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Shaw J, Eltenn J, Ferguson J, Obermaier H, Lord RV. Gastroesophageal reflux disease symptoms after sleeve gastrectomy with anterior hemifundoplication: a pilot study. ANZ J Surg 2025; 95:904-910. [PMID: 40071737 DOI: 10.1111/ans.70041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 02/05/2025] [Accepted: 02/09/2025] [Indexed: 05/27/2025]
Abstract
BACKGROUND Gastroesophageal reflux disease (GORD) is a significant problem after laparoscopic sleeve gastrectomy (SG). This study aimed to assess the long-term effect of SG with an anterior fundoplication on GORD symptoms. METHODS A single-centre cohort study of all patients who underwent SG with anterior hemifundoplication (SGAF), with a 2:1 SG only comparison group. GORD symptoms were assessed using a structured symptom questionnaire. RESULTS SGAF was performed in 36 patients between 2010 and 2015; 26 patients were available for follow-up and 17 of these were followed up for more than 6 years. The comparison group included 53 consecutive contactable patients who underwent SG without fundoplication during the same period. The two patient groups were similar with regard to pre-operative factors, weight loss, and weight regain. After 6 years, 12 (71%) of SGAF patients reported no GORD symptoms compared to 9 (17%) of SG patients. GORD symptoms were no worse in 21 (81%) following SGAF, whereas GORD symptoms worsened (worse or new symptoms) in 22 (58.5%) of patients after SG. PPI use was similar in both groups. Eight of 26 (31%) SGAF patients had some degree of fundoplication dilatation and underwent conversion to SG or RYGB. CONCLUSIONS SGAF provided superior control of symptomatic GORD than SG in this study. Fundoplication dilatation treated by conversion to standard SG was not uncommon and was the reason for suspending this series. Reducing intragastric pressure and reducing fundoplication volume may alleviate this problem, which may also be overestimated in this pilot study.
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Affiliation(s)
- Justin Shaw
- Department of Surgery, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Justin Eltenn
- Department of Surgery, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Jorgen Ferguson
- Department of Surgery, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Helena Obermaier
- Department of Surgery, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Reginald V Lord
- Department of Surgery, University of Notre Dame Australia, Sydney, New South Wales, Australia
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2
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Park KB, Jun KH. Bariatric surgery for treatment of morbid obesity in adults. Korean J Intern Med 2025; 40:24-39. [PMID: 39778524 PMCID: PMC11725483 DOI: 10.3904/kjim.2024.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/02/2024] [Accepted: 10/20/2024] [Indexed: 01/11/2025] Open
Abstract
Morbid obesity requires active intervention, with treatment options including lifestyle modification, pharmacotherapy, and surgery. As the prevalence of obesity continues to rise in Korea, it is crucial for specialists and general practitioners to have a comprehensive understanding of obesity and its management. Bariatric surgery is the most effective treatment modality for obesity, leading to significant weight loss and metabolic benefits. It involves surgical alterations of normal anatomical structures to improve overall health. Therefore, selecting the appropriate procedure based on the individual characteristics of patients is crucial. This review highlights the two most commonly performed bariatric procedures worldwide, including in Korea: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Furthermore, it provides a comprehensive overview of the surgical techniques involved in SG and RYGB, addresses potential complications, and presents findings from key studies on the weight loss and metabolic outcomes of these surgeries. Additionally, to support clinical application, the review provides outcome data for these procedures based on studies conducted in Korean populations. In addition to SG and RYGB, this review briefly introduces other surgical and endoscopic options, as well as pharmacological treatments that are currently available or may become viable options in the near future.
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Affiliation(s)
- Ki Bum Park
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Clinic of Metabolic and Bariatric Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kyong-Hwa Jun
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Clinic of Metabolic and Bariatric Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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3
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Pereira AM, Pereira SS, Monteiro MP, Guimarães M. Is single anastomosis duodenoileal bypass (SADI) an effective option for conversional surgery following sleeve gastrectomy? A comprehensive review and revised scope of current literature. Obes Res Clin Pract 2025; 19:1-10. [PMID: 39864989 DOI: 10.1016/j.orcp.2025.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 01/07/2025] [Accepted: 01/19/2025] [Indexed: 01/28/2025]
Abstract
BACKGROUND Conversional surgery following sleeve gastrectomy (SG) is required in about 20 % of patients due to suboptimal outcomes. Single anastomosis duodenoileal bypass (SADI) has emerged as an option for such cases, though long-term outcomes remain unclear. This review analyzed available data on SADI as a conversional or second-stage procedure after SG. METHODS A systematic search across PubMed, Web of Science, and Scopus included studies on adult patients who underwent SADI as a conversional or second-stage surgery following SG, with a minimum of 12 months' follow-up up to July 2024. RESULTS Nineteen studies involving 867 patients examined weight loss, comorbidity resolution, postoperative complications, and nutritional deficiencies. Results showed a total weight loss (TWL) of 24 % in the first year post-revision, with a trend toward weight stabilization or regain over two years. Maximum TWL (27 %) occurred at 24 months, decreasing to 24 % at 60 months. Average follow-up of 27 months showed remission rates for type 2 diabetes, hypertension, and dyslipidemia at 68 %, 53 %, and 37 %, respectively. Short-term morbidity within 30 days was 8 %, including a 5 % rate of anastomotic leaks or fistulas and a 5 % reoperation rate. Overall mortality was 2 %. CONCLUSION In conclusion, SADI shows promise as a safe and effective mid-term conversional surgery after SG with suboptimal results. However, further studies are needed to confirm its long-term safety and effectiveness.
