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1.
Victoria E. Sanborn Mary-Beth Spitznagel Ross Crosby Kristine Steffen James Mitchell John Gunstad 《Surgery for obesity and related diseases》2018,14(9):1396-1401
Background
Both poor quality of life (QoL) and cognitive impairment are common in persons with severe obesity. Work in other patient populations show that cognitive impairment is associated with poorer QoL, though this possibility has not been examined in bariatric surgery candidates.Objectives
We sought to determine the association between cognitive performance and QoL, both total and work related, in a sample of bariatric surgery candidates.Setting
Three sites were used for data collection, including the Neuropsychiatric Research Institute in Fargo, North Dakota, Columbia University in New York, and Cornell University in New York.Methods
Sixty participants from the Longitudinal Assessment of Bariatric Surgery project were assessed at preoperative baseline.Results
Hierarchical regression analyses showed that poorer cognitive function was independently associated with lower total QoL and that both reported and objectively measured cognitive impairment were associated with poorer work-related QoL.Conclusions
These preliminary findings suggest that cognitive impairment may contribute to poorer total and work-related QoL in bariatric surgery candidates. Future studies should examine whether interventions to improve cognitive function can improve QoL and other outcomes in this population. 相似文献2.
Mohamed Kamel Naleen Raj Bhandari Rodney Davis Nalin Payakachat 《Urologic oncology》2018,36(10):469.e13-469.e20
Background
Health-related quality of life (HRQOL) among elderly Americans diagnosed with upper tract urothelial cancer (UTUC) is unknown. We compared HRQOL in patients from before and after UTUC diagnosis and among different tumor stages after UTUC diagnosis using the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey database.Materials and Methods
This cross-sectional study used the 14 cohorts (1998–2013) of Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey to identify elderly Americans (≥65years) diagnosed with UTUC and with completed HRQOL surveys (the Short Form-36 or Veterans Rand-12). Patient surveys were grouped into pre- (Group A) and postdiagnosis (Group B) surveys. HRQOL was reported as least squares means of the physical component summary (PCS), mental component summary (MCS), and 8 subscales, adjusted for covariates. HRQOL least squares means-differences were estimated from separate multivariable regression models. Bonferroni correction was used for multiple comparisons on subscales.Results
Qualifying patients were identified (n?=?408; Group A?=?177; Group B?=?231). Mean PCS and MCS were similar between the 2 groups. However, Group B had significantly worse HRQOL outcomes on general health (P = 0.015), vitality (P?=?0.016), and social functioning (P?=?0.003) subscales, compared to Group A. Mean MCS was the lowest within 1 year of diagnosis (P < 0.001), compared to patients with >1 year before diagnosis, but mean PCS did not change. Mean PCS and MCS were similar across UTUC stages.Conclusions
UTUC affected some aspects of patients’ HRQOL. Most significant decline in mental health was within 1 year of diagnosis. HRQOL measures were not different among different stages. Attention to and provision of remedy to these HRQOL deficits are warranted. 相似文献3.
Isabelle Fontanille Adrien Boillot Hélène Rangé Maria Clotilde Carra Silvia Helena de Carvalho Sales-Peres Sebastien Czernichow Philippe Bouchard 《Surgery for obesity and related diseases》2018,14(10):1618-1631
Objective
To review and analyze periodontal clinical parameters after bariatric surgery.Background
Periodontitis, a dysbiotic inflammatory disease, has been associated with obesity. The purpose of bariatric surgery is to reduce weight and systemic inflammation. Consequently, it is of interest to systematically review the impact of bariatric surgery on periodontal status.Methods
Electronic searches were conducted in MEDLINE, EMBASE, Thesis database, and the Cochrane Library databases. Gray literature and the main journals of both specialties were also reviewed. Only cross-sectional and prospective studies focusing on bleeding on probing, pocket depth, and clinical attachment levels were selected.Results
After a thorough screening of 651 studies, 10 studies were selected by 2 independent reviewers. Four (n?=?250) and 3 studies (n?=?191) were included in the meta-analysis at 6- and 12-month follow-up, respectively. At 6-month follow-up increased periodontal inflammation (P?=?.03) and periodontal destruction were observed. However, 12 months after baseline, the difference between bariatric patients and control was no longer significant.Conclusion
The present systematic review and meta-analysis suggests that deterioration of periodontal status may be observed in the first 6 months after surgery. Consequently, periodontal screening and management of the patient's request for bariatric surgery should be recommended to avoid further deterioration of periodontal status after bariatric surgery. 相似文献4.
