Impact of Sleeve Gastrectomy on Type 2 Diabetes Mellitus,Gastric Emptying Time,Glucagon-Like Peptide 1 (GLP-1), Ghrelin and Leptin in Non-morbidly Obese Subjects with BMI 30–35.0 kg/m<Superscript>2</Superscript>: a Prospective Study

Background

The study was conducted to evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on type 2 diabetes mellitus (T2DM) in patients with a body mass index (BMI) of 30.0–35.0 kg/m². Possible mechanisms, including alterations in gastric emptying time (GET), glucagon-like peptide 1 (GLP-1), ghrelin and leptin, were evaluated.

Methods

Twenty obese patients with T2DM and with a BMI of 30.0–35.0 kg/m² underwent LSG during March 2012 to February 2015. Glycosylated haemoglobin (HbA1c), fasting plasma glucose (FPG) and GET were measured at baseline, 3 months, 6 months, 12 months and 24 months after surgery. Fasting and post-prandial levels of serum GLP-1, ghrelin and leptin were measured pre-operatively and after 3 and 6 months.

Results

The average duration of follow-up was 17.6 months, and 10 patients had completed 2 years of follow-up. After 2 years, the average BMI decreased from 33.4?±?1.2 to 26.7?±?1.8 kg/m². The mean HbA1c decreased from 8.7?±?1.6 to 6.7?±?1.5 %, respectively. Ten patients achieved complete remission. Insulin could be stopped in all six patients who were on it pre-operatively. Meal-stimulated GLP-1 response and serum insulin at 30 min showed a significant increase following surgery. There was a significant decrease in GET.

Conclusions

This prospective study confirms the positive impact of LSG on diabetic status of non-morbidly obese patients. The possible mechanisms include the rise in post-prandial GLP-1 level induced by accelerated gastric emptying, leading to an increase in insulin secretion. LSG also leads to decreased ghrelin and leptin levels which may have a role in improving glucose homeostasis after surgery.

     

Metabolic Parameters,Weight Loss,and Comorbidities 4 Years After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

Background

Sleeve gastrectomy (LSG) is now the predominant bariatric surgery performed, yet there is limited long-term data comparing important outcomes between LSG and Roux-en-Y gastric bypass (RYGB). This study compares weight loss and impact on comorbidities of the two procedures.

Methods

We retrospectively evaluated weight, blood pressure, hemoglobin A1c, cholesterol, and medication use for hypertension, diabetes, and hyperlipidemia at 1–4 years post-operatively in 380 patients who underwent RYGB and 334 patients who underwent LSG at the University of Michigan from January 2008 to November 2013. Follow-up rates from 714 patients initially were 657 (92%), 556 (78%), 507 (71%), and 498 (70%) at 1–4 years post-operatively.

Results

Baseline characteristics were similar except for higher weight and BMI in LSG. There was greater weight loss with RYGB vs. LSG at all points. Hemoglobin A1c and total cholesterol improved more in RYGB vs. LSG at 4 years. There was greater remission of hypertension and discontinuation of all medications for hypertension and diabetes with RYGB at 4 years.

Conclusions

Weight loss, reduction in medications for hypertension and diabetes, improvements in markers of diabetes and hyperlipidemia, and remission rates of hypertension were superior with RYGB vs. LSG 4 years post-operatively. Choice of bariatric procedures should be tailored to surgical risk, comorbidities, and weight loss goals.

     

Seven Years of Mini-Gastric Bypass in Type II Diabetes Patients with a Body Mass Index &lt;35 kg/m<Superscript>2</Superscript>

Background

Mini-gastric bypass (MGB) is a safe, effective, and reversible procedure for patients with type II diabetes mellitus (T2DM) and morbid obesity. Less is known, however, about its long-term effects in patients with a body mass index (BMI) <35 kg/m².

Methods

From February 2007 to February 2014, 1468 patients underwent MGB at our institution, including 983 with T2DM. Of these, 128 (82 women), of mean age 41.6?±?10.2 years, had a BMI of 30–35 kg/m². Prospectively collected data were analyzed retrospectively. Factors assessed included disease duration, family history, medication use, remission, and biochemical indicators, including fasting plasma glucose, glycosylated hemoglobin (HbA1c), serum insulin, and C-peptide concentrations. Remission of T2DM was defined as HbA1c <6.0 % without medication.