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Affiliation(s)
- Ana Marta Pereira
- Unit for Multidisciplinary Research in Biomedicine (UMIB), School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal; Department of General Surgery, Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal; ITR- Laboratory of Integrative and Translocation Research in Population Health, Porto, Portugal
| | - Sofia S Pereira
- Unit for Multidisciplinary Research in Biomedicine (UMIB), School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal; ITR- Laboratory of Integrative and Translocation Research in Population Health, Porto, Portugal
| | - Mariana P Monteiro
- Unit for Multidisciplinary Research in Biomedicine (UMIB), School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal; ITR- Laboratory of Integrative and Translocation Research in Population Health, Porto, Portugal
| | - Marta Guimarães
- Unit for Multidisciplinary Research in Biomedicine (UMIB), School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal; Department of General Surgery, Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal; ITR- Laboratory of Integrative and Translocation Research in Population Health, Porto, Portugal.
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Son HJ, Gee DW, Gomez D, Jung JJ. The Obesity Paradox Revisited: Is Obesity Still a Protective Factor for Patients With High Comorbidity Burden or High-Complexity Procedures? ANNALS OF SURGERY OPEN 2024; 5:e531. [PMID: 39711668 PMCID: PMC11661752 DOI: 10.1097/as9.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 11/18/2024] [Indexed: 12/24/2024] Open
Abstract
Objective To investigate the relationship between obesity and postoperative mortality in the context of high procedural complexity and comorbidity burden. Background The "obesity paradox" suggests better postoperative outcomes in patients with higher body mass index (BMI), despite obesity's associated health risks. Research remains scarce on the influence of procedural complexity and comorbidities on the obesity-postoperative mortality relationship. Methods We performed an observational study of adult patients undergoing major surgery using the 2016 to 2019 National Surgical Quality Improvement Program database. The outcome was 30-day mortality. We first estimated the risk-adjusted effects of BMI on mortality across the full cohort via multivariable regression and restricted cubic spline models. Then, we investigated the subgroups stratified by procedural complexity and comorbidity burden using a modified Charlson Comorbidity Index (mCCI) and mortality probability. Results Among 3,085,582 patients, 47% had obesity. There was a reverse J-shaped relationship between BMI and mortality in the full cohort, consistent with the obesity paradox. However, no difference in odds of mortality was observed in patients with obesity who underwent high-complexity procedures compared with normal BMI counterparts (BMI 30-34.9: odds ratio, 0.93 [95% confidence interval: 0.86-1.01]; BMI 35-39.9: 0.92 [0.83-1.03]; BMI ≥ 40: 0.94 [0.83-1.07]), and in patients with obesity with high comorbidity burden (mCCI ≥ 8 [BMI 30-34.9: 0.95 (0.77-1.16); BMI 35-39.9: 0.78, (0.60-1.02); BMI ≥ 40: 0.84 (0.63-1.12)] and top 3% mortality probability [BMI 30-34.9: 0.96 (0.90-1.02); BMI ≥ 40: 0.94 (0.86-1.01)]). Conclusion Our findings suggest the existence of an obesity paradox in most adult surgical patients, yet the trend dissipates with high procedural complexity and comorbidity burden.
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Affiliation(s)
- Hyo Jin Son
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Denise W. Gee
- Division of General Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - David Gomez
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James J. Jung
- Division of Minimally Invasive Surgery, Department of Surgery, Duke University, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
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Lee S, Dang J, Chaivanijchaya K, Farah A, Kroh M. Endoscopic management of complications after sleeve gastrectomy: a narrative review. MINI-INVASIVE SURGERY 2024. [DOI: 10.20517/2574-1225.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Sleeve gastrectomy (SG) has become the most widely performed bariatric procedure globally due to its technical simplicity and proven efficacy. However, complications following SG, including bleeding, leakage, fistulas, stenosis, gastroesophageal reflux disease (GERD), and hiatal hernia (HH), remain a significant concern. Endoscopic interventions have emerged as valuable minimally invasive alternatives to traditional surgical approaches for managing these complications. This review aims to provide a comprehensive overview of the endoscopic management strategies available for addressing the various complications encountered after SG, emphasizing their critical role in optimizing patient outcomes.