Chun Hai Tan Nawaf Al-Kalifah Kong-Han Ser Yi-Chih Lee Jung-Chien Chen Wei-Jei Lee 《Surgery for obesity and related diseases》2018,14(10):1600-1606
Background
Nonalcoholic steatohepatitis (NASH) is an important etiology of end-stage liver disease. Long-term effect of bariatric surgery in improvement of NASH is not clear.Objectives
To validate a scoring system for predicting NASH in morbidly obese patients and using it to evaluate the long-term effect of bariatric surgery on NASH.Setting
Tertiary referral hospital, Taiwan.Methods
A new 5-point clinical NASH (C-NASH) score incorporating body mass index, alanine aminotransferase, and triglyceride was validated in a group of 307 bariatric patients (mean age 30.2 years, incorporating body mass index 45.0 kg/m2) with concurrent liver biopsy from 2003 to 2008. Remission of NASH in 5741 obese patients undergoing bariatric/metabolic surgery with long-term follow-up was then evaluated using the C-NASH score.Results
Among 307 patients with liver biopsy, the prevalence of NASH was 44.0%. At baseline, the NASH group had significantly worse fasting glucose levels, triglycerides, uric acid, aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase, and glycated hemoglobin. The diagnostic sensitivity of C-NASH score was 84.4%, and the accuracy was 68.4%. Among 5741 bariatric patients, the prevalence of high risk for NASH evaluated by C-NASH score was 40.9%. Postoperative follow-up showed good weight loss and almost complete remission of high risk for NASH up to 10 years. Patients with gastric banding had less weight loss, higher mean level of C-NASH score, and a higher incidence of high risk for NASH compared with other procedures at follow-up.Conclusion
This study demonstrated that improvement in C-NASH score suggesting remission of NASH is durable up to 10 years in all kinds of bariatric procedures. 相似文献5.
Amihai Rottenstreich Jaber Shufanieh Geffen Kleinstern Ariela Goldenshluger Uriel Elchalal Ram Elazary 《Surgery for obesity and related diseases》2018,14(10):1594-1599
Background
Pregnancy outcomes after bariatric surgery have been addressed extensively; however, the impact of pregnancy on long-term outcomes after bariatric surgery has only been sparsely studied.Objectives
We explored the effects of pregnancy on weight loss outcomes after laparoscopic sleeve gastrectomy (LSG).Setting
University hospital.Methods
A cross-sectional case-control study. Eighty women who became pregnant after LSG were matched by preoperative body mass index, age, and follow-up duration to 80 post-LSG patients who did not conceive after surgery (control group).Results
The median follow-up duration was 5.2 years for the study group and 5.3 years for the control group (P?=?.73). For the study group, the median time from surgery to conception was 508 (interquartile range 372–954) days and the median gestational weight gain was 9 (6–12) kg. Comparing the study with the control group, median percentage total weight loss was similar, 31% versus 30% (P?=?.77); as was percentage excess weight loss (EWL%) 72% versus 71% (P?=?.77). For the study group, a multivariable analysis showed EWL% at the end of follow-up to be directly correlated with the lowest EWL% achieved before pregnancy (β?=?.78, P < .0001), and inversely correlated with time lapsed from surgery (β?=??.26, P < .0001); yet EWL% was not found to be associated with surgery-to-conception time interval, gestational weight gain, breastfeeding, co-morbidities, smoking, occupational status, physical activity, and dietary habits.Conclusions
Pregnancy after LSG does not affect long-term weight results. Coupled with the positive reports of improved pregnancy outcomes after bariatric surgery, these data should reassure women who wish to conceive after surgery. 相似文献6.