Results

Prior to surgery, patients had a mean BMI of 33.4?±?3.3 kg/m², mean waist circumference of 104.5?±?8.2 cm, mean C-peptide concentration of 3.4?±?1.2 ng/ml, and mean T2DM duration of 6.5?±?3.1 years. Within 6 months of MGB, 95 % of these patients had attained HbA1c <7 %. Complete remission rates at 1, 2, and 7 years were 64, 66, and 53 %, respectively. Mean HbA1c decreased from 10.7?±?1.5 % at baseline to 6.2?±?0.5% at 1 year, 5.4?±?1.2 % at 3 years, and 5.7?±?1.8 % at 7 years. No deaths occurred, but two (1.6 %) patients experienced major complications.

Conclusions

MGB provides good, long-term control of T2DM in patients with class I obesity. Early intervention results in higher remission rates.

     

Laparoscopic Sleeve Gastrectomy: Co-morbidity Profiles and Intermediate-Term Outcomes

Background

Bariatric surgery is effective at achieving sustained weight loss and improving the control and resolution of obesity-related co-morbidities. Most studies that have demonstrated co-morbidity resolution in patients undergoing laparoscopic sleeve gastrectomy (LSG) only follow patients for the short term (less than 1 year) or follow a relatively small cohort (<100 patients) for the intermediate or long term (more than 5 years). We report our experience following a large cohort of morbidly obese patients who underwent LSG with intermediate-term follow-up.

Methods

We retrospectively reviewed 435 consecutive patients who underwent LSG from January 2004 to November 2013. Co-morbidities investigated included diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia (HL). A co-morbidity was determined to be resolved if the patient was no longer taking any medication to treat that specific co-morbidity.

Results

Mean follow-up was 26?±?25 months (range?=?1–112). Mean postoperative total weight loss (%TWL) at 6, 12, 24, 36, 48, 60, and 72 months were 23.6, 29.9, 29.5, 25.2, 26.7, 25.4, and 24.3 %, respectively. The incidence of all three co-morbidities was found to be significantly lower at the last patient follow-up. The resolution rates for DM, HTN, and HL were 59, 31, and 50 %, respectively. In patients who continued to have co-morbidities, the mean numbers of medications for DM (1.2?±?0.7 vs. 0.5?±?0.7, p?<?0.0001), HTN (1.8?±?1.1 vs. 1.3?±?1.2, p?<?0.0001), and HL (0.9?±?0.7 vs. 0.6?±?0.6, p?<?0.0001) postoperatively were all significantly less.

Conclusions

LSG is effective at achieving significant and sustained weight loss, improvement in co-morbidity profiles, and a reduction in poly-pharmacy for these conditions over intermediate-term follow-up.

     

Weight Loss and Comorbidity Resolution 3 Years After Bariatric Surgery—an Indian Perspective

Introduction

Bariatric surgery has seen a sharp rise in India in the last decade. India is one of the 10 most obese nations of the world, ranking second in number of type 2 diabetics.

Aims

To evaluate clinical outcomes of bariatric surgery after 3 years of follow-up in terms of weight loss, co-morbidity resolution, complaints of gastroesophageal reflux disease and weight regain.

Methodology

All patients who underwent bariatric surgery from January to December 2013 with a minimum follow-up of 3 years were included in the study. Their demographic, preoperative, and postoperative data were prospectively maintained on Microsoft Office Excel and analyzed statistically.

Results

One hundred seventy-eight patients (157 lap. sleeve gastrectomy and 21 patients lap. RYGB) completed 3 years of follow-up. In the LSG group, patients had a pre-operative BMI 44.8?±?8.33 kg/sq. m (mean ± S.D.) and excess body weight 52.3?±?23.0 kg. In the RYGB group, pre-operative BMI was 42.7?±?8.82 kg/sq. m and excess body weight 45?±?18.7 kg. In the LSG group, % excess weight loss (EWL) at 1 year was 87.6?±?24.4% and 3 years was 71.8?±?26.7%. In the RYGB group, % EWL at 1 year was 97.2?±?27.3% and at 3 years was 85.8?±?25.3%. Diabetes resolution was seen in 32 (80%) in LSG group and 11 (91.7%) in RYGB group (Figs. 1, 2, 3, and 4).

