共查询到20条相似文献，搜索用时 468 毫秒
1.
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2.
Ramon V. Cortez Tarissa Petry Pedro Caravatto Rodrigo Pessôa Sabri S. Sanabani Marina B. Martinez Thais Sarian João E. Salles Ricardo Cohen Carla R. Taddei 《Surgery for obesity and related diseases》2018,14(11):1748-1754
Background
In recent years, studies indicate gut microbiota as an important modulator in the pathophysiology of type 2 diabetes. Environmental and genetic factors interact to control the host's intestinal microbiota, triggering metabolic disorders such as obesity and insulin resistance.Objectives
The objective of this study was to identify the fecal microbiota in adult type 2 diabetes patients and to assess changes in composition after metabolic surgery.Setting
University Hospital of the University of São Paulo.Methods
Twenty-one patients were enrolled in a randomized controlled study divided into 2 arms. One group underwent duodenal-jejunal bypass surgery with minimal gastric resection, and fecal samples were collected before the operation and after 6 and 12 months. The other group received medical care (standard care group) and was followed for 12 months. Fecal samples were collected at baseline and after 6 and 12 months. Fecal microbiota was analyzed using high-throughput sequencing with V4 16 S rRNA primers.Results
The fecal microbiota in duodenal-jejunal bypass surgery with minimal gastric resection group (Bacteroides, Akkermansia, and Dialister) exhibited increased abundance and diversity compared with that in the standard care group; however, the increase in A. muciniphila was only statistically significant in the surgical group, probably due to the study's small sample size.Conclusions
The data presented suggest that duodenal-jejunal bypass surgery with minimal gastric resection increases microbial richness and abundancy, mainly for those bacteria related to weight loss and metabolic control (Akkermansia), providing a better understanding of the role of microbiota in type 2 diabetes regulation and its changes after metabolic surgery. 相似文献3.
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4.
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5.
Recep Aktimur Cuneyt Kirkil Kadir Yildirim Nizamettin Kutluer 《Surgery for obesity and related diseases》2018,14(12):1850-1856
Background
One-anastomosis gastric bypass (OAGB) is considered new from the bariatric standpoint.Objectives
To assess the effectiveness and safety of the enhanced recovery after surgery protocol compared with the conventional approach in perioperative care of OAGB patients.Setting
Turkey.Methods
The prospectively collected data of 92 patients managed with standard care (group 1) were compared with 216 patients managed by the enhanced recovery after surgery pathway (group 2). All patients underwent OAGB by the same surgeon. The groups were compared in terms of mean postoperative length of stay; costs for surgery and recovery; and rates of complications, emergency room visits, and readmissions.Results
Length of stay was always 5 days in group 1 and had a mean of 1.2 ± 1.3 days in group 2 (P < .001). The mean total cost for surgery and recovery was 858.6 ± 33.1 USD in group 1 and 625.2 ± 289.1 USD in group 2 (P < .001). Specific complications (Clavien-Dindo IIIa) occurred in 1 patient (1.1%) in group 1 and in 3 patients (1.4 %) in group 2 (P?=?1.000). Fifty-seven patients (61.9%) in group 1 and 45 (20.9%) in group 2 visited the emergency room within 1 month of being discharged (P < .001). Two patients (.9%) in group 2 needed hospital readmission; there was no need for rehospitalization in group 1 (P < .001).Conclusion
The enhanced recovery after surgery pathway significantly reduces length of stay and cost after OAGB, with no significant difference in terms of surgical outcomes. It also reduces postdischarge resource utilization. 相似文献6.
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7.
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8.
Omar A. Khan Emma Rose McGlone William Maynard James Hopkins Simon Dexter Ian Finlay David Hewin Peter Sedman Peter Walton Shaw Somers Marcus Reddy Peter Small Marco Adamo Richard Welbourn 《Surgery for obesity and related diseases》2018,14(10):1516-1520
Background
For patients in whom laparoscopic adjustable gastric band has failed, conversion to Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy are both options for further surgical treatment. There are limited data comparing these 2 procedures. The National Bariatric Surgery Registry is a comprehensive United Kingdom–wide database of bariatric procedures, in which preoperative demographic characteristics and clinical outcomes are prospectively recorded.Objectives
To compare perioperative complication rate and short-term outcomes of patients undergoing single-stage conversion of gastric band to Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy.Setting
United Kingdom national bariatric surgery database.Methods
From the National Bariatric Surgical Registry data set, we identified 141 patients undergoing single-stage conversion from gastric band to either gastric bypass (113) or sleeve gastrectomy (28) between 2009 and 2014, and analyzed their clinical outcomes.Results
With respect to perioperative outcomes gastric bypass was associated with a higher incidence of readmission or reintervention postoperatively (16 versus 0; P?=?.04). There was no difference in percentage excess weight loss between sleeve gastrectomy and gastric bypass at final follow-up at 1 year (52.1% versus 57.1% respectively; P?=?.4).Conclusions
Conversion from band to sleeve or bypass give comparable good early excess weight loss; however, conversion to sleeve is associated with a better perioperative safety profile. 相似文献9.