Alexandra M. Falvo Frances Hite Philp George M. Eid 《Surgery for obesity and related diseases》2018,14(8):1149-1154
Background
Obesity is a serious health problem that affects a wide range of patients and disease processes.Objective
The purpose of this study is to evaluate perceptions, knowledge, and practice habits of primary care providers (PCPs) regarding the care of patients with obesity, including barriers to effective care and their experience with bariatric surgery in our integrated health network.Setting
Integrated health network.Methods
A 16-question survey was distributed electronically to 160 PCPs at our integrated health network. Results were analyzed to identify attitudes, knowledge, practice habits, and bariatric surgery referral patterns while treating patients with obesity.Results
Among 160 PCPs, 45 (28.1%) responded. Specialty, sex, patient population, insurance accepted, and practice years of PCPs were reported. Most PCPs reported “always” calculating patient body mass index (88.9%) with only 13.3% “always” discussing the body mass index results. Respondents most frequently prescribed diet and exercise to patients with obesity and rarely prescribed medications, with bariatric surgery referrals falling between the two. PCPs viewed management of obesity as the responsibility of the patient (97.6%) and the PCP (100%). Ninety-three percent felt obesity is a common diagnosis in their practice, but no one correctly identified the prevalence of obesity in our region. Respondents demonstrated adequate knowledge regarding medical consequences of obesity. A majority was able to identify the correct eligibility criteria for bariatric surgery, as well specific medical problems that can improve or be eliminated postoperatively. While 61.9% of respondents were aware of free weight loss and bariatric informational sessions offered, 28.6% reported that they were unfamiliar with existing bariatric surgeons. One respondent was not aware of any bariatric surgery performed. Some PCPs reported prior negative experiences with post-bariatric surgery patients, and thus were hesitant to refer additional patients.Conclusions
PCPs report discussing an obesity diagnosis with patients but are not always using body mass index in that discussion. They most often prescribe lifestyle modification as treatment for patients, which they believe to be most effective to treat obesity. However, they report only one third of their patients are motivated to lose weight. Additionally, they demonstrate appropriate knowledge of indications and benefits of bariatric surgery. A majority of the PCPs is aware of weight loss informational sessions and bariatric services provided within our integrated health network, but almost one third were unable to identify a surgeon, a possible target for improved relationships. Barriers to care include patient motivation and insurance coverage. 相似文献7.
Dino Kröll Philipp C. Nett Yves Michael Borbély Sabine Schädelin Debora Bertaggia Calderara Lorenzo Alberio Guido Stirnimann 《Surgery for obesity and related diseases》2018,14(12):1890-1896
Background
Thromboembolic disease is a potentially serious complication in bariatric surgery patients. Direct oral anticoagulants (DOAC) have been investigated in orthopedic surgery patients. DOAC data after bariatric surgery are still limited to the early postsurgical period. Whether postsurgical midterm adaptations due to anatomic and physiologic alterations influence drug pharmacology is currently not known.Objective
The aim of this study was to investigate the influence of weight loss and type of bariatric surgery on midterm postsurgical pharmacokinetic and pharmacodynamic parameters of rivaroxaban.Setting
University hospital.Methods
In this monocentric study, bariatric patients received a single oral dose of rivaroxaban (10 mg) 6 to 8 months after sleeve gastrectomy (SG) or Roux-en-Y-gastric bypass (RYGB). Pharmacokinetic and pharmacodynamic parameters were assessed and compared with prebariatric surgery results.Results
We included 6 RYGB and 6 SG patients. Percent excess weight loss was 71.4% (interquartile range 56.4, 87.9) in the SG group and 76.6% (64.5, 85.7) in the RYGB group. Rivaroxaban mean areas under the curve 6 to 8 months after the bariatric procedure (922.4 µg?×?h/L, coefficient of variation 43.2) were comparable to those measured preoperatively (952.6 µg?×?h/L, 16.8). There was no relevant difference between the 2 surgical procedure groups. Rivaroxaban led to a decrease of prothrombin fragments F1+2 over 12 hours after oral intake confirming in vivo efficacy.Conclusions
Significant weight loss and altered anatomy after RYGB and SG procedures do not appear to affect the pharmacokinetics and pharmacodynamics of prophylactic rivaroxaban. A single dose of Rivaroxaban was well tolerated and considered safe in this trial. 相似文献8.