Conclusion

Our study reflects that there is no statistically significant difference between outcomes of sleeve gastrectomy and Roux-en-Y gastric bypass surgery in terms of weight loss and diabetes resolution at 3 years.

     

The Predictive Factors for Diabetic Remission in Chinese Patients with BMI &gt; 30 kg/m<Superscript>2</Superscript> and BMI &lt; 30 kg/m<Superscript>2</Superscript> Are Different

Introduction

Roux-en-Y gastric bypass has been proven to be beneficial for patients with obesity and type 2 diabetes mellitus (T2DM). In less-obese patient (BMI 30–35 kg/m²), surgical treatment is indicated when medication fails to control the T2DM. Asian develops diabetes at a lower BMI. For lower-BMI patients, the rate of diabetes amelioration varies significantly with patients of higher BMI after surgical treatment. The factors that contribute to the post-operative diabetes response rate in lower-BMI patients have not been elucidated.

Methods

Between 2010 and 2014, a total of 144 patients who underwent gastric bypass for the treatment of T2DM were included for study. Patients were divided into two groups for subgroup analysis, namely BMI >?30 kg/m² and BMI <?30 kg/m². Factors affecting the remission rate were examined.

Results

Of the studied patients, the DM remission rate for the high-BMI group (BMI >?30 kg/m²) was 80% (n?=?90) whereas for the lower BMI (BMI <?30 kg/m²) was 50% (n?=?54), p?<?0.001. For high-BMI group, low HbA1c and high fasting C-peptide are predictive factors whereas for lower-BMI group, along with elevated C-peptide level, disease duration is the positive predictive factor for DM remission.

Conclusion

Patients with BMI >?30 kg/m² and those with BMI <?30 kg/m² have distinct remission predicting factors. Low HbA1c is a predictor of remission in low-high-BMI patients while duration of diabetes is for high-low-BMI patients. C-peptide is a predictor of remission in both groups. Further large-scale studies are required to define the predictors of diabetes remission after gastric bypass in low- and high-BMI patients.

     

Morbidity Rates and Weight Loss After Roux-en-Y Gastric Bypass,Sleeve Gastrectomy,and Adjustable Gastric Banding in Patients Older Than 60 Years old: Which Procedure to Choose?

Background

As life expectancy increases, more elderly patients fit into the criteria for bariatric procedures. The aim of our study is to evaluate and compare the safety and efficacy of Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB) in patients older than 60.

Material and Methods

Between January 2005 and December 2013, 68 LAGB, 73 LSG, and 212 RYGB patients were 60 years or older at the time of primary procedure. A retrospective review was performed in these patients.

Results

Mean age and body mass index (BMI) was 62.7?±?2.2, 64.1?±?2.9, and 62.6?±?2.3 years and 42.7?±?5.6, 44.0?±?7.0, and 45.2?±?6.7 kg/m² for LAGB, LSG, and RYGB at the time of procedure, respectively.Seven (10.3 %) patients from the LAGB, 3 (4.1 %) from the LSG, and 29 (13.8 %) from the RYGB group required readmissions. Reoperation rate was 10.3, 1.4, and 9.5 % in LAGB, LSG, and RYGB, respectively. The difference in reoperation rates was statistically significant (p?<?0.03) while that in readmission rates was not (p?>?0.58). Procedure-related mortality rate was 1.4 % in the RYGB group, while no mortality was observed in LSG and LAGB groups. At 6, 12, and 18 months postoperatively, mean percentage of excess weight loss were highest in the RYGB group, followed by LSG and LAGB group (p?<?0.01). Mean number of comorbidities at the last follow-up significantly decreased in LSG and RYGB patients.

Conclusions

LSG showed the lowest readmission and reoperation rate, and RYGB patients had the highest mortality rate. Weight loss and comorbidity resolution were effectively achieved in RYGB and LSG patients.