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Tish S, Corcelles R. The Art of Sleeve Gastrectomy. J Clin Med 2024; 13:1954. [PMID: 38610719 PMCID: PMC11012326 DOI: 10.3390/jcm13071954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Sleeve gastrectomy (SG) has historically evolved from gastroplasty and anti-reflux procedures into one of the most commonly performed primary metabolic surgeries in the United States and worldwide. Initially initiated in the 1980s as part of the duodenal switch procedure, its standalone effectiveness and simplicity have led to increasing popularity globally. The rise in obesity rates transcends age boundaries, alarmingly affecting not only adults but also the younger demographic. This escalating trend is concerning, as it predisposes these populations to numerous future health complications, as well as highlighting the critical necessity for a safe and potent weight loss strategy. Although sleeve gastrectomy carries a higher risk for gastroesophageal reflux disease (GERD) compared to other bariatric procedures, it stands out as a reliable, safe and effective surgical solution for obesity. It is particularly beneficial for adolescents and patients with complex medical comorbidities, including, but not limited to, heart failure and immunocompromisation. It has also served as a bridge for transplants in morbidly obese patients with end-stage heart, liver and kidney disease due to its favorable safety profile.
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Affiliation(s)
- Shahed Tish
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA;
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7
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Sobutay E, Bilgiç Ç, Kabaoğlu B, Yavuz Y. Can Weight of The Resected Stomach Predict Weight Loss Results After Laparoscopic Sleeve Gastrectomy? Surg Laparosc Endosc Percutan Tech 2024; 34:29-34. [PMID: 38306493 DOI: 10.1097/sle.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/11/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Many factors have been investigated in the literature to predict weight loss outcomes after LSG. However, insufficient data regarding the resected stomach weight (RGW) exists. This retrospective study aimed to investigate the association between RGW and weight loss outcomes 1 year after LSG. MATERIALS AND METHODS Fifty-four patients who underwent LSG in a tertiary care center were evaluated retrospectively. The statistical analyses were performed to investigate the correlation between preoperative demographics, RGW, and the excess weight loss percentage (%EWL) and percent total weight loss (%TWL). RESULTS The mean RGW was 169.7±40.1, ranging from 101 to 295 grams. The RGW was significantly correlated with preoperative weight (r=0.486; P<0.001), body mass index (r=0.420; P=0.002), and age (r=0.327; P=0.01). However, RGW did not predict postoperative weight loss, as measured by percent total weight loss (%TWL) and percent excess weight loss (%EWL), respectively (r=0.044; P=0.75 and r=-0.216; P=0.11). Multiple linear regression analysis identified age as a negative predictor for both %TWL (β=-0.351, P=0.005) and %EWL (β=-0.265, P=0.03), while preoperative body mass index was a negative predictor for %EWL (β=-0.469, P<0.001). CONCLUSION The RGW, although correlated with patient characteristics, does not serve as a reliable predictor of postoperative weight loss in the first year after LSG. Further research is needed to improve predictive models and patient care in bariatric surgery.
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Affiliation(s)
- Erman Sobutay
- Department of General Surgery, Koç Foundation American Hospital
| | - Çağri Bilgiç
- Department of General Surgery, Koç Foundation American Hospital
| | - Burçak Kabaoğlu
- Department of General Surgery, Koç Foundation American Hospital
| | - Yunus Yavuz
- Department of General Surgery, Koç Foundation American Hospital
- Department of General Surgery, Obesity and Metabolic Surgery Center, Koç University, School of Medicine, Istanbul, Turkey
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Srilatha M, Malla R, Adem MP, Foote JB, Nagaraju GP. Obesity associated pancreatic ductal adenocarcinoma: Therapeutic challenges. Semin Cancer Biol 2023; 97:12-20. [PMID: 37926347 DOI: 10.1016/j.semcancer.2023.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
Obesity is a prominent health issue worldwide and directly impacts pancreatic health, with obese individuals exhibiting a significant risk for increasing pancreatic ductal adenocarcinoma (PDAC). Several factors potentially explain the increased risk for the development of PDAC, including obesity-induced chronic inflammation within and outside of the pancreas, development of insulin resistance and metabolic dysfunction, promotion of immune suppression within the pancreas during inflammation, pre- and malignant stages, variations in hormones levels (adiponectin, ghrelin, and leptin) produced from the adipose tissue, and acquisition of somatic mutations in tumor once- and suppressor proteins critical for pancreatic tumorigenesis. In this manuscript, we will explore the broad impact of these obesity-induced risk factors on the development and progression of PDAC, focusing on changes within the tumor microenvironment (TME) as they pertain to prevention, current therapeutic strategies, and future directions for targeting obesity management as they relate to the prevention of pancreatic tumorigenesis.
