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1.
Ahmad Assalia Anat Ilivitzki Amos Ofer Alain Suissa Elias Manassa Iyad Khamaysi Ahmad Mahajna 《Surgery for obesity and related diseases》2018,14(8):1093-1098
Background
Laparoscopic sleeve gastrectomy (LSG) is considered as a first line treatment for morbid obesity around the globe. Leakage and subsequent gastric fistula is the most dreadful complication, which may lead to serious morbidity and even mortality.Objectives
To assess the safety and efficacy of fibrin glue application in the setting of gastric fistula after LSG.Setting
University hospital, Israel.Methods
Twenty-four morbidly obese patients (mean age?=?42.2 yr, mean body mass index?=?42 kg/m2) developed gastric fistula after LSG. The fistula was acute in 10 patients, subacute in 9, and chronic in 5. Sixteen patients (67%) have had previous failed endoscopic interventions. Fibrin glue was applied percutaneously with fluoroscopic guidance, under endoscopic visualization. A pigtail drain was left in the distal tract to monitor and manage possible continuous leakage.Results
There were no complications except abdominal pain in 2 patients associated with fever in 1. Both resolved within 1 to 2 days. Fistula closure was achieved in all patients but 1 (95.8%). Closure was accomplished after a single application in 9 patients (39%), 2 applications in 8, 3 applications in 3, 5 applications in 2, and 6 applications in 1. All patients were followed with a mean time of 42.3 months (range, 20–46).Conclusions
Although in most patients there was a need for multiple applications, our experience indicates that percutaneous fluoroscopic application of Fibrin glue under endoscopic visualization proved to be a simple, tolerable, and highly effective method for the treatment of selected patients with gastric fistula after LSG. 相似文献2.
Collin Creange Megan Jenkins Matthew Pergamo George Fielding Christine Ren-Fielding Bradley Schwack 《Surgery for obesity and related diseases》2018,14(10):1531-1536
Background
Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are often used as revisional surgeries for a failed laparoscopic adjustable gastric band (LAGB). There is debate over which procedure provides better long-term weight loss.Objective
To compare the weight loss results of these 2 surgeries.Setting
University hospital, United States.Methods
A retrospective review was conducted of all LAGB to RYGB and LAGB to LSG surgeries performed at a single institution. Primary outcomes were change in body mass index (BMI), percent excess BMI lost, and percent weight loss. Secondary outcomes included 30-day complications and reoperations.Results
The cohort included 192 conversions from LAGB to RYGB and 283 LAGB to LSG. The baseline age and BMI were similar in the 2 groups. Statistical comparisons made between the 2 groups at 24 months postconversion were significant for BMI (RYGB?=?32.93, LSG?=?38.34, P?=?.0004), percent excess BMI lost (RYGB?=?57.8%, LSG?=?29.3%, P < .0001), and percent weight loss (RYGB?=?23.4%, LSG?=?12.6%, P < .0001). However, the conversion to RYGB group had a higher rate of reoperation (7.3% versus 1.4%, P?=?.0022), longer operating room time (RYGB?=?120.1 min versus LSG?=?115.5 min, P < .0001), and longer length of stay (RYGB?=?3.33 d versus LSG?=?2.11 d, P < .0001) than the LAGB to LSG group. Although not significant, the conversion to RYGB group had a higher rate of readmission (7.3% versus 3.5%, P?=?.087).Conclusion
Weight loss is significantly greater for patients undergoing LAGB conversion to RYGB than LAGB to LSG. However, those undergoing LAGB conversion to RYGB had higher rates of reoperation and readmission. Patients looking for the most effective weight loss surgery after failed LAGB should be advised to have RYGB performed, while also understanding the increased risks of the procedure. 相似文献3.