     

Preoperative Prediction of Type 2 Diabetes Remission After Gastric Bypass Surgery: a Comparison of DiaRem Scores and ABCD Scores

Background

Gastric bypass surgery has been well accepted as a novel treatment modality for type 2 diabetes mellitus (T2DM) in obese patients. Some scoring systems have been proposed for the selection of T2DM patients who are eligible for gastric bypass surgery. This study compares two scoring systems with regard to remission of T2DM after gastric bypass surgery.

Methods

This retrospective cohort study included 245 patients (150 females and 95 males) who had undergone gastric bypass surgery for the treatment of T2DM with 1 year follow-up. We examined the predictive power of complete remission of two scoring systems, the DiaRem score, and the ABCD score. The DiaRem score includes the factors of age, HbA1c, medication, and insulin usage. The ABCD score includes the factors of age, BMI, C-peptide level, and duration of T2DM. The rate of remission of T2DM after gastric bypass surgery was evaluated using both scoring systems.

Results

At 1 year after surgery, the percent weight loss was 26.5 % and the mean BMI decreased from 35.7 to 26.2 kg/m². The mean HbA1c decreased from 8.8 to 6.2 %. A significant number of patients showed improvement in glycemic control, including 130 (53.1 %) patients with complete remission (HbA1c?<?6.0 %), 36 (14.7 %) patients with partial remission (HbA1c?<?6.5 %), and 26 (10.6 %) patients with improvement (HbA1c?<?7 %). Both the DiaRem score and the ABCD score predicted the success of the gastric bypass surgery, but the ABCD score was better at differentiating patients with poorer score (27.9 vs. 9.1 %, p?<?0.001).

Conclusions

Gastric bypass surgery is a treatment option for obese T2DM patients. The ABCD score is better at predicting T2DM remission at 1 year after gastric bypass surgery than the DiaRem score.

     

Ethnicity Does Not Influence Glycemic Outcomes or Diabetes Remission After Sleeve Gastrectomy or Gastric Bypass in a Multiethnic Asian Cohort

Background

In Asia, metabolic-bariatric surgery (MBS) rates have grown rapidly in parallel with rising prevalence of obesity and type 2 diabetes (T2D).

Objective

The objective of this study was to identify factors that influence glycemic outcomes and diabetes remission 12 months after sleeve gastrectomy (SG) or gastric bypass (GB) in a multiethnic Asian cohort.

Setting

The study’s setting was in a tertiary hospital in Singapore.

Methods

Data from 145 T2D patients who had SG (37%) or GB (63%) and at least 1-year follow-up were analyzed. Diabetes remission was defined as hemoglobin A1c ≤?6.0% without diabetes medications. Analysis involved binary logistic regression to identify predictors and general linear regression for variables associated with glycemic improvement after surgery.

Results

Baseline parameters are as follows: BMI 40.0?±?7.6 kg/m², A1c 8.4?±?1.6%, diabetes duration 9.3 years, ethnic composition: Chinese (51.7%), Malay (23.4%), Indian (20.7%), Others (4.1%). 55.9% achieved diabetes remission at 1 year. Baseline A1c, baseline BMI, and diabetes duration were significant pre-operative factors for remission (cumulative R ²?=?0.334). At 12 months, percentage weight loss was similar after SG (24.1?±?7.4%) and GB (25.4?±?7.4%, p?=?0.31). Greater A1c decrease was seen with GB compared to SG (2.7?±?1.6 vs 2.0?±?1.5%, p?=?0.006), significant even after adjustment for weight loss, age, BMI, baseline A1c, and diabetes duration (p?=?0.033). Weight loss at 12 months also correlated independently with A1c reduction. Ethnicity did not influence weight loss, diabetes remission, or glycemic control after MBS.

Conclusion

Baseline A1c, baseline BMI, and diabetes duration independently predict diabetes remission after MBS. GB is more effective in controlling T2D compared to SG despite similar weight loss, whereas ethnicity does not play a significant role in the multiethnic Asian cohort.

     

Incidence,Indications, and Predictive Factors for ICU Admission in Elderly,High-Risk Patients Undergoing Laparoscopic Sleeve Gastrectomy

Background

Obesity affects the elderly, leading to increased prevalence of age- and obesity-associated comorbidities. There are no guidelines for indications and risk assessment for the elderly undergoing bariatric surgery.