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10.
Rafael Alvarez Elika Ridelman Natalie Rizk Morgan S. White Chuan Zhou Heang-Ping Chan Oliver A. Varban Mark A. Helvie Randy J. Seeley 《Surgery for obesity and related diseases》2018,14(11):1643-1651
Background
Mammographic breast density (BD) is an independent risk factor for breast cancer. The effects of bariatric surgery on BD are unknown.Objectives
To investigate BD changes after sleeve gastrectomy (SG).Setting
University hospital, United States.Methods
Fifty women with mammograms before and after SG performed from 2009 to 2015 were identified after excluding patients with a history of breast cancer, hormone replacement, and/or breast surgery. Patient age, menopausal status, co-morbidities, hemoglobin A1C, and body mass index were collected. Craniocaudal mammographic views before and after SG were interpreted by a blinded radiologist and analyzed by software to obtain breast imaging reporting and data system density categories, breast area, BD, and absolute dense breast area (ADA). Analyses were performed using χ2, McNemar's test, t test, and linear regressions.Results
Radiologist interpretation revealed a significant increase in breast imaging reporting and data system B+C category (68% versus 54%; P?=?.0095) and BD (9.8 ± 7.4% versus 8.3 ± 6.4%; P?=?.0006) after SG. Software analyses showed a postoperative decrease in breast area (75,398.9 ± 22,941.2 versus 90,655.9 ± 25,621.0 pixels; P < .0001) and ADA (7287.1 ± 3951.3 versus 8204.6 ± 4769.9 pixels; P?=?.0314) with no significant change in BD. Reduction in ADA was accentuated in postmenopausal patients. Declining breast area was directly correlated with body mass index reduction (R2?=?.4495; P < 0.0001). Changes in breast rather than whole body adiposity better explained ADA reduction. Neither diabetes status nor changes in hemoglobin A1C correlated with changes in ADA.Conclusions
ADA decreases after SG, particularly in postmenopausal patients. Software-generated ADA may be more accurate than radiologist-estimated BD or breast imaging reporting and data system for capturing changes in dense breast tissue after SG. 相似文献11.
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12.
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13.
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14.
Ryan J. Marek Kristine J. Steffen David R. Flum Alfons Pomp Walter J. Pories J. Peter Rubin Bruce M. Wolfe James E. Mitchell 《Surgery for obesity and related diseases》2018,14(11):1740-1747
Background
Bariatric surgery usually results in substantial weight loss and a reduction in medical comorbidities. Many patients, as a consequence of the weight loss, subsequently evidence loose, redundant skin.Objectives
This investigation seeks to examine the prevalence of body contouring surgery (BCS) by patients approximately 4 to 5 years after Roux-en-Y gastric bypass surgery. Demographics, change in BMI, and psychosocial variables were also used to predict body dissatisfaction, desire for BCS, and patients who reported obtaining BCS.Setting
The clinical sites involved in the Longitudinal Assessment of Bariatric Surgery project, which included 10 hospitals across the United States.Methods
The sample comprised 1159 patients who underwent Roux-en-Y gastric bypass and were enrolled in the Longitudinal Assessment of Bariatric Surgery-2 study. Participants were surveyed using the Excessive Skin Survey and other psychosocial measures at their 4- or 5-year postoperative outcome. The participants were predominately women (80.5%), Caucasian (88.3%), and middle-aged (mean?=?46.1 yr, standard deviation?=?11.11 yr).Results
Participants reported modest degrees of being bothered by excessive skin, primarily in their waist/abdomen, thighs, and chest/breasts body areas. Only 11.2% of the sample had undergone any BCS procedure, and a majority of those participants paid “out of pocket” for BCS. Desire for BCS and body dissatisfaction 4 to 5 years postsurgery was associated with higher depression scores and poorer quality of life scores.Conclusions
Excessive skin is associated with poorer psychosocial functioning. Despite reporting modest levels of being bothered by excessive skin and body dissatisfaction, only a small fraction of participants underwent BCS. Cost of BCS was reported to be a primary barrier for not obtaining BCS. All rights reserved. 相似文献15.