Michał R. Janik Rami R. Mustafa Tomasz G. Rogula Adel Alhaj Saleh Mujjahid Abbas Leena Khaitan 《Surgery for obesity and related diseases》2018,14(9):1276-1282
Background
An increase in the prevalence of obesity and longer life expectancy has resulted in an increased number of candidates over the age of 60 who are pursuing a bariatric procedure.Objective
The aim of this study was to assess the safety of laparoscopic Roux-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG) in patients aged 60 years or older.Setting
University Hospital, United StatesMethods
Preoperative characteristics and 30-day outcomes from the MBSAQIP 2015 were selected for all patients aged 60 years or older who underwent a LSG or LRYGB. LRYGB cases were closely matched (1:1) with LSG patients by age (±1 year), BMI (±1 kg/m2), gender, preoperative steroid or immunosuppressant use, preoperative functional health status and comorbidities including: diabetes, gastroesophageal reflux disease, hypertension, hyperlipidemia, venous stasis, sleep apnea and history of severe chronic obstructive pulmonary disease.Results
A 3371 matched pairs were included in the study. The mean operative time in LRYGB was significantly longer in comparison to LSG patients (122 vs 84 min., P<0.001). Patients after LRYGB had a significantly increased anastomotic leakage rate (1.01% vs 0.47 %, p = 0.011), 30-day readmission rate (6.08% vs 3.74%, p < 0.001) and 30-day reoperation rate (2.49% vs 0.89%, p < 0.001) The length of hospital stay was longer in LRYGB. Mortality and bleed rate was comparable.Conclusions
LRYGB and LSG in patients aged 60 years or older are relatively safe in the short term with an acceptable complication rate and low mortality. However, LRYGB is more challenging and is associated with significantly increased rates of leakage events, 30-day reoperation, 30-day readmission, longer operative time and longer hospital stay. 相似文献4.
Eman Al-Shawaf Ebaa Al-Ozairi Fahad Al-Asfar Shaima Al-Beloushi Surbhi Kumari Jaakko Tuomilehto Hossein Arefanian 《Surgery for obesity and related diseases》2018,14(9):1284-1294
Background
Angiopoietin-like 8 (ANGPTL8) a hepatic protein, is implicated by several studies with a role in promoting pancreatic β-cell proliferation and improving glucose tolerance. Although a matter of controversy, a growing number of reports support ANGPTL8’s potential, yet unclear, role in type 2 diabetes (T2D).Objectives
To examine changes in fasting ANGPTL8 level in people with morbid obesity, with or without diabetes after laparoscopic sleeve gastrectomy (LSG) in a 1-year prospective study.Setting
Dasman Diabetes Institute, government, and private hospitals, Kuwait.Methods
Fasting serum ANGPTL8 was measured by enzyme-linked immunosorbent assay at baseline in participants with morbid obesity, 17 with diabetes and 23 without diabetes, and in healthy weight participants, 19 with and 15 without diabetes, during 1 year post-LSG in participants with morbid obesity.Results
At baseline, people with T2D had higher ANGPTL8 level, (morbid obese, mean ± standard error of the mean; 1415 ± 196.4 pg/mL, and healthy weight, 2231 ± 328.1 pg/mL), compared with individuals without T2D (morbid obese, 876 ± 155.0 pg/mL, and healthy weight controls 868.9 ± 218.7 pg/mL). In participants with diabetes and morbid obesity, T2D remission occurred 15 days post-LSG, defined by a sustained reduced fasting blood glucose levels <6.9 mmol/L. In this group, the 1-year post-LSG measurement of ANGPTL8 showed unique biphasic changes, first a prominent elevation (day 60, 3336 ± 916.5 pg/mL, P < .01), followed by a gradual decrease to reach almost the baseline level (day 360, 1184 ± 119.3 pg/mL).Conclusion
Elevated baseline ANGPTL8 in participants with diabetes at baseline reflected a link to T2D. Interestingly, the unique biphasic pattern of change in fasting ANGPTL8 post-LSG, occurred only in people with diabetes, suggesting ANGPTL8’s potential role in T2D remission. 相似文献5.
