fangyuan Liu Yinfang Tu Pin Zhang Yuqian Bao Junfeng Han Weiping Jia 《Surgery for obesity and related diseases》2018,14(4):462-468
Background
Obesity and type 2 diabetes (T2D) are recognized as risk factors for hypogonadism in males. Serum sex hormone profiles have not been assessed adequately in obese Chinese males with T2D who have undergone Roux-en-Y gastric bypass (RYGB).Objective
This study was conducted to examine the changes in sex hormone profiles, anthropometric parameters, and metabolic indexes before and after RYGB.Setting
University Hospital, China.Methods
There were 45 obese males with T2D who had undergone RYGB enrolled in this retrospective study, focusing on anthropometric parameters, metabolic indexes, and sex hormone profiles before and after surgery.Results
The baseline prevalence of hypogonadism (defined by total testosterone [TT] levels<8 nM) was 33.33%. After surgery, both the levels of TT and sex hormone-binding globulin increased, while the levels of estradiol decreased. However, the calculated free testosterone, follicle-stimulating hormone, and luteinizing hormone levels remained unchanged. Multiple linear regression analysis showed that the visceral fat area was the only significant and independent parameter associated with TT levels at baseline (β = ?.479, P = .001). After surgery, decreases in the visceral fat area continued to be negatively associated with increases in TT (r = ?.411, P = .024).Conclusion
These preliminary results demonstrated that TT could be significantly increased in obese Chinese males with T2D after RYGB; this occurs in part via a reduction in adipose tissue, especially visceral fat. Therefore, RYGB might be a promising therapy to treat hypogonadism in obese men with T2D. 相似文献14.
Owaid M. Almalki Wei-Jei Lee Keong Chong Kong-Han Ser Yi-Chih Lee Shu-Chun Chen 《Surgery for obesity and related diseases》2018,14(4):509-515
Background
In recent years, gastric bypass surgery has been found to have therapeutic potential for the treatment of type 2 diabetes (T2D). However, the difference between 2 bypass procedures, Roux-en-Y gastric bypass (RYGB) and another single anastomosis gastric bypass (SAGB), is not clear.Objective
To evaluate the differences between SAGB and RYGB in the efficacy of T2D remission in obese patients.Setting
Tertiary teaching hospital.Methods
Outcomes of 406 (259 women and 147 male) patients who had undergone RYGB (157) or SAGB (249) for the treatment of T2D with 1-year follow-up were assessed. The remission of T2D after surgery was evaluated in matched groups, including body mass index (BMI) and the ABCD scoring system, which comprises patient age, BMI, C-peptide levels, and duration of T2D (yr).Results
The weight loss of the SAGB patients at 1 year after surgery was better than the RYGB patients (24.1% [8.4%] versus 30.7% [8.7%]; P<.001). The mean BMI decreased from 39.9 (8.0) to 27.4 (4.6) kg/m2 in SAGB patients at 1 year after surgery and decreased from 34.5 (6.6) to 26.2 (4.2) kg/m2 in the RYGB patients. The mean glycated hemoglobin A1C (HbA1C) decreased from 8.6% to 6.2% of the RYGB group and from 8.6% to 5.5% of the SAGB group. Eighty-seven (55.4%) patients of the RYGB group and 204 (81.9%) of the SAGB group achieved complete remission of T2D (HbA1C<6.0%) at 1 year after surgery (P<.001). SAGB exhibited significantly better glycemic control than RYGB surgery in selected groups stratified by different BMI and ABCD score. At 5 years after surgery, SAGB still had a better remission of T2D than RYGB (70.5% versus 39.4%; P = .002). Multivariate analysis confirms that both SAGB and ABCD score are independent predictors of T2D remission after bypass surgery.Conclusions
Both RYGB and SAGB are effective metabolic surgery. SAGB carries a higher power on T2D remission than RYGB in a small group of patients. ABCD score is useful in T2D patient classification and selection for different procedures. 相似文献15.
