|
1
|
Sánchez-Pernaute A, Lasses B, Antoñanzas LL, Rubio MÁ, Marcuello C, Ferré NP, Torres A, Pérez-Aguirre E. Revisional surgery for malnutrition after SADI-S: prevalence, indications, techniques and outcomes. Updates Surg 2024; 76:1879-1885. [PMID: 38805173 PMCID: PMC11455684 DOI: 10.1007/s13304-024-01900-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
KEY POINTS SADIS with short common limb (< 250 cm) is a malabsorptive operation. Reoperation is advised in patients requiring admission for severe malnutrition. Elongation of the common channel is the preferred revisional technique Introduction: Single-Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy (SADI-S) is a modification of the duodenal switch. Initial common channel's length was 200, and after malnutrition was detected in some patients, it was elongated to 250 or 300 cm. The present study analyzes presentation and treatment of malnutrition after SADI-S. MATERIALS Three hundred and thirty-three consecutive patients undergoing SADI-S between May 2007 and February 2019 were included. The common limb length was 200 cm in 50 cases, 250 cm in 211, 300 in 71 and 350 in 1. Thirty-one patients were admitted for severe hypoalbuminemia and 17 patients were submitted to revisional surgery, and constitute the series of our study. Mean weight before reoperation was 57 kg and mean body mass index (BMI) was 21 kg/m2. Mean number of daily bowel movements was 5,6. RESULTS Mean time to reoperation was 56 months. The limb was found shorter than expected in 6 cases. Revisional surgery was conversion into a Roux en Y duodenal switch in 3 cases, elongation of the common limb in 11 patients, duodeno-duodenostomy in 1 and duodeno-jejunostomy to the first jejunal loop in 2. Mean weight regain was 14 kg, and mean final BMI 26 kg/m2. Daily bowel movements were reduced to 1,3. Factors related to hypoalbuminemia were hypertension, poor-controlled diabetes, shorter common limb and liver-test alterations. CONCLUSION SADI-S is expected to be less malabsorptive than previous biliopancreatic diversions. However, caution must be taken with certain patients to avoid postoperative malnutrition. Adequate follow up with long-term supplementation is required.
Collapse
Affiliation(s)
- Andrés Sánchez-Pernaute
- Department of Surgery, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
| | - Bibiana Lasses
- Department of Surgery, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Leyre López Antoñanzas
- Department of Surgery, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel Ángel Rubio
- Department of Endocrinology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Clara Marcuello
- Department of Endocrinology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Natalia Pérez Ferré
- Department of Endocrinology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Torres
- Department of Surgery, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Elia Pérez-Aguirre
- Department of Surgery, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
|
2
|
Schiavo L, Busetto L, Cesaretti M, Zelber-Sagi S, Deutsch L, Iannelli A. Nutritional issues in patients with obesity and cirrhosis. World J Gastroenterol 2018; 24:3330-3346. [PMID: 30122874 PMCID: PMC6092576 DOI: 10.3748/wjg.v24.i30.3330] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to cirrhosis. Patients with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver cirrhosis. Sarcopenic obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronic liver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver transplantation. Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble, water-soluble vitamins and trace elements and should be supplemented appropriately. Diet, physical activity and protein intake should be carefully monitored in these fragile patients according to recent recommendations. Bariatric surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver transplantation. The risk of sarcopenia, micronutrient status, and the recommended supplementation in patients with obesity and cirrhosis are discussed in this review. Furthermore, the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.