Xiao Du Xiang-hui Fu Bo-qiang Peng Rong Luo Jian-kun Hu Zhong Cheng 《Surgery for obesity and related diseases》2018,14(9):1348-1356
Background
The effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on metabolic syndrome (MS) in morbidly obese patients have not been well studied.Objective
To compare the effectiveness of LSG and LRYGB in Chinese morbidly obese patients with MS.Setting
University Hospital, China.Methods
Patients who underwent LRYGB or LSG surgery and had completed at least 1 year of follow-up were retrospectively reviewed. Bariatric and metabolic outcomes in the 2 groups were compared. Univariate and multivariate analyses were performed to identify the predictors of MS remission.Results
Of the 176 patients enrolled in this study, 79 underwent LSG and 97 underwent LRYGB. Eighty-three met 3 of the International Diabetes Federation criteria for diagnosis of MS, 69 met 4 of the criteria, and 24 met 5 of the criteria. At 1 year after bariatric surgery, 79% of patients achieved remission of MS. In both LSG and LRYGB groups, the number of MS criteria met by patients decreased significantly after surgery. The MS remission rate was not significantly different between the 2 groups (74.7% in LSG versus 82.5% in LGB; P?=?.21). In LSG patients, there was no significant decrease in blood pressure or increase in the high-density lipoprotein cholesterol at 1 year. On logistic regression analysis, younger age, lower body mass index, and lower homeostatic model of assessment-insulin resistance were independently associated with MS remission at 1 year after surgery. Both groups showed satisfactory and comparable weight loss (percentage of excess weight loss: 71.7% in LSG versus 74.4% in LRYGB). No surgery-related mortality occurred.Conclusions
Both LSG and LRYGB are feasible, safe, and effective in Chinese obese patients with MS. LSG seems to be inferior to LRYGB with regard to control of hypertension and high-density lipoprotein cholesterol. 相似文献6.
Jingge Yang Zhiguang Gao D. Brandon Williams Cunchuan Wang Shing Lee Xiangmao Zhou Peicai Qiu 《Surgery for obesity and related diseases》2018,14(10):1521-1529
Background
Changes in gastrointestinal and pancreatic hormones may play a role in promoting long-term weight reduction and improved glucose metabolism after sleeve gastrectomy and Roux-en-Y gastric bypass. However, few studies have examined the metabolic and endocrine effects of these procedures in Mainland China.Objectives
To compare the effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on gastrointestinal and pancreatic peptide hormones.Setting
University hospital, China.Methods
A nonrandomized prospective study was conducted in Chinese obese patients undergoing LSG or LRYGB. Of 20 patients in this study, 10 underwent LSG, and 10 underwent LRYGB. Fasting plasma levels of insulin, glucagon, ghrelin, gastric inhibitory peptide, peptide YY, glucagon-like peptide (GLP)-1, and GLP-2 were measured preoperatively and at 1, 3, 6, and 12 months after surgery. This trial was registered at www.clinicaltrials.gov (NCT02963662).Results
During the first year after both operations, mean body mass index and fasting insulin levels steadily decreased at all intervals. Fasting plasma glucose levels significantly decreased at 1 month after surgery, then remained stable in both groups. Glucagon levels significantly decreased at 1, 3, and 6 months after surgery in both groups, but returned to baseline at 12 months. Fasting GLP-1 and peptide YY significantly increased in both groups, but more so after LRYGB. However, GLP-2 did not change in either group. Ghrelin levels significantly decreased after LSG, but not after LRYGB. Gastric inhibitory peptide levels decreased after LRYGB but not after LSG.Conclusions
LSG and LRYGB resulted in significant and distinct changes in multiple gastrointestinal and pancreatic peptide hormones that are important regulators of obesity and metabolic health. 相似文献7.