Afton M. Koball Dylan J. Jester Marisa A. Pruitt Rebecca V. Cripe Jill J. Henschied Sarah Domoff 《Surgery for obesity and related diseases》2018,14(12):1897-1902
Background
Support after bariatric surgery is critical. Access to bariatric support groups is sometimes challenging, leading people to seek support on social media platforms like Facebook. Given the ubiquity of recommendations solicited and provided on Facebook regarding nutrition and bariatric surgery, understanding the content and accuracy of these posts is important.Objectives
The primary aim of the present study was to describe the content of nutrition-related information sought on bariatric Facebook support groups/pages. A secondary aim was to evaluate the accuracy of this content.Setting
Integrated multispecialty health system.Methods
An iterative content analysis process was conducted and resulted in identification of 8 primary coding themes. Additionally, 3 registered dieticians with extensive experience in bariatric surgery and obesity treatment examined posts that provided nutritional recommendations to determine accuracy.Results
Members most commonly sought advice regarding products and practices to assist in achieving nutritional guidelines (35%). Over half of the posts contained inaccurate content or information that was too ambiguous to determine accuracy; 7% of posts were found to be inaccurate or inconsistent with American Society for Metabolic and Bariatric Surgery nutrition guidelines and expert registered dietician opinions, 22% of posts were found to contain both accurate and inaccurate information, and 24% of posts were considered too ambiguous and required more context to determine the accuracy.Conclusions
Results highlight the need for bariatric programs to provide greater nutrition education support to patients postoperatively and to provide caution about the inconsistent nature of some nutrition-related content found on Facebook bariatric support groups. 相似文献9.
William Hilgendorf Annabelle Butler Lava Timsina Jennifer Choi Ambar Banerjee Don Selzer Dimitrios Stefanidis 《Surgery for obesity and related diseases》2018,14(8):1167-1172
Background
Bariatric surgery represents the most effective intervention for severe obesity available today; however, significant variability in postoperative outcomes exists. Effective tools that predict postoperative outcomes are needed for decision-making and patient counseling.Objectives
We hypothesized that a validated behavioral assessment tool, the Cleveland Clinic Behavioral Rating Scale (CCBRS), would predict excess weight loss, health-related quality of life, depression, anxiety, and alcohol use after bariatric surgery.Setting
Hospital in the United States.Methods
A prospective observational study with 2-year planned follow-up was conducted with patients who completed a psychological clinical interview, the Short Form 36 (SF-36) v.2 Health Survey and brief self-report questionnaires measuring depression (PHQ-9), anxiety (GAD-7), and alcohol use (AUDIT) preoperatively. At the conclusion of the preoperative psychological evaluation, the psychologist completed the CCBRS. All questionnaires were readministered at 6, 12, 18, and 24 months after surgery. Generalized estimating equations were used to assess whether any CCBRS ratings predicted surgery outcomes.Results
One hundred seventy-nine patients (113 Roux-en-Y gastric bypass and 66 sleeve gastrectomy) were included in the analyses. SF-36 scores, PHQ-9 scores, and the AUDIT total scores improved significantly after surgery, while GAD-7 scores did not change appreciably. Higher preoperative CCBRS ratings predicted higher SF-36 scores, and lower PHQ-9, GAD-7 and AUDIT scores. The CCBRS social support rating predicted higher postoperative percent excess weight loss.Conclusion
A behavioral rating scale (CCBRS) completed before bariatric surgery predicted postoperative weight loss, quality of life, depression, and anxiety. Therefore, this tool may prove useful in patient counseling and expectation management before surgery. 相似文献10.