Collapse
Affiliation(s)
- Luigi Schiavo
- Department of Translational Medical Science, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
- IX Division of General Surgery, Vascular Surgery and Applied Biotechnology, Naples University Policlinic, Naples 80131, Italy
| | - Luca Busetto
- Department of Medicine, University of Padua, Padua 35128, Italy
- Center for the Study and the Integrated Management of Obesity, University Hospital of Padua, Padua 35128, Italy
| | - Manuela Cesaretti
- Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, AP-HP, Clichy 92110, France
- Department of Nanophysics, Italian Institute of Technology, Genova 16163, Italy
| | - Shira Zelber-Sagi
- School of Public Health, University of Haifa, Haifa 3498838, Israel
- Department of Gastroenterology and Liver disease, Tel Aviv Medical Center, 62431, Tel-Aviv 62431, Israel
| | - Liat Deutsch
- Department of Gastroenterology and Liver disease, Tel Aviv Medical Center, 62431, Tel-Aviv 62431, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 62431, Israel
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, F-06202, Nice, France; Inserm, U1065, Team 8 “Hepatic complications of obesity”, Nice F-06204, France
- University of Nice Sophia-Antipolis, Nice F-06107, France
| |
Collapse
|
|
3
|
Medium-Term Results of Combined Laparoscopic Sleeve Gastrectomy and Modified Jejuno-Ileal Bypass in Bariatric Surgery. Obes Surg 2017; 26:2316-23. [PMID: 26922187 DOI: 10.1007/s11695-016-2098-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The ideal bariatric operation achieves 70-100 % maintained excess weight loss, is simple with low operative risks, and maintains absorption of trace elements. Our aim was to find a bariatric procedure that achieves the above while avoiding drawbacks of current options. METHODS A standard sleeve gastrectomy was combined with a modified jejuno-ileal bypass dividing the small bowel 75 cm distal to the duodeno-jejunal flexure, anastomosing it to the ileum 75 cm proximal to the ileocaecal valve. Operative and follow-up data were collected prospectively between December 2004 and January 2013. RESULTS One hundred sixty-eight procedures were analysed (110 female, 58 male). Mean patient age was 43 years (IQR 37-47), and median preoperative body mass index (kg/m(2)) was 52 (IQR 49-59). All operations were completed laparoscopically. Excess weight loss was 78 % (IQR 70-83 %, 12 months, n = 168), 79 % (IQR 70-85 %, 24 months), maintained at most recent follow-up with 77 % (IQR 68-84 %, n = 168), and for 8 year follow-up alone 75 % (IQR 66-84 %, n = 18). There was no operative mortality and 5.4 % morbidity. A 6.5 % of patients experienced transient vomiting. No symptoms of dumping or bacterial overgrowth were observed. All had normal liver enzymes. Hypocalcaemia (20.8 %) and zinc deficiency (25.6 %) resolved with oral supplementation. Type 2 diabetes mellitus resolved in 80.3 % and improved in the remainder of patients, hypertension resolved in 92.3 % and improved in the rest. CONCLUSIONS Whilst currently an investigative procedure, and within the studies limitations combined sleeve gastrectomy with modified jejuno-ileal bypass is safe and effective, and evades many problems associated with current bariatric operations whilst offering maintained excess weight loss.
Collapse
|
|
4
|
Angelakis E, Lagier JC. Samples and techniques highlighting the links between obesity and microbiota. Microb Pathog 2016; 106:119-126. [PMID: 26828871 DOI: 10.1016/j.micpath.2016.01.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/23/2016] [Accepted: 01/28/2016] [Indexed: 12/17/2022]
Abstract
The composition of gut microbiota and its relationship to human health, particularly its links with obesity remain an ongoing challenge for scientists. The current gold standard for exploring human gut microbiota consists of using stool samples and only applying next generations sequencing techniques, which sometimes generate contradictory results. Here, we comprehensively describe nutrient absorption, fat digestion, carbohydrate and protein absorption, demonstrating that absorption of these diverse nutrients occurs mainly in the stomach and small intestine. Indeed, bariatric surgery, including Roux-en-Y, removes part of the upper intestine, resulting in weight loss, while colonic surgery is associated with a stable weight. However, most studies only use stool samples rather than small intestine samples because of the easy with which this can be accessed. Metagenomics studies are associated with several biases such as extraction and primer biases and depth bias, including the more modern platforms. High-throughput culture-dependent techniques, such as culturomics, which uses rapid identification methods such as MALDI-TOF, remain time-consuming, but have demonstrated their complementarity with molecular techniques. In conclusion, we believe that a comprehensive analysis of the relationships between obesity and gut microbiota requires large-scale studies coupling metagenomics and culture-dependent research, in order to analyse both small intestine and stool samples.
Collapse
Affiliation(s)
- Emmanouil Angelakis
- Aix-Marseille Université URMITE, UM63, IHU Méditerranée Infection, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Jean-Christophe Lagier
- Aix-Marseille Université URMITE, UM63, IHU Méditerranée Infection, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France.