Objectives

To determine the incidence, indications, and outcomes of planned ICU admission in elderly, high-risk patients after laparoscopic sleeve gastrectomy (LSG) and to assess if preoperative risk factors for planned postoperative ICU admission in elderly patients undergoing LSG could be predicted preoperatively.

Methods

Retrospective review of prospectively collected data for all patients aged ≥?60 years who underwent LSG (2011–2016) at Hamad General Hospital in Qatar.

Results

We followed up 58 patients aged 60–75 years for 28?±?17 months. About 77.6% of patients were in the intermediate-risk group of the Obesity Surgery Mortality Risk Score (OS-MRS). Fourteen patients (24%) required ICU admission for 2?±?1.2 days; all patients belonged to the American Society of Anesthesiologists (ASA) III class and intermediate to high risk on OS-MRS. There were no reported mortalities. The mean body mass index (BMI) decreased from 49?±?10.6 to 37.6?±?10.1 kg/m². The number of patient comorbidities (OR, 1.43; 95% CI, 1.03–1.99) and the diagnosis of obstructive sleep apnea (OSA; OR, 7.8; 95% CI, 1.92–31.68) were associated with planned ICU admission.

Conclusion

Elderly patients undergoing LSG usually have excellent postoperative course despite the associated high risk and the required ICU admission. The number of comorbidities, diagnosis of OSA, and ASA score are possible clinically significant predictive factors for the need of post-LSG ICU admission.

     

Portion Control Eating—a Determinant of Bariatric Outcomes

Introduction

Bariatric surgery leads to significant weight loss but the results vary. Application of dietary principles like portion-controlled eating leads to greater weight loss and fewer complications.

Aims

To evaluate the improvement in weight loss outcomes by incorporating portion-controlled eating behavior in postbariatric patients.

Methods

All patients who underwent bariatric surgery from January 2012 to December 2013 were included in the study. Portion-controlled eating behavior was incorporated in the post-bariatric nutritional protocol. Their demographic, preoperative, and postoperative data were prospectively maintained on Microsoft Office Excel and analyzed statistically.

Results

Three hundred and seventy-two (89.6%) underwent laparoscopic sleeve gastrectomy (LSG), while 43 (10.4%) underwent laparoscopic Roux-en-Y gastric bypass (RYGB). In the LSG group, lowest (nadir) BMI was 28.99?±?5.6 kg/m² and % Excess weight loss (EWL) was 87.3?±?27.2%, achieved between 1 and 2 years. In the RYGB group, lowest (nadir) BMI was 27.5?±?12.09 kg/m and % EWL was 94.32?±?33.12%. Surgical failure (less than 50% EWL) were 10 (3.27%) in the LSG group and 1 (3%) in the RYGB group. There were no leaks reported in our study.

Conclusion

Our study highlights the importance of postoperative nutritional interventions like portion-controlled eating for successful bariatric outcome.

     

Results of Laparoscopic Sleeve Gastrectomy in 541 Consecutive Patients with Low Baseline Body Mass Index (30–35 kg/m<Superscript>2</Superscript>)

Background

Laparoscopic sleeve gastrectomy (LSG) is currently the leading bariatric procedure and targets, among other obesity classes, patients with BMI 30–35 kg/m², which are reaching alarming proportions.

Methods

Between February 2010 and August 2015, data on 541 consecutive patients with BMI 30–35 kg/m² undergoing LSG were prospectively collected and analyzed.

Results

Mean age was 32?±?8 years (13–65) and 419 (77.4 %) were women. Preoperative weight was 92.0?±?8.8 kg (65–121) and BMI was 32.6?±?1.5 kg/m² (30–35). Comorbidities were detected in 210 (39 %) patients. Operative time was 74?±?12 min (40–110) and postoperative stay was 1.7?±?0.22 days (1–3). There were no deaths, leaks, abscesses or strictures and the rate of hemorrhage was 1.2 %. At 1 year, 98 % were followed and BMI decreased to 24.7?±?1.6, the percentage of total weight loss (% TWL) was 24.1?±?4.7 while the percentage of excess BMI loss (%EBMIL) reached 106.1?±?24.1. At 5 years, 76 % of followed patients achieved a ≥50 % EBMIL.