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Affiliation(s)
- Mundla Srilatha
- Department of Biotechnology, Sri Venkateswara University, Tirupati, Andhra Pradesh 517502, India
| | - Ramarao Malla
- Cancer Biology Laboratory, Department of Biochemistry and Bioinformatics, School of Science, GITAM (Deemed to be University), Visakhapatnam, Andhra Pradesh 530045, India
| | - Megha Priya Adem
- Department of Biotechnology, Sri Padmavati Mahila Visvavidyalayam (Women's University), Tirupati, Andhra Pradesh 517502, India
| | - Jeremy B Foote
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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9
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Parkash O, Sohail Z, Khalid N. Endoscopic stent placement for the management of gastro-pleural and gastro-cutaneous fistula post laparoscopic sleeve gastrectomy: a case report. J Med Case Rep 2023; 17:461. [PMID: 37926809 PMCID: PMC10626742 DOI: 10.1186/s13256-023-04200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Gastro-pleural and gastro-cutaneous fistulae formation are rare yet life-threatening complications post-bariatric surgery. To our knowledge so far only limited cases of gastro-pleural and gastro-cutaneous fistulae post gastric sleeve surgery have been reported in the literature with their corresponding management. Therefore, we are reporting a case of placement of an endoscopic stent in the management of gastro-cutaneous fistula post laparoscopic sleeve gastrectomy. CASE PRESENTATION A 42 years old Pakistani, female morbidly obese patient, underwent laparoscopic sleeve gastrectomy. Within a week after the procedure, the patient presented with dyspnea. Workup showed a gastric leak for which percutaneous drain placement was done. Later, gastro-pleural and gastro-cutaneous fistulae were formed for which endoscopic fistula closure was done using a metallic stent. CONCLUSION Endoscopic stent placement is an emerging field and it is considered safe and effective for the management of complications related to bariatric surgery.
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Affiliation(s)
- Om Parkash
- The Aga Khan University Hospital, Karachi, Pakistan
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Sewefy AM, Sabry K, Hetta HM, Atyia AM. The Impact of Blood Pressure Switching (from Controlled Hypotension to Late Elevated Blood Pressure) During Laparoscopic Sleeve Gastrectomy: Controlled Clinical Trial. Obes Surg 2023; 33:2602-2607. [PMID: 37351766 DOI: 10.1007/s11695-023-06699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) is the most done bariatric procedure. Bleeding and leak are the most common associated complications. Elevation of systolic blood pressure (SBP) leads to discovering the bleeding sites but results in a bloody field and increases the operative time. Controlled hypotension shortens the operative time, reduces tissue edema, and improves field vision. We aimed to test controlled hypotension during LSG. MATERIAL AND METHODS This was a randomized controlled trial that included 200 patients who were operated by LSG, randomly assigned to 2 equal groups: group 1, operated with controlled hypotensive anesthesia, and group 2, operated with elevated SBP to 140 mmHg. RESULTS Of the patients, 162 (81%) were females, and 38 (19%) were male. The mean BMI was 45.7 kg/m2. The mean age was 41.7 years. The operative time was 36.43 ± 6.73 min in group 1 vs. 44.71 ± 5.47 min in group 2. The mean of total number of used gauzes and clips was 2.70 ± 3.49 in group 1 vs. 8.83 ± 3.15 in group 2. The mean amount of drain output was 37.65 ± 21.90 ml in group 1 vs. 74.00 ± 16.54 ml in group 2. The mean drop in the postoperative hematocrit was 0.08 in group 1 vs. 0.22 in group 2. The incidence of postoperative bleeding was 0% in group 1 vs. 1% in group 2. CONCLUSIONS Controlled hypotensive anesthesia in LSG reduces the operative time, reduces the intraoperative bleeding, and improves the operative field.
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Affiliation(s)
- Alaa M Sewefy
- Department of Surgery, Minia University Hospital, Minia, Egypt.
| | - Karim Sabry
- Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
| | - Hassan M Hetta
- Department of Anesthesia, Minia University Hospital, Minia, Egypt
| | - Ahmed M Atyia
- Department of Surgery, Minia University Hospital, Minia, Egypt
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Maselli DB, Hoff AC, Kucera A, Weaver E, Sebring L, Gooch L, Walton K, Lee D, Cratty T, Beal S, Nanduri S, Rease K, Gainey CS, Eaton L, Coan B, McGowan CE. Endoscopic sleeve gastroplasty in class III obesity: Efficacy, safety, and durability outcomes in 404 consecutive patients. World J Gastrointest Endosc 2023; 15:469-479. [PMID: 37397974 PMCID: PMC10308273 DOI: 10.4253/wjge.v15.i6.469] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is an effective therapy for class I-II obesity, but there are knowledge gaps in the published literature about its implementation in patients with class III obesity [body mass index (BMI) ≥ 40 kg/m2].
AIM To evaluate the safety, clinical efficacy, and durability of ESG in adults with class III obesity.
METHODS This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m2 who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss (TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss (EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration.
RESULTS 404 consecutive patients (78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m2) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type II diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization (0.2% serious adverse event rate).
CONCLUSION When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class III obesity, with improvement in comorbidities and an acceptable safety profile.