| |
Collapse
|
|
5
|
Carubbi F, Ruscitti P, Pantano I, Alvaro S, Benedetto PD, Liakouli V, Giuliani A, Piccione F, Ciccia F, Amicucci G, Triolo G, Giacomelli R, Cipriani P. Jejunoileal bypass as the main procedure in the onset of immune-related conditions: the model of BADAS. Expert Rev Clin Immunol 2013; 9:441-52. [PMID: 23634738 DOI: 10.1586/eci.13.26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bariatric surgery represents a common approach for the control of severe morbid obesity, reducing caloric intake by modifying the anatomy of the gastrointestinal tract. Following jejunoileal bypass, a large spectrum of complications has been described, with rheumatic manifestation present in up to 20% of cases. Although bowel bypass syndrome, also called blind loop syndrome, is a well-recognized complication of jejunoileal bypass, the same syndrome was recognized in patients who had not had intestinal bypass surgery, and the term the 'bowel-associated dermatosis-arthritis syndrome' (BADAS) was coined. The pathogenesis of BADAS is as yet poorly understood and only few data concerning this issue have been published in the literature. The aim of the present paper is to review the literature and to discuss putative pathogenic mechanisms of BADAS, focusing on the immune system.
Collapse
Affiliation(s)
- Francesco Carubbi
- Department of Clinical Science and Biotechnology, Rheumatology Unit, University of L'Aquila, L'Aquila, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
6
|
[Acute liver failure after bariatric surgery. A case report and literature review]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 36:76-80. [PMID: 23218652 DOI: 10.1016/j.gastrohep.2012.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 06/12/2012] [Accepted: 06/28/2012] [Indexed: 12/15/2022]
Abstract
Non-alcoholic fatty liver disease is common among morbidly obese people. Bariatric surgery is increasingly used in this population to control weight but is not free of risks. We present the case of a 28-year-old morbidly obese woman who underwent gastroplasty with intestinal resection and a gastro-jejunal anastomosis. Eleven months later, and with a weight reduction of 35%, the patient developed acute liver failure. A biopsy showed severe steatohepatitis and fibrosis. After prolonged hospital stay and management that consisted of support measures, nutritional assistance, N-acetyl cysteine, zinc and vitamin E, liver function was restored. A follow-up biopsy showed marked regression of the initial findings. Bariatric surgery has many beneficial effects. However, even with the most up-to-date techniques, complications can occur. Familiarity with these complications is important for their prevention and treatment.
Collapse
|
|
7
|
Affiliation(s)
- Vivek N Prachand
- Department of Surgery, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue MC 5036, Chicago, IL, 60637, USA.
| | | |
Collapse
|
|
8
|
Alverdy JC, Prachand V, Flanagan B, Thistlethwaite WA, Siegler M, Garfinkel M, Angelos P, Agarwal S, Santry H. Bariatric surgery: a history of empiricism, a future in science. J Gastrointest Surg 2009; 13:465-77. [PMID: 19005732 DOI: 10.1007/s11605-008-0742-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 10/28/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND The observation that obesity can be successfully treated by gastrointestinal surgery is a tribute to the innovative efforts by determined surgeons and the ever improving safety of general anesthesia. Yet as the body of knowledge and discovery on the root causes of human obesity accumulate, surgical approaches to treat morbid obesity are likely to change dramatically. While there is little doubt that dramatic weight loss can be achieved by surgically creating volume and absorption limitation to the reservoir and digestive functions of the gastrointestinal tract, human progress to more processed foods, less physical activity, and the pervasive public opinion that obesity is self-imposed are major obstacles to more widespread application of this approach. DISCUSSION Here we provide a mechanico-physiologic analysis of current operations, their rationale and limitations, as well as a glimpse of how future interventions might develop as a result of current knowledge in the field. The future of bariatric surgery is discussed in the context of these emerging technologies and in the context of the politics of obesity.
Collapse
Affiliation(s)
- John C Alverdy
- Department of Surgery and Medicine, University of Chicago, 5841 S. Maryland MC 6090, Chicago, IL, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
9
|
D'Albuquerque LAC, Gonzalez AM, Wahle RC, de Oliveira Souza E, Mancero JMP, de Oliveira e Silva A. Liver transplantation for subacute hepatocellular failure due to massive steatohepatitis after bariatric surgery. Liver Transpl 2008; 14:881-5. [PMID: 18508357 DOI: 10.1002/lt.21472] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
New therapeutic options for obesity include restrictive bowel surgery and surgery that promotes malabsorption, such as the Fobi-Capella (gastric bypass) and Scopinaro (biliopancreatic diversion) techniques. Complications associated with these procedures, such as hepatocellular failure, have been observed with increasing frequency. Reported here are 3 patients who, 7 to 24 months after bariatric surgery, developed hepatocellular failure, for which liver transplantation was considered to be indicated. Liver transplantation was undertaken in 2 of the patients; the third patient died while waiting for this procedure. We discuss the possible causes of this uncommon and poorly understood complication of surgery for obesity. One possibility is that it might arise as a result of progression of steatohepatitis. An alternative concept is that this complication may be secondary to rapid, massive loss of body weight.