Conclusion

With appropriate surgical expertise, LSG in patients with BMI 30–35 kg/m² achieved excellent outcomes with a zero fistula rate.

     

Investigating Nutritional Deficiencies in a Group of Patients 3 Years Post Laparoscopic Sleeve Gastrectomy

Background

Laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure has shown to be effective in achieving significant weight loss and resolving obesity-related co-morbidities. However, its nutrition consequences have not been extensively explored. This study aims to investigate weight loss and evolution of nutritional deficiencies in a group of patients 3 years post LSG.

Methods

Retrospective data of a group of patients, 3 years following LSG as a stand-alone procedure was collected. Data included anthropometry, nutritional markers (hemoglobin, iron studies, folate, calcium, iPTH, vitamins D, and B₁₂), and compliancy with supplementations.

Results

Ninety-one patients (male/female; 28:63), aged 51.9?±?11.4 years with a BMI of 42.8?±?6.1 kg/m² were identified to be 3 years post LSG. Percentage of weight loss at 1 and 3 years post-operatively was 29.8?±?7.0 and 25.9?±?8.8 %, respectively. Pre-operatively, the abnormalities included low hemoglobin (4 %), ferritin (6 %), vitamin B₁₂ (1 %), vitamin D (46 %), and elevated iPTH (25 %). At 3 years post-operatively, the abnormal laboratory values included low hemoglobin (14 % females, P?=?0.021), ferritin (24 %, P?=?0.011), vitamin D (20 %, P?=?0.018), and elevated iPTH (17 %, P?=?0.010). Compliancy with multivitamin supplementation was noted in 66 % of patients.

Conclusion

In these patients, LSG resulted in pronounced weight loss at 1 year post-operatively, and most of this was maintained at 3 years. Nutritional deficiencies are prevalent among patients prior to bariatric surgery. These deficiencies may persist or exacerbate post-operatively. Routine nutrition monitoring and supplementations are essential to prevent and treat these deficiencies.

     

Early Weight Loss as a Predictor of 2-Year Weight Loss and Resolution of Comorbidities After Sleeve Gastrectomy

Background

The objective of this study was to investigate whether early postoperative weight loss predicts weight loss 1 and 2 years after laparoscopic sleeve gastrectomy (LSG) and to determine its effect on the resolution of comorbidities.

Methods

This was a prospective study of patients who underwent LSG at Jordan University Hospital from February 2009 to January 2014.

Results

One hundred ninety patients (mean age 34.0?±?10.8 years; mean preoperative body mass index 46.2?±?7.7 kg/m²) were included in the study. Of these, 146 were followed for 1 year and 73 were followed for 2 years. Thirty patients (20.5 %) had hypertension, 23 (15.8 %) had diabetes, 78 (53.4 %) had hyperlipidemia, 30 (20.5 %) had obstructive sleep apnea, and 50 (34.2 %) had more than one comorbidity. The percentage of excess weight loss (%EWL) was 22.7?±?8.1, 75.1?±?22.8, and 72.6?±?17.5 at 1, 12, and 24 months, respectively. Fifty-five patients (37.7 %) had a 1-year %EWL of ≥80 %, and 29 (39.7 %) had a 2-year %EWL of ≥80 %. Linear regression analysis showed a strong correlation between 1-month %EWL and %EWL at 1 year (r ²?=?0.23, p?<?0.001) and 2 years (r ²?=?0.28, p?<?0.001). Resolution of comorbidities was associated with higher %EWL achieved at 1 year, but early postoperative weight loss did not have a significant effect on comorbidity resolution.

Conclusions

Early postoperative weight loss can be used to identify and target poor responders.

     

Increased Metabolic Benefit for Obese,Elderly Patients Undergoing Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Purpose

We sought to assess outcomes of laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB) in a cohort of morbidly obese, elderly patients.

Materials and Methods

Retrospective review was conducted of all patients age 60 years or greater undergoing LSG or LRYGB at our institution between 2007 and 2014.