Elisenda Climent David Benaiges Juana A. Flores-Le Roux Jose M. Ramón Juan Pedro-Botet Albert Goday 《Surgery for obesity and related diseases》2018,14(8):1099-1105
Background
Few studies have compared mid-term results of laparoscopic Roux-en-Y gastric bypass (LRYGB) versus laparoscopic sleeve gastrectomy (LSG), and none have focused on lipid profile.Objectives
To compare LRYGB versus LSG with respect to lipid disturbance evolution and remission at mid-term after bariatric surgery (BS) and to assess associated factors with the remission of lipid disturbances at 5 years.Setting
Hospital del Mar, Barcelona, from January 2005 to January 2012.Methods
A retrospective analysis of a nonrandomized, prospective cohort was conducted on patients undergoing BS at Hospital del Mar, Barcelona, from January 2005 to January 2012 with ≥5 years’ follow-up.Results
Of 259 patients, 151 (58.3%) completed the 5-year follow-up. The proportion of patients who achieved normal low-density lipoprotein cholesterol levels at 5 years post-LRYGB was greater than after LSG (30/49 [61.2%] versus 6/23 [26.1%]; P?=?.005), being male sex, absence of statins treatment, and type of BS technique (LRYGB) the associated factors with remission. Hypertriglyceridemia remission was also higher after LRYGB (23/25 [92.0%] versus 10/15 [66.7%]; P?=?.041), although type of surgery was not an associated factor. No differences were found in remission rates of low high-density lipoprotein cholesterol between groups. Absence of fibrates treatment and 5-year percentage of excess weight loss were independently associated with hypertriglyceridemia remission, and only the latter was independently associated with low high-density lipoprotein cholesterol remission 5 years after surgery.Conclusions
Five-year outcome data showed that, among patients with severe obesity undergoing BS, LRYGB was associated with a higher total and low-density lipoprotein cholesterol reduction and remission in comparison to LSG, with no differences in hypertriglyceridemia and high-density lipoprotein cholesterol normalization. 相似文献8.
Colette S. Inaba Christina Y. Koh Sarath Sujatha-Bhaskar Marija Pejcinovska Ninh T. Nguyen 《Surgery for obesity and related diseases》2018,14(10):1448-1453
Background
Laparoscopic sleeve gastrectomy (LSG) is associated with low morbidity and mortality and a short length of stay. Studies on the safety of same-day discharge after LSG are limited.Objective
To compare outcomes between same-day versus first-postoperative-day (POD1) discharge after LSG.Setting
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database.Methods
The 2015 to 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was analyzed for elective LSG cases with same-day or POD1 discharge. Open, revisional, and converted cases were excluded. Multivariate analysis was performed to compare adjusted 30-day mortality, morbidity, readmission, and reoperation for same-day versus POD1 discharge.Results
We examined 85,321 LSG cases, including 4728 same-day discharges and 80,593 POD1 discharges. Compared with POD1 discharges, same-day discharges were associated with higher overall morbidity (1.31% versus .84%, respectively; adjusted odds ratio [AOR] 1.72; P?=?.0002), a higher readmission rate (2.14% versus 1.64%, respectively; AOR 1.40; P?=?0.0034), and a higher reoperation rate (.61% versus .27%, respectively; AOR 2.35; P < .0001). There was no difference in mortality (.08% versus .04%, respectively; AOR 2.62; P?=?.0923).Conclusion
Same-day discharge after LSG is associated with increased complications, readmissions, and reoperations compared with POD1 discharge. Further studies are needed to examine objective criteria for safe same-day discharge after LSG. 相似文献9.
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10.
Andrew Demeusy Anne Sill Andrew Averbach 《Surgery for obesity and related diseases》2018,14(10):1454-1461
Background
Laparoscopic sleeve gastrectomy (LSG) has become a dominant bariatric procedure. In the past, significant leak rates prompted the search for staple line reinforcement (SLR) techniques. Previous analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for all LSG suggested a detrimental influence of SLR on leak rates and overall morbidity.Objective
To investigate the relationship between various SLR techniques and bougie size with 30-day outcomes.Setting
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited bariatric surgery hospitals.Methods
Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 to 2016 Participant Use File data, primary LSG cases were divided into study groups based on surgical techniques. All variables were reported in the Participant Use File except leak rate and overall morbidity, which had to be derived. Multiple bivariate analyses were used to analyze the 30-day outcomes.Results
A total of 198,339 primary LSG operations were included and grouped into No SLR (23.0%), SLR (54.2%), oversewn staple line (9.5%), and a combination of SLR?+?oversewn staple line (13.3%). There were no statistical differences between study groups in mortality, overall morbidity, or leak rate. Bleeding and reoperation rates were statistically higher in the No SLR group. Bougie size was not associated with change in leak rates.Conclusion
Primary LSG is a safe procedure with low morbidity and mortality rates. SLR is associated with decreased rates of bleeding and reoperations but does not affect leak rates. The selection of SLR technique should be left to the surgeon's discretion with an understanding of the associated risks, benefits, and costs. 相似文献11.