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Affiliation(s)
- Daniel Barry Maselli
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Anna Carolina Hoff
- Bariatric Endoscopy, Angioskope Clinic, São José dos Campos 12243-680, São Paulo, Brazil
| | - Ashley Kucera
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Emily Weaver
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Laura Sebring
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Lori Gooch
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kathleen Walton
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Daniel Lee
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Taylor Cratty
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Selena Beal
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Srikar Nanduri
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kendall Rease
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Christina S Gainey
- Gastroenterology and Hepatology, University of North Carolina System, Chapel Hill, NC 27599, United States
| | - Laura Eaton
- UltaMed Corporation, UltaMed Corporation, Fort Lauderdale, FL 33308, United States
| | - Brian Coan
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
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12
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Bigolin AV, Iaroseski J, de Lima JNC, Machry MC, Bonamigo ER, Grossi JVM, Fonseca MK, Silveira IVD. Optimization of Surgical Time Through the Implementation of a Rational Protocol to Prevent Bleeding in Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2023; 33:15-20. [PMID: 35731002 DOI: 10.1089/lap.2022.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Staple line oversewing (SLO) is a prophylactic alternative due to its low cost and its effect of decreasing the incidence and severity of bleeding complications in sleeve gastrectomy (SG). However, this approach significantly increases the surgical time and may be associated with stenosis. The study aims to identify whether its usage was sufficient to optimize the surgical time in patients whose screening for the risk of occult bleeding was negative. Materials and Methods: The study enrolled 103 patients. Having the systolic blood pressure goal of 140 mmHg, the staple line is checked for bleeding points, counting as follows: >5 bleeding points proceed to SLO, <5 bleeding points are managed using clips, and if no bleeding points are found, the procedure can be completed. Results: The bleeding test was positive in 79.6% of the cases and oversewing was necessary for 44.7% of the total. The bleeding test result was significant for the increased surgical time. The mean surgical time in SLO was 16.4% higher than in clipping. There was a significant difference in surgical time between SLO and clipping; however, no significant difference was identified between clipping and continuing the procedure without further measures. No postoperative complication related to staple line bleeding was identified. Discussion: In a scenario with limitations for the use of high-cost homeostatic agents, the stratified protocol to prevent bleeding in SG stapling line was able to significantly reduce surgical time without significant added risks. Conclusion: A stratified protocol to prevent bleeding in SG stapling line was able to significantly reduce surgical time.
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Affiliation(s)
- André Vicente Bigolin
- Digestive Surgery Department, Santa Casa de Misericórdia Hospital, Porto Alegre, Brazil.,Nutrition Department, Cardiology Institute, University Foundation of Cardiology, Porto Alegre, Brazil
| | - Júlia Iaroseski
- Digestive Surgery Department, Santa Casa de Misericórdia Hospital, Porto Alegre, Brazil.,Medical Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Mayara Christ Machry
- Digestive Surgery Department, Santa Casa de Misericórdia Hospital, Porto Alegre, Brazil
| | | | | | | | - Izabele Vian da Silveira
- Nutrition Department, Cardiology Institute, University Foundation of Cardiology, Porto Alegre, Brazil
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Hany M, Sabry A, Torensma B, Ahmed K, Refaie M, Zidan A, Agayby ASS, Ibrahim M, Mourad M. Comparison of the mid-term outcomes of banded and non-banded sleeve gastrectomy: safety, food tolerance, and weight regain. Surg Endosc 2022; 36:9146-9155. [PMID: 35764843 PMCID: PMC9652222 DOI: 10.1007/s00464-022-09395-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/06/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Long-term weight regain (WR) after sleeve gastrectomy (SG) is a major challenge. Laparoscopic banded SG (BSG) was introduced to overcome pouch dilation and, consequently, WR; however, its mid-and long-term outcomes have not been sufficiently demonstrated. OBJECTIVE This study retrospectively evaluated the mid-term weight loss efficacy and morbidity over at least a 4-year follow-up after laparoscopic banded SG using a MiniMizer Gastric Ring® and laparoscopic non-banded SG. METHOD The data of 1586 bariatric surgeries were retrospectively evaluated. To ensure homogeneity in our study cohort, propensity score matching (PSM) was performed. RESULTS The final cohort comprised 1392 patients: the non-banded SG (n = 1260) and BSG (n = 132) groups. In our matched cohort (SG, n = 655 and BSG, n = 132), WR was noted in 4 (3.0%) and 71 (10.8%) patients in the BSG and SG groups, respectively. Gastric band erosion or slippage was not noted in the BSG cohort. The levels of cholesterol and triglyceride were similar in the two groups. Postoperative glycemic control was significantly reduced in the BSG group. CONCLUSION Although the percentage of weight loss achieved in the BSG group was low in the first year postoperatively, the mid-term (sustained) weight loss associated with BSG was superior to that associated with non-banded SG. BSG is a safe procedure with no significant mid-term band-related morbidity; its impact on the resolution of comorbidities is equivalent and perhaps superior to SG.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt.
- Consultant of Bariatric Surgery at Madina Women's Hospital (IFSO Center of Excellence), Alexandria, Egypt.
| | - Ahmed Sabry
- Depatment of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Bart Torensma
- Clinical Epidemiologist, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Khaled Ahmed
- Depatment of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mostafa Refaie
- Depatment of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Ann Samy Shafiq Agayby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Mohamed Mourad
- Depatment of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Chiappetta S, Lainas P, Kassir R, Valizadeh R, Bosco A, Kermansaravi M. Gastroesophageal Reflux Disease as an Indication of Revisional Bariatric Surgery-Indication and Results-a Systematic Review and Metanalysis. Obes Surg 2022; 32:3156-3171. [PMID: 35776239 DOI: 10.1007/s11695-022-06183-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Abstract
This systematic review evaluates the indications and results of revisional bariatric surgery (RBS) in gastroesophageal reflux disease (GERD). A systematic literature search and meta-analysis was performed for articles published by April 1, 2021. After examining 722 papers involving 17,437 patients, 48 studies were included (n = 915 patients). RBS for GERD was mostly reported after sleeve gastrectomy (n = 796, 87%) and one anastomosis gastric bypass (n = 62, 6.8%) and was performed due to intractable GERD (71.6%), GERD and weight issues (16%), and biliary reflux (6.2%). Mean follow-up of the studies was 31.5 (3-84) months. Pooled estimation of a meta-analysis of studies reported 7% of GERD following primary surgery needing RBS, in which 99% of the patients experienced remission.