Collapse
|
|
10
|
Gonzalez F, Kerdraon O, Arnalsteen L, Pattou F, Leteurtre E, Proye C, Paris JC, Mathurin P. [Effects of bariatric surgery on the liver]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2005; 29:280-6. [PMID: 15864179 DOI: 10.1016/s0399-8320(05)80762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Florent Gonzalez
- Services des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Claude Huriez, CHRU de Lille
| | | | | | | | | | | | | | | |
Collapse
|
|
11
|
Picard M, Frédéric Simon H, Stéfane L, Simon M, Simon B. Complications of combined gastric restrictive and malabsorptive procedures: part 2. ACTA ACUST UNITED AC 2004; 60:274-9; discussion 279-81. [PMID: 14972252 DOI: 10.1016/s0149-7944(02)00791-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marceau Picard
- Department of Surgery, Laval Hospital, Laval University, Quebec City, Canada
| | | | | | | | | |
Collapse
|
|
12
|
Johnston KL, Lamport AI, Ballèvre OP, Batt RM. Effects of oral administration of metronidazole on small intestinal bacteria and nutrients of cats. Am J Vet Res 2000; 61:1106-12. [PMID: 10976744 DOI: 10.2460/ajvr.2000.61.1106] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine effects of oral administration of metronidazole on the number and species of duodenal bacteria and selective nutrients of cats. ANIMALS 6 healthy domestic shorthair cats. PROCEDURE Undiluted duodenal fluid was obtained for quantitative and qualitative bacterial culture to determine species and number of bacteria in healthy cats. Blood samples were assayed for taurine, total protein, albumin, cobalamin, and folate concentrations. Cats then were given metronidazole (20 mg/kg of body weight, PO, q 12 h) for 1 month, after which bacterial cultures and serum assays of nutrients were repeated. Nine months after cessation of antibiotic treatment, duodenal bacteria were re-evaluated and serum was assayed for total protein, albumin, cobalamin, and folate concentrations. RESULTS Oral administration of metronidazole caused a significant decrease in aerobic and anaerobic bacterial counts in the duodenum of healthy cats, accompanied by emergence of Streptococcus spp and Corynebacterium spp. Serum concentrations of cobalamin and albumin increased when duodenal bacterial counts were decreased, although changes in folate or taurine concentrations were not detected. Measured variables did not differ, when comparing results obtained before and 9 months after cessation of metronidazole. CONCLUSIONS AND CLINICAL RELEVANCE Oral administration of metronidazole decreased the number of aerobic bacteria and altered indigenous flora in the small bowel of cats. Normal duodenal flora appeared to be stable, because species of bacteria were re-established by 9 months after cessation of metronidazole. Bacterial flora appeared to have an impact on nutrients, because albumin and cobalamin increased during antibiotic administration and returned to preadministration concentrations after cessation of the antimicrobial.
Collapse
Affiliation(s)
- K L Johnston
- Department of Small Animal Medicine and Surgery, The Royal Veterinary College, University of London, Hertfordshire, UK
| | | | | | | |
Collapse
|
|
13
|
De la malnutrition à la dénutrition. NUTR CLIN METAB 2000. [DOI: 10.1016/s0985-0562(00)80064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
|
14
|
Abstract
The medical risks of obesity increase exponentially as weight increases, and these risks are reduced by sustained weight loss. Behavior modification and dieting provide an approximately 6% loss of body weight at 1 year. Fenfluramine provides an approximately 8% weight loss at 1 year, which can be doubled to 16% when a drug such as phentermine, which works through a different biochemical mechanism, is added to it. This amount of weight loss is insufficient for many severely obese individuals. It was with these facts in mind that the National Institutes of Health Consensus Conference in 1992 recommended that obesity surgery is an appropriate treatment for patients with a body mass index greater than 40 kg/m2 who had failed in attempts at medical treatment and for patients with a body mass index greater than 35 kg/m2 with severe complications of obesity. Vertically banded gastroplasty and Roux-en-Y gastric bypass are the two operations presently recommended because of their relative safety and effectiveness. This article reviews previous procedures that have provided insight into the mechanisms by which these surgeries cause weight loss. The presently used surgeries and their results also are reviewed because until medical therapy improves substantially, surgery remains the most reasonable treatment option for most morbidly obese patients.
Collapse
Affiliation(s)
- F L Greenway
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, USA
| |
Collapse
|