Amit Surve Daniel Cottam Hinali Zaveri Austin Cottam LeGrand Belnap Christina Richards Walter Medlin Titus Duncan Karleena Tuggle Alberto Zorak Thomas Umbach Matthew Apel Peter Billing Josiah Billing Robert Landerholm Kurt Stewart Jedediah Kaufman Eric Harris Benjamin Horsley 《Surgery for obesity and related diseases》2018,14(10):1442-1447
Background
Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure that can be performed as an outpatient procedure.Objectives
The aim of the study was to determine whether same-day discharge LSG is safe when performed in an outpatient surgery center.Setting
Outpatient surgery centers.Methods
The medical records of 3162 patients who underwent primary LSG procedure by 21 surgeons at 9 outpatient surgery centers from January 2010 through February 2018 were retrospectively reviewed.Results
Three thousand one hundred sixty-two patients were managed with enhanced recovery after surgery protocol and were included in this analysis. The mean age and preoperative body mass index were 43.1 ± 10.8?years and 42.1 ± 7.1 kg/m2, respectively. Sleep apnea, type 2 diabetes, gastroesophageal reflux disease, hypertension, and hyperlipidemia were seen in 14.4%, 13.5%, 24.7%, 30.4%, and 17.6% patients, respectively. The mean total operative time was 56.4 ± 16.9 minutes (skin to skin). One intraoperative complication (.03%) occurred. The hospital transfer rate was .2%. The 30-day follow-up rate was 85%. The postoperative outcomes were analyzed based on the available data. The 30-day readmission, reoperation, reintervention, and emergency room visit rates were .6%, .6%, .2%, and .1%, respectively. The 30-day mortality rate was 0%. The total short-term complication rate was 2.5%.Conclusions
Same-day discharge seems to be safe when performed in an outpatient surgery center in selected patients. It would appear that outpatient surgery centers are a viable option for patients with minimal surgical risks. 相似文献12.
Amit Surve Hinali Zaveri Daniel Cottam Austin Cottam Samuel Cottam LeGrand Belnap Walter Medlin Christina Richards 《Surgery for obesity and related diseases》2018,14(8):1139-1148
Background
Inadequate weight loss, weight recidivism, and device-related complications after an adjustable gastric banding (AGB) can be treated by a laparoscopic conversion to stomach intestinal pylorus-sparing surgery (SIPS).Objective
The aim of the study was to analyze the midterm outcomes of revision SIPS surgery after failed AGB.Setting
Private practice, United States.Methods
This is a retrospective review of our prospectively collected data of patients who underwent laparoscopic conversion from AGB to SIPS surgery from June 2013 and February 2017 by a single surgeon in a single institution.Results
Twenty-seven patients (1 stage: 22 and 2 stage: 5) underwent a laparoscopic revision of AGB to SIPS surgery. The mean ± standard deviation preoperative body mass index (BMI) before AGB was 47.5 ± 6.8 kg/m2, while the mean nadir BMI after AGB was 36 ± 7.7 kg/m2. The overall time to reoperation was 9.3 ± 8.7 and 5.6 ± 2.5 years in 1- and 2-stage conversion patients, respectively. The mean preoperative BMI before revision SIPS surgery was 46.7 ± 7 kg/m2. At 36 months, the patients had an average change in BMI of 20.9 units with 90% excess weight loss. A major complication occurred in 4 patients. Postoperatively, the fasting blood glucose, insulin, low-density lipoprotein, triglyceride, and most of the co-morbidities were resolved or improved.Conclusion
This study demonstrates that conversion of failed AGB to SIPS surgery is an effective approach to AGB failure. 相似文献13.