Results

A total of 134 patients who underwent LSG (n = 65) or LRYGB (n = 69) were identified. Groups were similar with respect to age (64 years, range 60–75 years), BMI (44.0 ± 6.1), and ASA score (91% ≥ ASA 3). There were no differences in major post-operative complications (3, 4.7% LSG vs 4, 5.8% LRYGB, p = 0.75). Median follow-up was 39 months (IQR 14–64 months) with no patients lost to follow-up. Patients undergoing LRYGB had improvement in each of diabetes mellitus 2 (DM2), hypertension (HTN), hyperlipidemia (HL), and gastroesophageal reflux disease (GERD) as well as a significant decrease in insulin use (16/47, 34.0% pre-operatively vs 7/47, 15.2% post-operatively; p = 0.03). Patients undergoing LSG had improvement in DM2 and HTN but not in HL or GERD; there was no reduction in insulin dependence. Weight loss was not significantly different between groups; mean percent total weight loss at 36 months was 26.9 ± 9.0% in the LSG group and 23.9 ± 9.3% in the LRYGB group, p = 0.24.

Conclusions

Both LSG and RYGB can be safely performed on morbidly obese, elderly adults. At intermediate follow-up, there is an increased metabolic benefit for elderly patients undergoing LRYGB over LSG.

     

Long-Term Outcomes of Three Types of Bariatric Surgery on Obesity and Type 2 Diabetes Control and Remission

Background

Different bariatric surgeries have demonstrated different effectiveness for weight loss and glucose control in obese persons with diabetes, over a short follow-up time. The aim of this study was to compare weight loss, glucose control, and diabetes remission in individuals with type 2 diabetes, after three types of bariatric surgery: gastric banding (GB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB), with 5 years follow-up.

Methods

A retrospective study was conducted on bariatric surgeries performed during 2002–2011 in a large nationwide healthcare organization.

Results

Of 2190 patients, 64.8 % were women. The operations performed were 1027 GB, 1023 SG, and 140 RYGB. Mean BMI?±?SD at baseline, 1 year postoperatively, and 5 years postoperatively were 43.5?±?6.18, 37.1?±?6.35, and 35.5?±?6.48 for GB; 43.6?±?6.42, 34.4?±?6.08, and 35.3?±?6.7 for SG; and 42.8?±?5.81, 32.8?±?4.9, and 34.1?±?5.09 for RYGB. Mean HbA1c?±?SD at baseline, 1 year postoperatively, and 5 years postoperatively were 7.6?+?1.58, 6.5?+?1.22, and 6.8?+?1.48 for GB; 7.7?+?1.63, 6.4?+?1.18, and 6.7?+?1.57 for SG; and 8.0?+?1.78, 6.3?+?0.98, and 7.04?+?1.42 for RYGB. At 1 year follow-up, 53.2 % had achieved remission; at 5 years, 54.4 %. Remission rates at 5 years were similar for the three surgeries. Five-year remission was inversely associated with baseline HbA1c and with treatment with insulin at baseline and positively associated with BMI.

Conclusions

For all three surgeries, diabetes remission was higher than the baseline after 5 years; mean BMI and HbA1c decreased considerably during the first year postoperatively and remained lower than basal values throughout follow-up. Early improvements were greatest for RYGB, though the advantage over the other operations diminished with time.

     

The Effects of Laparoscopic Sleeve Gastrectomy on Obesity-Related Hypertriglyceridemia-Induced Acute Pancreatitis

Background

Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is a significant clinical problem and is characterized by high recurrence rate compared with non-HTG-AP. The objective of this study was to investigate the effects of laparoscopic sleeve gastrectomy (LSG) on obesity-related HTG-AP.

Methods

Twenty-nine patients with obesity-related HTG-AP were admitted to our hospital and treated with the conventional therapy or LSG surgery according to the wishes of patients. Clinical data and the recurrence rate of AP were collected at baseline and at four different time points (3, 6, 9, and 12 months) after the treatments for all patients.

Results

Of the 29 patients, 28 patients (19 patients with conventional therapy and 9 patients with LSG surgery) completed the 12-month follow-up. Clinical data and the severity scores of AP were comparable at baseline when the patients were admitted to the intensive care unit. The LSG group experienced a large weight loss (percent total weight loss, 26.87?±?1.44%; percent excess weight loss, 79.56?±?1.37%) and triglyceride reduction (from 15.77?±?1.02 to 1.36?±?0.09 mmol/L), and no recurrence was observed at 12 months after the surgery. In the conventional treatment group, however, body weight was not changed although triglyceride was significantly decreased (from 17.34?±?1.29 to 8.25?±?1.12 mmol/L), and more importantly, 47.4% of the patients had at least one recurrence of AP in 12 months after the treatment.