Yung Lee Michał Pędziwiatr Piotr Major Karanbir Brar Aristithes G. Doumouras Dennis Hong 《Surgery for obesity and related diseases》2018,14(11):1766-1782
Background
Excess visceral adipose tissue has been identified as an important risk factor for obesity-related co-morbidities. Conflicting information exists on whether omentectomy added to bariatric surgery is beneficial to metabolic variables.Objective
To evaluate the impact of omentectomy added to bariatric surgery on metabolic outcomesSetting
University Hospital, Canada.Methods
MEDLINE, EMBASE, and PubMed were searched up to May 2018. Studies were eligible for inclusion if they were randomized controlled trials comparing omentectomy added to bariatric surgery with bariatric surgery alone. Primary outcome measures were absolute change in metabolic variables (body mass index, insulin, glucose, cholesterol, lipoproteins, and triglycerides); secondary outcomes were changes in adipocytokines. Pooled mean differences (mean deviation; MD) were calculated using random effects meta-analyses, and heterogeneity was quantified using the I2 statistic.Results
Ten trials involving a total of 366 patients met the inclusion criteria with a median follow-up time of 1 year after surgery. Adding omentectomy to bariatric surgery demonstrated a minimal but statistically significant decrease in body mass index compared with bariatric surgery alone (MD 1.29, 95% confidence interval .35–2.23, P?=?.007, I2?=?0%, 10 trials). Conversely, patients who underwent bariatric surgery alone had significant increases in high-density lipoprotein (MD ?2.12, 95% confidence interval ?4.13 to ?.11, P?=?.04, I2?=?0%, 6 trials). Other metabolic outcomes and adipocytokines showed no significant difference between procedures.Conclusion
The addition of omentectomy to bariatric surgery results in minimal reduction of body mass index. Considering no overall improvement in metabolic outcomes and the time and effort required, the therapeutic use of omentectomy added to bariatric surgery is not warranted. 相似文献11.
Tom P. Walsh Stephen J. Quinn Angela M. Evans Alison Yaxley Jacob A. Chisholm Lilian Kow E. Michael Shanahan 《Surgery for obesity and related diseases》2018,14(9):1389-1395
Background
Foot pain is a common manifestation of obesity.Objective
To determine if bariatric surgery is associated with a reduction in foot pain and if body mass index (BMI) or body composition predict a change in foot pain.Setting
University hospital.Methods
Participants with foot pain awaiting bariatric surgery were recruited for this prospective study. Multivariable linear regression was used to determine predictors of change in foot pain between baseline and 6-month follow-up using body composition (fat mass index and fat-free mass index) or BMI, adjusting for, depression, age, sex, and group (surgery versus control).Results
Forty-five participants (38 female), mean ± standard deviation age of 45.7 ± 9.4 years, were recruited for this study. Twenty-nine participants mean ± standard deviation BMI of 44.8 ± 7.0 kg underwent bariatric surgery, while 16 participants mean ± standard deviation BMI of 47.9 ± 5.2 kg were on the waiting list (control). One participant was lost to follow-up. The treatment group lost a mean of 24.3 kg (95% confidence interval [CI] 21.1–27.5), while the control group gained 1.2 kg (95% CI ?2.5 to 4.9), respectively. In multivariable analysis, bariatric surgery was significantly associated with reduced foot pain at 6-month follow-up ?32.6 points (95% CI ?43.8 to ?21.4, P < .001), while fat mass index was significantly associated with increased pain at follow-up 1.5 points (95% CI .2 to 2.8, P?=?.027), after controlling for fat-free mass index, age, sex, and depression.Conclusions
Bariatric surgery was significantly associated with reduced foot pain. Higher baseline fat mass index, but not fat-free mass index or BMI, was predictive of increased foot pain at follow-up. Foot pain may be mediated by metabolic, rather than mechanical, factors in bariatric surgery candidates. 相似文献12.