Amihai Rottenstreich Gabriel Levin Geffen Kleinstern Misgav Rottenstreich Uriel Elchalal Ram Elazary 《Surgery for obesity and related diseases》2018,14(12):1795-1803
Background
The optimal timing of pregnancy after bariatric surgery has not been established, with data limited regarding laparoscopic sleeve gastrectomy (LSG), currently the most common bariatric operation performed.Objectives
We explored associations of the surgery-to-conception interval with pregnancy outcomes after LSG.Setting
A university hospital.Methods
We assessed pregnancy outcomes in relation to the surgery-to-conception interval for all women who underwent LSG and delivered during 2006 to 2018.Results
Of 154 patients, 67 (43.5%) conceived within the first 18 months postoperatively (early-pregnancy group), whereas 87 (56.5%) conceived later (late-pregnancy group). The median surgery-to-conception interval was 390 (interquartile range 247–459) days in the early-pregnancy group and 1104 (8527–1548) days in the late-pregnancy group. Compared with the early-pregnancy group, the late-pregnancy group had higher gestational weight gain (median 11 versus 8 kg, P < .001) and lower hemoglobin levels in early pregnancy (12.3 versus 12.6 g/dL, P?=?.03) and after delivery (10.0 versus 10.4 g/dL, P?=?.02). Other maternal and perinatal outcomes were similar between the groups, including the proportion of small-for-gestational-age infants (11.9% versus 14.9%, P?=?.64) for those who conceived within or later than 18 months after surgery. Similar rates of small-for-gestational-age infants were found between those who conceived within or ≥12 months after surgery (P?=?1.0).Conclusions
Timing of pregnancy after LSG was found not to be associated with pregnancy outcomes. Together with documentations of a similar safety profile of pregnancy occurring earlier or later in the postoperative course, these data should reassure women who do not wish to delay conception after surgery. 相似文献14.
Adrian Mancini Anne-Laure Borel Sandrine Coumes Nelly Wion Catherine Arvieux Fabian Reche 《Surgery for obesity and related diseases》2018,14(11):1700-1704
Background
Beyond medical complications, people with obesity experience dramatic impairment of quality of life, including adverse workplace effects. Obesity results in weight-based discrimination and a high rate of unemployment because of work disability, absenteeism, loss of productivity, and cost. A few studies have been performed to assess the relationship between obesity surgery and the workplace, finding an improvement in weekly working hours and productivity and a decrease in absenteeism, days of sick leave, and state benefit claims. However, the results are still controversial concerning the overall employment rate.Objectives
This study aimed to compare the employment rate before and 2 years after obesity surgery and to evaluate the difference in weight loss between worker and nonworker patients.Setting
Participants were recruited from a tertiary care university hospital in France.Methods
The 2-year outcomes of all patients who underwent obesity surgery between 2010 and 2015 were retrospectively reviewed. The employment status was recorded preoperatively and postoperatively. Retired or permanently disabled patients were excluded from the analysis.Results
Preoperatively, 158 of 238 patients were employed compared with 199 of 238 postoperatively (P < .0001). There was no difference in weight loss between the worker and nonworker patients regarding the percentage of excess weight loss and the change in body mass index.Conclusion
This study supports the finding that bariatric surgery also has a positive impact on the professional sphere, providing the opportunity for unemployed patients to return to work. 相似文献15.
Thomas H. Inge R. Yates Coley Lydia A. Bazzano Stavra A. Xanthakos Kathleen McTigue David Arterburn Neely Williams Rob Wellman Karen J. Coleman Anita Courcoulas Nirav K. Desai Jane Anau Roy Pardee Sengwee Toh Cheri Janning Andrea Cook Jessica Sturtevant Casie Horgan Marc Michalsky 《Surgery for obesity and related diseases》2018,14(9):1374-1386
Background
Bariatric surgery has been used for treatment of severe obesity in adolescents but most studies have been small and limited in follow-up.Objectives
We hypothesized that electronic health record data could be used to compare effectiveness of bariatric procedures in adolescents.Setting
Data were obtained from clinical research networks using a common data model to extract data from each site.Methods
Adolescents who underwent a primary bariatric procedure from 2005 through 2015 were identified. The percent change in body mass index (BMI) at 1, 3, and 5 years was estimated using random effects linear regression for patients undergoing all operations. Propensity score adjusted estimates and 95% confidence intervals were estimated for procedures with >25 patients at each time period.Results
This cohort of 544 adolescents was predominantly female (79%) and White (66%), with mean (±standard deviation) age of 17.3 (±1.6) years and mean BMI of 49.8 (± 7.8) kg/m2. Procedures included Roux-en-Y gastric bypass (RYGB; n?=?177), sleeve gastrectomy (SG; n?=?306), and laparoscopic adjustable gastric banding (n?=?61). For those undergoing RYGB, SG, and laparoscopic adjustable gastric banding, mean (95% confidence interval) BMI changes of ?31% (?30% to ?33%), ?28% (?27% to ?29%), and ?10% (?8% to ?12%), were estimated at 1 year. For RYGB and SG, BMI changes of ?29% (?26% to ?33%) and ?25% (?22% to ?28%) were estimated at 3 years.Conclusions
Adolescents undergoing SG and RYGB experienced greater declines in BMI at 1- and 3-year follow-up time points, while laparoscopic adjustable gastric banding was significantly less effective for BMI reduction. 相似文献16.