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16.
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17.
Prapimporn Chattranukulchai Shantavasinkul Michael J. Muehlbauer James R. Bain Olga R. Ilkayeva Damian M. Craig Christopher B. Newgard Laura P. Svetkey Svati H. Shah Alfonso Torquati 《Surgery for obesity and related diseases》2018,14(8):1126-1132
Background
Gastric bypass surgery for weight reduction often corrects dysglycemia in diabetic patients, but a full understanding of the underlying biochemical pathways continues to be investigated.Objectives
To explore the effects of weight loss by surgical and dietary interventions on plasma metabolites using both targeted and discovery-oriented metabolomics platforms.Setting
An academic medical center in the United States.Methods
Improvement in homeostatic model assessment for insulin resistance (HOMA-IR), as an index of insulin resistance, was compared at 6 months in 11 patients that underwent Roux-en-Y gastric bypass against 11 patients that were matched for weight loss in the Weight Loss Maintenance (WLM) program. Metabolites in plasma were evaluated by nontargeted gas chromatography/mass spectrometry for the potential detection of >1100 biochemical markers.Results
Among multiple metabolites detected, 2-hydroxybutyric acid (2-HBA) declined most significantly after 6 months in comparing patients that underwent Roux-en-Y gastric bypass with those in WLM (P < .001), corresponding with declines in HOMA-IR (P?=?.025). Baseline levels of 2-HBA for all patients were correlated with preintervention levels of HOMA-IR (R2?=?.565, P < .001). Moreover, the changes in 2-HBA after 6 months were correlated with changes in HOMA-IR (R2?=?.399, P?=?.0016).Conclusions
Correlation between insulin resistance and 2-HBA suggests the utility of the latter as an excellent biomarker for tracking glycemic improvement, and offers further insight into the pathways that control diabetes. This is the first report of a decline in 2-HBA in response to bariatric surgery. 相似文献18.
Rafael Alvarez Niki Matusko Amanda L. Stricklen Rachel Ross Colleen M. Buda Oliver A. Varban 《Surgery for obesity and related diseases》2018,14(12):1903-1910
Background
Bariatric surgery is underutilized.Objectives
To identify factors associated with eligible patient dropout from bariatric surgery.Setting
University hospital, United States.Methods
Eligible candidates were identified after a multidisciplinary review committee (MRC) of all patients (n?=?484) who attended a bariatric surgery informational session (BIS) at a single-center academic institution in 2015. We compared patients who underwent surgery within 2 years of BIS with those who did not (i.e., dropped out) by evaluating patient, insurance, and program-specific variables. Univariate analyses and multivariable regressions were performed to identify factors associated with patient dropout among eligible candidates.Results
We identified 307 (63%) patients who underwent MRC. Thirty-three (11%) patients were deemed poor candidates and surgery was not recommended. Among eligible candidates, 82 (30%) dropped out from the program. Factors independently associated with eligible patient dropout included coronary artery disease (odds ratio [OR] .13 [.02–.66]; P?=?.014), hypertension (OR .46 [.24–.87]; P?=?.017), time from BIS to MRC (OR .99 [.99–.99]; P?=?.002), 3 months of medically supervised weight loss documentation (OR .09 [.02–.51]; P?=?.007), endocrinology clearance (OR .26 [.09–.76]; P?=?.014), hematology clearance (OR .37 [.14–.95]; P?=?.039), urine drug screen testing (OR .31 [.13–.72]; P?=?.006), additional psychological evaluation (OR .43 [.20–.93]; P?=?.031), and required extra sessions with the dietician (OR .39 [.17–.92]; P?=?.032). Thirty-three (6.8%) patients underwent surgery at another institution, and 42% of these patients lived more than 50 miles from attended BIS site.Conclusions
Twenty-seven percent of patients did not undergo bariatric surgery at their initial site of evaluation despite being considered eligible candidates after MRC. Dropout was independently associated with patient, insurance, and program-specific variables that may represent barriers to care amenable to improvement. 相似文献19.
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20.
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