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Affiliation(s)
- Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Via Argine 604, 80147, Naples, Italy.
| | - Panagiotis Lainas
- Department of Digestive Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
| | - Radwan Kassir
- Digestive Surgery Unit, University Hospital of La Réunion -Félix Guyon Hospital, Saint-Denis, La Réunion, France
- Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI), UMR 1188, INSERM, Université de La Réunion, 97400, Saint Denis, France
| | - Rohollah Valizadeh
- Department of Epidemiology, School of Public Health, University of Medical Sciences, Tehran, Iran
| | - Alfonso Bosco
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Via Argine 604, 80147, Naples, Italy
| | - Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Department of SurgeryRasool-E Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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15
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Shinoda S, Nakamura N, Roach B, Bernlohr DA, Ikramuddin S, Yamamoto M. Obesity and Pancreatic Cancer: Recent Progress in Epidemiology, Mechanisms and Bariatric Surgery. Biomedicines 2022; 10:1284. [PMID: 35740306 PMCID: PMC9220099 DOI: 10.3390/biomedicines10061284] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 12/24/2022] Open
Abstract
More than 30% of people in the United States (US) are classified as obese, and over 50% are considered significantly overweight. Importantly, obesity is a risk factor not only for the development of metabolic syndrome but also for many cancers, including pancreatic ductal adenocarcinoma (PDAC). PDAC is the third leading cause of cancer-related death, and 5-year survival of PDAC remains around 9% in the U.S. Obesity is a known risk factor for PDAC. Metabolic control and bariatric surgery, which is an effective treatment for severe obesity and allows massive weight loss, have been shown to reduce the risk of PDAC. It is therefore clear that elucidating the connection between obesity and PDAC is important for the identification of a novel marker and/or intervention point for obesity-related PDAC risk. In this review, we discussed recent progress in obesity-related PDAC in epidemiology, mechanisms, and potential cancer prevention effects of interventions, including bariatric surgery with preclinical and clinical studies.
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Affiliation(s)
- Shuhei Shinoda
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (N.N.); (B.R.); (S.I.)
| | - Naohiko Nakamura
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (N.N.); (B.R.); (S.I.)
| | - Brett Roach
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (N.N.); (B.R.); (S.I.)
| | - David A. Bernlohr
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (N.N.); (B.R.); (S.I.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Masato Yamamoto
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA; (S.S.); (N.N.); (B.R.); (S.I.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
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Ibrahim Mohamed BK, Barajas-Gamboa JS, Rodriguez J. Endoscopic Bariatric Therapies: Current Status and Future Perspectives. JSLS 2022; 26:JSLS.2021.00066. [PMID: 35444403 PMCID: PMC9005302 DOI: 10.4293/jsls.2021.00066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Obesity is a chronic, multifactorial disease associated with multiple cardiometabolic conditions. The successful management of this condition includes a multidisciplinary approach with interventions focused on lifestyle modification, pharmaceutical therapies, and bariatric surgery. Endoscopic bariatric therapies (EBT) have been proposed as a way to bridge the gap between medical management and bariatric surgery. The Association for Bariatric Endoscopy in conjunction with the American Society for Gastrointestinal Endoscopy published the position statement approving and integrating EBT into practice. The aim of this article is to review the most common primary EBT’s, their indications, outcomes, and complications. Database: A medical literature review was conducted using the defined keywords. Databases included PubMed, Google Scholar, Embase, and EBSCO. Articles in English were considered for review from June 1, 2000 to June 30, 2021. Conclusion: Endoscopic bariatric therapies should be offered in conjunction with lifestyle modification and with nutritional guidance, as part of a multidisciplinary approach in obesity management. They require a formal training process for endoscopists and bariatric surgeons to obtain the endoscopic skills needed before performing these procedures. Longer follow-up and larger trials are needed to validate current evidence, in order to enhance the process of standardization of these techniques.