Conclusions

LSG might be an effective way to cure obesity-related HTG-induced AP since it prevents the recurrence of this disease. Further randomized studies will be needed to standardize this way of treatment.

     

Trends in Early Morbidity and Mortality after Sleeve Gastrectomy in Patients over 60 Years

Background

The population are getting older and obesity is growing. Laparoscopic sleeve gastrectomy (LSG) is increasingly used worldwide but is still used with skepticism in the elderly. The purpose of our analysis is to judge the security of LSG in patients older than 60 years compared to patients younger than 60 years.

Methods

This retrospective review included data of all patients in Germany who underwent LSG between January 2005 and December 2016.The data were published online in the German Bariatric Surgery Registry. A total of 21,571 operations were gathered and divided into two groups: group I, patients <?60 years old; and group II, patients ≥?60 years old.

Results

The total number of patients and the mean body mass index of group I and group II was 19,786, 51.7?±?9.5 kg/m² and 1771, 49.2?±?8.1 kg/m², respectively. Regarding comorbidities, group II suffered statistically significantly more comorbidities than group I (p?<?0.001). The general postoperative complications were 4.9% in group I and 7.8% in group II (p?<?0.001). There was no significant difference in special postoperative complications (p?=?0.048) and a slightly higher intraoperative complication rate in group II (2.2% vs. 1.6%, p?=?0.048). Thirty-day mortality rate for group I versus II was 0.22% and 0.23% (p?=?0.977), respectively.

Conclusions

LSG is a low-risk operation and safe surgical method with acceptable, not elevated perioperative morbidity and mortality rates in patients ≥?60 years of age.

     

Efficacy of Bariatric Surgery in Type 2 Diabetes Mellitus Remission: the Role of Mini Gastric Bypass/One Anastomosis Gastric Bypass and Sleeve Gastrectomy at 1 Year of Follow-up. A European survey

Background

A retrospective study was undertaken to define the efficacy of both mini gastric bypass or one anastomosis gastric bypass (MGB/OAGB) and sleeve gastrectomy (SG) in type 2 diabetes mellitus (T2DM) remission in morbidly obese patients (pts).

Methods

Eight European centers were involved in this survey. T2DM was preoperatively diagnosed in 313/3252 pts (9.62 %). In 175/313 patients, 55.9 % underwent MGB/OAGB, while in 138/313 patients, 44.1 % received SG between January 2006 and December 2014.

Results

Two hundred six out of 313 (63.7 %) pts reached 1 year of follow-up. The mean body mass index (BMI) for MGB/OAGB pts was 33.1?±?6.6, and the mean BMI for SG pts was 35.9?±?5.9 (p?<?0.001). Eighty-two out of 96 (85.4 %) MGB/OAGB pts vs. 67/110 (60.9 %) SG pts are in remission (p?<?0.001). No correlation was found in the % change vs. baseline values for hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) in relation to BMI reduction, for both MGB/OAGB or SG (ΔFPG 0.7 and ΔHbA1c 0.4 for MGB/OAGB; ΔFPG 0.7 and ΔHbA1c 0.1 for SG). At multivariate analysis, high baseline HbA1c [odds ratio (OR)?=?0.623, 95 % confidence interval (CI) 0.419–0.925, p?=?0.01], preoperative consumption of insulin or oral antidiabetic agents (OR?=?0.256, 95 % CI 0.137–0.478, p?=?<0.001), and T2DM duration >10 years (OR?=?0.752, 95 % CI 0.512–0.976, p?=?0.01) were negative predictors whereas MGB/OAGB resulted as a positive predictor (OR?=?3.888, 95 % CI 1.654–9.143, p?=?0.002) of diabetes remission.

Conclusions

A significant BMI decrease and T2DM remission unrelated from weight loss were recorded for both procedures if compared to baseline values. At univariate and multivariate analyses, MGB/OAGB seems to outperform significantly SG. Four independent variables able to influence T2DM remission at 12 months have been identified.