Eric J. Charles J. Hunter Mehaffey Robert B. Hawkins Dana Safavian Bruce D. Schirmer Peter T. Hallowell 《Surgery for obesity and related diseases》2018,14(2):162-167
Background
Bariatric surgery provides durable weight loss and decreases the incidence of co-morbid conditions for people with obesity. Most patients benefit from resultant weight loss, but some are at risk for postoperative refractory malnutrition, a serious but poorly understood complication.Objective
To evaluate differences in bariatric surgery patients who received a feeding tube postoperatively for malnutrition compared with other indications.Setting
Retrospective cohort study at an academic bariatric surgery center (1985–2015).Methods
All bariatric surgery patients that received a feeding tube postoperatively over a 30-year period were identified. Data abstraction from the medical record was performed to assess demographic characteristics, operative details, tube indication, and resultant body mass index (BMI) changes.Results
From a total of 3487 patients who underwent bariatric surgery during the study period, 139 (3.9%) required placement of a feeding tube postoperatively. Refractory malnutrition was the indication in 24 patients, all after Roux-en-Y gastric bypass. There were no significant differences between these patients and other bariatric surgery patients in terms of mean age (40.6±9.9 versus 43.1±13.4 years, P = .4) and preoperative BMI (47.5±10.5 versus 51.0±9.6 kg/m2, P = .1). The median time from surgery to tube placement for malnutrition patients was 4 years. Compared with other feeding tube indications, malnutrition patients had higher percent excess BMI lost after surgery (126.2±31.9 versus 52.5±44.3%, P<.0001). After tube placement, malnutrition patients had a significant increase in mean BMI compared with other indications (14.5±20.9 versus?13.0±14.0%, P< .001).Conclusion
Patients with refractory malnutrition benefit from feeding tube placement, which results in a significant increase in BMI. 相似文献16.
Antonio Jiménez-Pacheco María Salinero-Bachiller María C. Iribar Alfonso López-Luque José L. Miján-Ortiz Jose M. Peinado 《Urologic oncology》2018,36(5):243.e21-243.e27
Background
Prostate cancer (PCa) is the most frequently diagnosed noncutaneous malignant tumor among males in the Western world. Prostate-specific antigen has been considered the most important biomarker for PCa detection; however, it lacks specificity, leading to the search for alternative biomarkers. Volatile organic compounds (VOCs) are released during cell metabolism and can be found in exhaled breath, urine, and other fluids. VOCs have been used in the diagnosis of lung, breast, ovarian, and colorectal cancers, among others. The objective of this study was to identify urinary VOCs that may be sensitive and specific biomarkers for PCa.Methods
The study included 29 patients with PCa and 21 with benign prostatic hyperplasia. Urine samples were obtained from all participants before and after prostate massage. VOCs were identified by gas chromatography-mass spectrometry. IBM SPSS Statistics v.20 was used for statistical analysis. Sample normality and homogeneity of variances were studied and, according to the distribution normality, ANOVA or the Kruskal-Wallis test was applied to evaluate significant differences between groups. The Pearson test was used to establish correlations.Results
Fifty-seven VOCs were identified. Samples gathered before prostate massage showed significant between-group differences in urinary levels of furan (P 0.001), 2-ethylhexanol (P = 0.032), 3,5-dimethylbenzaldehyde (P = 0.027), santolin triene (P = 0.032), and 2,6-dimethyl-7-octen-2-ol (P = 0.003). Samples gathered after prostate massage showed significant differences in urinary levels of furan (P 0.001), 3- methylphenol (P = 0.014), p-xylene (P = 0.002), phenol (P 0.001), and 2-butanone (P = 0.001).Conclusions
Significant differences between PCa and BPH patients were found in urinary levels of certain VOCs both before and after prostate massage, supporting the proposal that VOCs may serve as PCa-specific biomarkers. 相似文献17.
Wendy Schijns Lisanne T. Schuurman Alida Melse-Boonstra Cees J.H.M. van Laarhoven Frits J. Berends Edo O. Aarts 《Surgery for obesity and related diseases》2018,14(7):1005-1012
Background
One of the side effects of bariatric surgery is the risk of vitamin and mineral deficiencies. Vitamin B12, vitamin D, folate, and iron deficiencies are especially common among Roux-en-Y gastric bypass patients.Objective
To examine the effectiveness of a specialized multivitamin supplement for Roux-en-Y gastric bypass patients on deficiencies the first 3 years postoperatively, retrospectively in a large, prospectively collected cohort.Setting
Large specialized bariatric hospital.Results
One thousand one hundred sixty patients were included, 883 users and 258 who were nonusers of the specialized multivitamin. Patient characteristics and total weight were comparable. Higher serum concentrations of ferritin (124.7 ± 96.2 µg/L versus 106.0 ± 83.0 µg/L, P = .016), vitamin B12 (347.3 ± 145.1 pmol/L versus 276.8 ± 131.4 pmol/L, P<.001), folic acid (34.9 ± 9.6 nmol/L versus 25.4 ± 10.7 nmol/L, P<.001), and vitamin D (98.4 ± 28.7 nmol/L versus 90.0 ± 34.5 nmol/L, P = .002) were observed in users compared with nonusers after 1 year. Less new deficiencies were found for ferritin (1% versus 4%, P = .029), vitamin B12 (9% versus 23%, P<.001), and vitamin D (0% versus 4%, P<.001) in users compared with nonusers. Two and 3 years after the surgery these findings remained almost identical.Conclusions
The use of specialized multivitamin supplements resulted in less deficiencies of vitamin B12, vitamin D, folic acid, and ferritin. The study showed that Roux-en-Y gastric bypass patients benefited from the specialized multivitamin supplements and it should be advised to this patient group. 相似文献18.