Jih-Hua Wei Ruey-Hsing Chou Po-Hsun Huang Wei-Jei Lee Shu-Chun Chen Shing-Jong Lin 《Surgery for obesity and related diseases》2018,14(12):1832-1840
Background
In recent years, bariatric surgery was found to have therapeutic potential for the treatment of type 2 diabetes (T2D) in severely obese patients (body mass index [BMI] ≥35 kg/m2) and to reduce cardiovascular disease (CVD) risk and mortality. However, the benefit of CVD risk reduction after metabolic surgery in nonseverely obese T2D patients (BMI <35 kg/m2) remained to be proven.Objective
To evaluate the CVD risk after metabolic surgery in T2D patients using The UK Prospective Diabetes Study score.Setting
Tertiary referral general hospital, Taiwan, Republic of China.Methods
Outcomes of 392 patients (235 women and 147 men) who had undergone sleeve gastrectomy (87) or gastric bypass (305) for treatment of T2D with 1-year follow-up were assessed. Data were prospectively collected for study, and cerebral and coronary heart disease risk was calculated by using The UK Prospective Diabetes Study risk engine. Outcomes of patients who had undergone different surgical procedures were assessed.Results
One year after surgery, weight and glycemic control with complete and partial remission of T2D were significant in most of the patients. The 10-year coronary heart disease risk and fatal coronary heart disease risk were also reduced from 8.8% to 4.6% and from 4.6% to 2.1%, respectively (both P < .001). Similar CVD risk reduction was seen in both patients with BMI ≥35 and BMI <35. Multivariable analysis confirmed that surgical procedure of sleeve gastrectomy was a negative independent predictor of CVD risk reduction after metabolic surgery.Conclusion
The present study confirms the efficacy of metabolic surgery for the T2D treatment and reduction of CVD risk up to 50% 1 year after surgery. Gastric bypass surgery has more power on CVD risk reduction than sleeve gastrectomy. 相似文献17.
Dvir Froylich Omer Sadeh Hagar Mizrahi Naama Kafri Guy Pascal Christopher R. Daigle Nisim Geron David Hazzan 《Surgery for obesity and related diseases》2018,14(10):1495-1500
Background
The increase in life expectancy presents health systems with a growing challenge in the form of elderly obesity. Bariatric surgery has been shown to be a safe and effective treatment for obesity with reduction of excess weight and improvement in obesity-related co-morbidities. However, only recently have surgeons begun performing these operations on elderly patients on a larger scale, making data regarding mid- and long-term outcomes scarce. The objective of this study was to evaluate the safety and midterm efficacy of laparoscopic sleeve gastrectomy (LSG) in patients aged ≥60 years.Methods
All patients aged ≥60 years who underwent LSG between 2008 and 2014 and achieved ≥24-month follow-up were retrospectively reviewed. Demographic characteristics and perioperative data were analyzed. Weight loss parameters and co-morbidity resolution rates were compared with preoperative data.Results
In total 55 patients aged ≥60 years underwent LSG. Mean patient age was 63.9 ± 3.2 years (range, 60–75.2), and mean preoperative body mass index was 43 ± 6.0 kg/m2. Perioperative morbidity included 5 cases of hemorrhage necessitating operative exploration, 2 cases of reduced hemoglobin levels treated with blood transfusion, and 1 case of portal vein thrombosis managed with anticoagulation. There were no mortalities. Mean follow-up time was 48.6 (range, 25.6–94.5) months. Mean percentage of excess weight loss was 66.4 ± 19.7, 67.5 ±1 6.4, 61.4 ± 18.3, 66.7 ± 25.6, 50.7 ± 21.4 at 12, 24, 36, 37 to 60, and 61 to 96 months, respectively. Statistically significant improvement of type 2 diabetes, hypertension, and dyslipidemia were observed at the latest follow-up (P < .01).Conclusion
LSG offers an effective treatment of obesity and its co-morbidities in patients aged ≥60 years, albeit with a high perioperative bleeding rate at our center; efficacy is maintained for at least 4.5 years. 相似文献18.