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Affiliation(s)
| | - Juan S Barajas-Gamboa
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - John Rodriguez
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
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Catchlove W, Johari Y, Forrest E, Au A, Shaw K, Nottle P, Ellis S, Brown WA, Burton P. Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks. Surg Obes Relat Dis 2021; 18:205-216. [PMID: 34952796 DOI: 10.1016/j.soard.2021.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/14/2021] [Accepted: 11/07/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Initial radiologic appearance rather than management strategy predicts the outcomes of sleeve gastrectomy leaks. OBJECTIVE Multiple modalities have been advocated for the treatment of sleeve gastrectomy leak, and there remains no consensus on the best treatment paradigm. For more than 10 years, we have variably attempted luminal occlusive therapies and repeated endoscopic debridement as treatment options. By evaluating the outcomes from these approaches, we aimed to determine whether the first management strategy is superior to the second in terms of outcomes. METHODS Patients were analyzed by group (luminal occlusive therapy versus repeated endoscopic debridement). Leaks were then stratified by radiologic appearance on computed tomography, defined as phlegmon, collection, contrast medium leak, or fistula. The primary outcome was length of stay (LOS). Secondary outcomes were comprehensive complication index and the need for resection. RESULTS There were 54 patients, with 22 in the luminal occlusion group and 32 in the repeated debridement group. There was no difference in LOS (59.8 ± 41.6 versus 46.5 ± 51.2 days, P = .179) and no difference in the requirement for resection (4 versus 3 resections, p = .425). Subset analysis suggested that patients who underwent operative versus conservative management (P = .006) had a longer LOS. Excluding management strategy, radiologic appearance on admission significantly predicted LOS (P = .0053). Patients presenting with fistula (84 ± 25.4 days) and contrast medium leak (64.1 ± 40 days) had a significantly longer LOS than those diagnosed with phlegmon (13.5 ± 5.5 days). Radiologic appearance was predictive of complication severity (P < .0001) and salvage resection (P = .008). CONCLUSION There was no significant difference in outcomes between patients treated with intraluminal occlusion or repeated debridement. Initial radiologic appearance was predictive of LOS and complication severity. This highlights the need for routine use of a validated classification system in studies reporting outcomes and treatment of sleeve leaks.
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Affiliation(s)
- William Catchlove
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia.
| | - Yazmin Johari
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia
| | - Edward Forrest
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Amos Au
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kalai Shaw
- Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Nottle
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Samantha Ellis
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Wendy A Brown
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Burton
- Oesophago-Gastric Bariatric Surgical Unit, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Monash University, and Centre for Obesity Research and Education, Alfred Hospital, Melbourne, Victoria, Australia
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18
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Walsh PR, Lamba M, Benias P, Lafta A, Hopkins G. Feasibility of resection and plication "RAP" technique for management of medically refractory GERD in patients with altered gastric anatomy. Endosc Int Open 2021; 9:E1549-E1555. [PMID: 34540549 PMCID: PMC8445683 DOI: 10.1055/a-1535-1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/16/2021] [Indexed: 11/02/2022] Open
Abstract
Background and study aims Gastroesophageal reflux disease (GERD) is common, especially in patients after gastric surgery. Medical management of GERD is ineffective in up to 30 % patients and revisional gastric surgery for management of GERD is associated with higher morbidity. We aimed to assess the safety, feasibility, and efficacy of a novel endoscopic resection and plication (RAP) anti-reflux procedure for management of medically refractory GERD in patients with altered gastric anatomy. Patients and methods The RAP procedure involves endoscopic mucosal resection and full-thickness plication over the right posterior-medial axis extending 15 mm above and 20 to 30 mm below the squamocolumnar junction. Adverse events, technical feasibility, GERD health-related quality-of-life (GERD-HRQL) scores, and medication use were prospectively recorded. Results Twenty consecutive patients with previous gastric surgery underwent RAP between September 2018 and August 2020 with a median follow-up of 5.7 months. The median procedure duration was 66 minutes (IQR 53.8-89.5). RAP was technically successful in 19 patients. One patient developed gastric hemorrhage from suture dehiscence, which was managed endoscopically, and four patients developed esophageal stricture requiring endoscopic dilation. Following the RAP procedure, significant improvement in GERD-HRQL score was observed (mean 26.9, 95 %CI 23.36-30.55, P < 0.01). Fourteen of 19 patients reported > 50 % improvement in GERD-HRQL scores. Sixteen of 18 patients reported reduction in requirement for or cessation of antacid therapy. Conclusions Patients with refractory GERD after gastric surgery have limited therapeutic options. We have demonstrated that the RAP procedure is feasible, safe, and clinically effective at short-term follow-up. It provides a potential alternative to revisional surgery in patients with altered gastric anatomy.
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Affiliation(s)
- Patrick R. Walsh
- St. Vincent’s Private Hospital Northside, Chermside, Australia,Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia
| | - Mehul Lamba
- Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia
| | - Petros Benias
- Division of Gastroenterology, North Shore-Long Island Jewish Medical Center, Zucker school of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, New York, United States
| | - Abdulnasser Lafta
- Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia
| | - George Hopkins
- St. Vincent’s Private Hospital Northside, Chermside, Australia,Royal Brisbane & Women’s Hospital, Butterfield Street, Herston, Australia
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19
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Tian P, Fu J, Liu Y, Bian S, Li M, Zhang M, Liu J, Jin L, Zhang Z, Zhang P. Current status of gastroesophageal reflux disease after sleeve gastrectomy: Still a long way to go. Biosci Trends 2021; 15:305-312. [PMID: 34373428 DOI: 10.5582/bst.2021.01288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Obesity is a public health concern that is becoming increasingly more serious around the world. Bariatric surgery has become more prevalent due to the obesity epidemic worldwide. Sleeve gastrectomy (SG) is one of the most popular procedures which is safe and efficient. Despite all its favorable features, however, there is an increasing evidence from the literature that the long-term incidence of gastroesophageal reflux disease (GERD) is likely to represent the Achilles' heel of this procedure. Management of severe reflux after SG usually requires revisional surgery. The relationship between SG and GERD needs to be better ascertained in order to prevent related complications, such as esophageal adenocarcinoma. This review attempts to elucidate the effect of SG on GERD and the postoperative management of reflux disease according to recent literature in the hope of drawing the attention of clinicians to postoperative gastroesophageal reflux and guiding the optimal management strategy associated with this "troublesome complication".