Peter Gerber Claes Anderin Eva Szabo Ingmar Näslund Anders Thorell 《Surgery for obesity and related diseases》2018,14(4):437-442
Background
An increasing number of older patients undergo bariatric surgery.Objective
To define the risk for complications and mortality in relation to age after gastric bypass.Setting
A national registry-based study.Methods
Patients (n = 47,660) undergoing gastric bypass between May 2007 and October 2016 and registered in the Scandinavian Obesity Register were included. Risk between age groups was compared by multivariate analysis.Results
The 30-day follow-up rate was 98.1%. In the entire cohort of patients, any complication within 30 days was demonstrated in 8.4%. For patients aged 50 to 54, 55 to 59, and ≥60 years, this risk was significantly increased to 9.8%, 10.0%, and 10.2%, respectively. Rates of specific surgical complications, such as anastomotic leak, bleeding, and deep infections/abscesses were all significantly increased by 14% to 41% in patients aged 50 to 54 years, with a small additional, albeit not significant, increase in risk in patients of older age. The risk of medical complications (thromboembolic events, cardiovascular, and pulmonary complications) was significantly increased in patients aged ≥60 years. Mortality was .03% in all patients without differences between groups.Conclusions
In this large data set, rates of complications and mortality after 30 days were low. For many complications, an increased risk was encountered in patients aged ≥50 years. However, rates of complications and mortality were still acceptably low in these age groups. Taking the expected benefits in terms of weight loss and improvements of co-morbidities into consideration, our findings suggest that patients of older age should be considered for surgery after thorough individual risk assessment rather than denied bariatric surgery based solely on a predefined chronologic age limit. 相似文献19.
Anabelle Cloutier Stéfane Lebel Frédéric Hould François Julien Simon Marceau Léonie Bouvet Serge Simard Laurent Biertho 《Surgery for obesity and related diseases》2018,14(1):30-37
Background
Biliopancreatic diversion with duodenal switch (BPD-DS) is one of the most effective bariatric surgeries, in terms of weight loss and remission of co-morbidities. It is however associated with a significant risk of protein and nutritional deficiency, as well as gastrointestinal side effects.Objectives
To assess the effect of increasing the strict alimentary limb on weight loss, nutritional deficiency and quality of life, compared with standard BPD-DS.Settings
University-affiliated tertiary care center.Methods
Prospective randomized double blind (patient-evaluator) trial in which patients were assigned in a 1:1 ratio to undergo a modified BPD-DS with a long alimentary limb (1 m from Treitz ligament, n = 10) or a standard biliopancreatic diversion (strict alimentary limb of 1.5 m, n = 10). Common channel was kept at 100 cm in both groups. Follow-up at 12 months was completed in all patients.Results
Initial weight (126 ± 10 versus 125 ± 17, P = .92), age (40 ± 7 versus 37 ± 8, P = .35), and sex ratio (1 female/9 males) were similar in both groups. Excess weight loss and total weight loss were significantly higher in the standard BPD-DS group (93.4 ± 12% versus 73.3 ± 7%, P = .0007 and 46 ± 5.6% versus 37 ± 3.4%, P = .0004). The study group had significantly higher vitamin D, manganese, and copper levels at 12 months. Both groups had similar drop in glycated hemoglobin, cholesterol levels, and resolution of co-morbidities at 12 months. Long alimentary limb was associated with significantly less bowel movements a day (1.6 ± .97 versus 2.55 ± 1.01, P = .01), less gastrointestinal side effects (bloating and gas, P<.05) and required less pancreatic enzymes supplements (0 versus 40%, P = .04) and calcium supplement. Quality of life was significantly improved in both groups in all domains (all P<.05).Conclusion
At 12 months, weight loss was lesser in the long alimentary limb group. There was however no difference in the remission of co-morbidities and higher levels of vitamin D, manganese, and copper. Gastrointestinal adverse effects and the need for pancreatic enzymes were less with similarly excellent quality of life at 12 months. Longer follow-up is necessary to evaluate long-term weight loss and nutritional deficiencies. 相似文献20.
Rana M. Higgins Melissa Helm Jon C. Gould Tammy L. Kindel 《Surgery for obesity and related diseases》2018,14(6):842-848