Piotr K. Kowalewski Robert Olszewski Maciej S. Walędziak Michał R. Janik Andrzej Kwiatkowski Krzysztof Paśnik 《Surgery for obesity and related diseases》2018,14(8):1163-1166
Background
Smoking cessation is often associated with weight gain. This study was conducted to verify whether it affects outcomes of bariatric surgery.Objectives
To present cigarette consumption among patients after bariatric surgery in a long-term follow-up and to evaluate whether smoking cessation impacts weight loss.Setting
High-volume bariatric center, Military Hospital, Poland.Methods
We collected data of patients who underwent bariatric surgery between 2003 and 2009. The data included sex, age, weight, body mass index, and smoking habits. An online survey regarding current weight, co-morbidities, and smoking was distributed. Percentage excess weight loss was calculated with an ideal weight for body mass index of 25 kg/m2.Results
One hundred seven patients had laparoscopic adjustable gastric banding between 2003 and 2006; 47 were included in the study. The mean follow-up time was 11.2 (±1.2). Of patients, 51% (n?=?24) were smokers before surgery. In the follow-up 43% (n?=?20) were smokers, of whom 4 patients began smoking after surgery. Twenty-seven patients were nonsmokers, 8 of whom quit over the years (33% of previous smokers). One hundred twenty-seven underwent laparoscopic sleeve gastrectomy between 2006 and 2009; 84 were included in the study. Our median follow-up was 8.0 years. Thirty-two patients never smoked; 52 were smoking before surgery, yet 24 successfully quit. In both groups there were no statistically significant differences in percentage excess weight loss between smokers and nonsmokers, or between those who quit and did not.Conclusions
In the long-term follow-up after laparoscopic adjustable gastric banding, 33% of smokers quit and 17% previously nonsmoking began smoking. After laparoscopic sleeve gastrectomy, 46% of previously smoking patients successfully quit. Smoking status was not significantly associated with weight loss. 相似文献13.
Witigo von Schönfels Jan Henrik Beckmann Markus Ahrens Alexander Hendricks Christoph Röcken Silke Szymczak Jochen Hampe Clemens Schafmayer 《Surgery for obesity and related diseases》2018,14(10):1607-1616
Background
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in industrialized countries. Nonalcoholic steatohepatitis is the fastest growing cause for liver failure. Bariatric surgery represents a treatment option for NAFLD with an established effect on liver histology.Objectives
We aimed to assess the impact of bariatric surgery on standardized liver histology using the NAFLD activity score.Setting
Retrospective comparison of metabolic data before and after bariatric surgery and comparison of sleeve gastrectomy and Roux-en-Y gastric bypass. The study was performed in an academic center, the university hospital Schleswig-Holstein in Kiel, Germany.Methods
Between 2009 and 2012, bariatric surgery was performed in 257 patients according to the national guidelines, and a liver biopsy was obtained in 150 of these patients during surgery. A follow-up biopsy was available in 53 of these patients at a median of 192 days. Liver histology was analyzed using the NAFLD activity score. In this subgroup of 53 patients an analysis of the metabolic improvement after bariatric surgery and a comparative analysis between the 2 different operative procedures was performed.Results
The study cohort showed improvement of preoperative pathologic liver histology findings after operative procedures took place. Both surgery methods improved the NAFLD activity score significantly, all improvement ?2.0 (confidence interval ?2.5 to ?1.0; P < .001); Roux-en-Y gastric bypass, improvement ?1.0 (confidence interval ?2.0 to ?.0; P?=?.038); sleeve gastrectomy, improvement ?2.5 (confidence interval ?3.5 to ?1.5; P < .001). No differences were found with regard to histologic recovery between gastric bypass and sleeve gastrectomy (P = .22).Conclusions
Bariatric surgery significantly improves NAFLD. 相似文献14.
Yaron Rudnicki Moran Slavin Andrei Keidar Ilan Kent Liron Berkovich Vitaly Tiomkin Roye Inbar Shmuel Avital 《Surgery for obesity and related diseases》2018,14(9):1297-1303
Background
Hypothyroidism is prevalent in morbidly obese patients and may improve after a weight reduction surgery.Objectives
Laboratory and clinical changes in hypothyroid patients undergoing laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) were compared and evaluated.Settings
Data were retrieved from a prospectively collected database of 2 public bariatric units.Methods
Patients with hypothyroidism prior to bariatric procedure were evaluated for changes in thyroid stimulating hormone (TSH) and changes or cessation of hormone replacement therapy after surgery. Correlation between changes in TSH levels and percentage of excess weight loss and comparison between effects of LSG and LRYGB were evaluated.Results
Ninety patients were included. Mean follow-up was 11 ± 9 .73 months. Mean body mass index decreased from 43.8 to 33.2 kg/m2. Forty patients had deranged elevated TSH levels prior to surgery that decreased significantly after surgery (mean 6.6 ± 1.9 to 2.9 ± 1.5 mU/L, P < .01). Of patients receiving hormone replacement therapy prior to surgery, 42% required lower doses, with a 61% mean decrease in doses, while 10% stopped hormone replacement therapy completely. No correlation was found between the improvement in TSH and percentage of excess weight loss. A significant advantage to one of the bariatric procedures (LSG [61] and LRYGB [29]) could not be established.Conclusions
LSG and LRYGB both proved to improve thyroid function in hypothyroid obese patients. No procedure was found to be superior. No correlation was found between percentage of excess weight loss and TSH reduction. This implies that the effect of bariatric surgery on the improvement of thyroid functions is mediated by mechanisms other than weight loss, probably hormonal. 相似文献15.