Roux-en-Y gastric bypass surgery in youth with severe obesity: 1-year longitudinal changes in spexin
Seema Kumar MD Jobayer Hossain Thomas Inge P Babu Balagopal 《Surgery for obesity and related diseases》2018,14(10):1537-1543
Background
Spexin is a novel peptide predominantly produced in human white adipose tissue and has recently been implicated as a potential signal in the regulation of body weight, energy homeostasis, and satiety. The effect of bariatric surgery on spexin is unknown.Objectives
To study the effect of Roux-en-Y gastric bypass (RYGB) surgery on endogenous spexin concentration and various risk factors of type 2 diabetes and cardiovascular disease in youth with severe obesity.Setting
University hospital, United StatesMethods
Spexin, body mass index (BMI), insulin, glucose, total and high molecular weight adiponectin, leptin, and high sensitivity C- reactive protein were measured longitudinally (baseline, 6 mo, and 12 mo) after RYGB surgery in girls with severe obesity (n?=?12; age?=?16.7 ± 1.5 years; BMI?=?51.6 ± 2.9 kg/m2).Results
Serum spexin concentration increased (P?=?.01) at 6 months after surgery and stabilized afterward. Spexin level correlated negatively with homeostatic model assessment insulin resistance, HOMA-IR (Spearman correlation r?=??.796, P < .001) and positively with high molecular weight adiponectin (Spearman correlation r?=?.691, P?=?.011). The change in spexin concentration, from baseline to 6 months after surgery, was inversely correlated with the corresponding change in BMI (Spearman correlation r?=??.573, P?=?.051). Furthermore, the 6-month changes in spexin and HOMA-IR were inversely correlated (slope [standard error, SE]?=??.0084 (.0019), P?=?.001)], even after adjusting for the change in BMI.Conclusions
The enhancement of circulating spexin concentration in response to RYGB and correlations with beneficial postoperative changes in various adipokines in youth are novel findings that require further validation. 相似文献19.
Athar S.M. Elward Mohamed H.A. Fahmy Ashraf M. Abu-Seida 《Surgery for obesity and related diseases》2018,14(12):1814-1820
Background
Laparoscopic sleeve gastrectomy (LSG) has serious complications, such as leaks, reflux, stenosis, and kinks, which are also consequences of shortcomings in the LSG technique.Objectives
We evaluated the feasibility and weight loss of a novel bariatric procedure, using the greater curvature as the gastric pouch for sleeve gastrectomy (SG) in dogs.Setting
Animal house in Faculty of Medicine, Cairo University.Methods
Five 20- to 25-kg stray mongrel male dogs were subjected to open SG using the greater curve as the gastric pouch (GCSG group). The weight was monitored at day of surgery and at postoperative weeks 2, 4, 6, and 8; weight progression was compared with a sham and a standard SG group. By the end of the follow-up period autopsy was done.Results
The mean operative time in GCSG group was 39.6 ± 3.97 minutes. At the end of the study, dogs in the sham group had gained 8% of their preoperative weight, while the GCSG and standard SG groups lost 24.7% and 25% of their preoperative weight, respectively. At autopsy, the gastric sleeve in the GCSG group showed excellent healing with no stenotic areas, kinks, or mucosal ulcerations.Conclusion
Greater curvature SG is technically feasible in a canine model. Larger studies with longer follow-up period will be needed to assess weight progression and resolution of the metabolic co-morbidities. 相似文献20.
Mohamad A. Minhem Bassem Y. Safadi Robert H. Habib Etwal P. Bou Raad Ramzi S. Alami 《Surgery for obesity and related diseases》2018,14(10):1463-1470