Manuel Macías-González Gracia María Martín-Núñez Lourdes Garrido-Sánchez Eduardo García-Fuentes Francisco José Tinahones Sonsoles Morcillo 《Surgery for obesity and related diseases》2018,14(9):1327-1334
Background
Obesity is characterized by a chronic, low-grade inflammation, and bariatric surgery is proposed as an effective treatment for reducing the obesity-related co-morbidities. Epigenetic modifications could be involved in the metabolic improvement after surgery.Objective
The main aim of this study was to evaluate whether DNA methylation pattern from genes related to inflammation and insulin response is associated with the metabolic improvement after bariatric surgery in morbidly obese patients and if these changes depend on the surgical procedure.Setting
University hospital, Spain.Methods
We studied 60 severely obese patients; 31 underwent Roux-en-Y gastric bypass and 29 underwent laparoscopic sleeve gastrectomy. All patients were examined before and at 6 months after bariatric surgery. DNA methylation profile of genes related to the inflammatory response and insulin sensitivity was measured by pyrosequencing.Results
The promoter methylation levels of the NFKB1 gene were increased significantly after surgery (2.16 ± .9 versus 2.8 ± 1.03). The decrease in blood pressure, both systolic and diastolic, after surgery was significantly associated with the changes in the promoter methylation levels of the NFKB1 gene (β?=??.513, P?=?.003 and β?=??.543, P?=?.004, respectively). A decrease in inflammation status, measured by high sensitivity C-reactive protein values, was associated with changes in SLC19A1 methylation levels.Conclusion
Our study shows for the first time an association between NFKB1 methylation levels and blood pressure after bariatric surgery, highlighting the possible function of this gene in the regulation of arterial pressure. Regarding SLC19A1, this gene could position as a potential target linking inflammation and insulin resistance. 相似文献16.
17.
Marianne C. Kalff Christel A.L. de Raaff Claire E.E. de Vries Usha K. Coblijn Meta Tjeenk Willink Janneke M.B. Fauquenot-Nollen Sebastiaan Jensch Steve M.M. de Castro Ruben N. van Veen 《Surgery for obesity and related diseases》2018,14(9):1310-1316
Background
Postbariatric anastomotic or staple line leakage (ASLL) is a dreaded complication with an incidence up to 1.6% and a leak-associated mortality of 5.0% to 16.7%. Feared low sensitivity of abdominal computed tomography (CT) for detecting ASLL is causing surgeons to omit CT and directly perform a diagnostic laparoscopy in patients with suspected ASLL.Objectives
To evaluate the diagnostic value of CT in case of suspected ASLL after bariatric procedures and to identify reliable CT characteristics predicting the presence of ASLL.Setting
A large teaching hospital and bariatric center of excellence.Methods
All CT scans performed for suspected ASLL after bariatric surgery in the period November 2007 until August 2016 were independently reevaluated by abdominal radiologists. The diagnostic value of CT by means of sensitivity, specificity, and positive and negative predictive value was analyzed comparing results of reevaluation to a standard of reference. Multivariable regression was performed to identify reliable CT characteristics for the presence of ASLL.Results
A total of 66 CT scans were performed because of suspected leakage. Reevaluation of CT scans revealed a sensitivity of 89% to 100%, a specificity of 69% to 78%, a positive predictive value of 39% to 50%, and a negative predictive value of 97% to 100% of CT for detecting ASLL after bariatric surgery. Multivariable logistic regression of ASLL characteristics on CT revealed ‘air near the anastomosis/staple line’ as the only independent predictor for the presence of ASLL.Conclusion
With a sensitivity of 89% to 100% and negative predictive value of 97% to 100%, a negative CT can rule out ASLL in patients with a lower suspicion of ASLL. 相似文献18.
Hendrika J.M. Smelt Johannes F. Smulders Lennard P.L. Gilissen Mohammed Said Surendra Ugale Sjaak Pouwels 《Surgery for obesity and related diseases》2018,14(10):1645-1657
Background
Numerous papers have discussed the importance of preoperative detection and eradication of Helicobacter pylori (HP) in bariatric patients.Objectives
This systematic review specifically focuses on the influence of HP infection on clinical symptoms, complications, and abnormal endoscopic findings in postbariatric patients.Methods
A systematic search on the influence of HP infection on postoperative complications in bariatric surgery was conducted. The methodologic quality of the included studies was rated using the Newcastle-Ottawa rating scale. The agreement between the reviewers was assessed with Cohen's kappa. The included studies were assessed into 2 groups, studies with and without eradication therapy preoperatively.Results
A total of 21 studies were included with a methodologic quality ranging from poor to good. The agreement between the reviewers, assessed with the Cohen's kappa, was .70. Overall, tendency in the included studies was that HP infection was associated with an increased risk for developing marginal ulcers and postoperative complications. A meta-analysis on the incidence of marginal ulcers and overall postoperative complications was conducted and showed, respectively, an odds ratio of .508 (.031–8.346) and 2.863 (.262–31.268).Conclusions
HP is frequently found in patients before and after bariatric and metabolic surgery. We assessed whether, according to the current literature, HP increases the risk for developing postoperative complications after surgery. This meta-analysis shows that a methodologically good study should be performed to clarify the role of HP in bariatric patients and the question of whether HP should be eradicated before surgery. 相似文献19.
Relationship between bariatric surgery and periodontal status: a systematic review and meta-analysis
Glaciele Maria de Souza Dhelfeson Willya Douglas de Oliveira Frederico Santos Lages Ighor Andrade Fernandes Saulo Gabriel Moreira Falci 《Surgery for obesity and related diseases》2018,14(8):1205-1216
Background
The effects of bariatric surgery can reflect in the oral cavity and can cause alterations in oral health. This high prevalence of oral alterations in the pre and post-operative periods has been highlighted in different studies.Objectives
To investigate the effect of bariatric surgery on periodontal status through a systematic review.Methods
Electronic search was conducted in PubMed, VHL, Web of Science, Science direct, Scopus, and Cochrane databases through May 2017. Manual search, gray literature, and counter-refence of included articles were also conducted. Eligibility criteria included observational studies that reported periodontal outcomes before and after bariatric surgery.Results
Search strategy resulted in 1878 articles. Following the selection process, nine studies were included in the qualitative analysis and five in the meta-analysis. Three cross-sectional studies showed risk of bias score ranging from 5 to 6 stars, and Cohort studies scored from 6 to 9 stars out of 9 possible stars on the Newcastle-Ottawa scale. The quantitative analysis showed that clinical attachment level (MD: 0.07; CI95% ?0.17 to 0.31), gingival index (MD: ?0.28; CI95% ?1.68 to 1.11), percentage of bleeding sites (MD: ?0.21; CI95% ?0.77 to 0.35), and pocket probing depth (MD: 0.08 CI95% ?0.14 to 0.31) were not different before and after bariatric surgery. However, the plaque index was lower after than before bariatric surgery (MD: ?1.29; CI 95% ?2.34 to ?0.24).Conclusions
Plaque index can be improved after bariatric surgery.The present systematic review investigated the association between bariatric surgery and periodontal status from cross-sectional and longitudinal studies. A systematic search strategy was developed until May 2017. The results of this systematic review allowed the conclusion that the plaque index can be improved after bariatric surgery. 相似文献20.
Deanna M. Arble Simon S. Evers Nadejda Bozadjieva Henriette Frikke-Schmidt Andriy Myronovych Alfor Lewis Mouhamadoul Habib Toure Randy J. Seeley 《Surgery for obesity and related diseases》2018,14(12):1857-1867