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Affiliation(s)
- Peirong Tian
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jing Fu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Shibo Bian
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Mengyi Li
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Meng Zhang
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Jia Liu
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Lan Jin
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhongtao Zhang
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Peng Zhang
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
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20
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Gjeorgjievski M, Imam Z, Cappell MS, Jamil LH, Kahaleh M. A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks. J Clin Gastroenterol 2021; 55:551-576. [PMID: 33234879 DOI: 10.1097/mcg.0000000000001451] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus. OBJECTIVE To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed. DESIGN A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes. RESULTS Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. CONCLUSION Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
| | - Zaid Imam
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Mitchell S Cappell
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Laith H Jamil
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Michel Kahaleh
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
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21
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Revisional Laparoscopic SADI-S vs. Duodenal Switch Following Failed Primary Sleeve Gastrectomy: a Single-Center Comparison of 101 Consecutive Cases. Obes Surg 2021; 31:3667-3674. [PMID: 33982240 DOI: 10.1007/s11695-021-05469-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Single-anastomosis duodeno-ileal bypass (SADI-S) is being proposed for obese patients with insufficient weight loss or weight regain after sleeve gastrectomy (SG), but limited information is available. The purpose of this study is to assess the safety and efficacy of SADI-S as a revisional surgery after SG, compared with standard duodenal switch (DS). METHODS Unicentric cohort study including all patients submitted to SADI-S and DS after failed SG in a high-volume institution, between 2008 and 2020. RESULTS Forty-six patients submitted to SADI-S and 55 to DS were included, 37.2 and 41.5 months after SG (p = 0.447), with initial BMI of 56.2 vs. 56.6 (p = 0.777) and 39.2 vs. 39.7 before revisional surgery (p = 0.675). All surgeries were laparoscopic. Clavien-Dindo > II complication rate was 6.5% for SADI-S and 10.9% for DS (p = 0.095), with no 90-day mortality. Follow-up at 2 years was available for 38 SADI-S' and 38 DS' patients, with total weight loss of 35.3% vs. 41.7% (p = 0.009), and excess weight loss 64.1% vs. 75.3% (p = 0.014). Comorbidities resolution for SADI-S and DS was: 44.4% vs. 76.9% for diabetes (p = 0.029) and 36.4% vs. 87.5% for hypertension (p = 0.006); with no differences for resolution of dyslipidemia (72.7% vs. 88.9%, p = 0.369) and obstructive sleep apnea (93.3% vs. 91.7%, p = 0.869). DS' patients required more extra nutritional supplementation. Three SADI-S patients needed conversion to DS, two for biliary reflux and one for weight regain. CONCLUSION After a failed SG, revisional DS permits better weight control and diabetes and hypertension resolution than SADI-S, at the expense of higher supplementation needs.
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22
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Chen G, Zhang GX, Peng BQ, Cheng Z, Du X. Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy Plus Procedures for Treatment of Morbid Obesity: Systematic Review and Meta-Analysis. Obes Surg 2021; 31:3303-3311. [PMID: 33956302 DOI: 10.1007/s11695-021-05456-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023]
Abstract
Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed bariatric procedures globally, but both techniques have shortcomings. Several modifications of SG (SG plus procedures) have been developed, but the efficacy of the different procedures has not been completely elucidated. In this meta-analysis, we aimed to evaluate the efficacy and safety of SG plus procedures. Out of the initially identified 2357 studies, thirteen were selected for this meta-analysis: two studies on banded sleeve gastrectomy (BSG), four studies on sleeve gastrectomy plus duodenal-jejunal bypass (SG + DJB) or sleeve gastrectomy with loop duodenal-jejunal bypass (SADJB), two studies on sleeve gastrectomy with jejunal-jejunal bypass (SG + JJB), four studies on single anastomosis duodenal-ileal switch (SADI-S), and one study on stomach intestinal pylorus-sparing surgery (SIPS). SADI-S procedure was found to achieve significantly greater percentage of excess weight loss than the RYGB. SG + DJB and SADJB achieved greater weight loss than the RYGB. Major complications were fewer with SG + JJB than with RYGB, but the difference was not significant. Overall, SG plus procedures appear to achieve better weight loss and cause fewer complications than RYGB.
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Affiliation(s)
- Gang Chen
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gui-Xiang Zhang
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo-Qiang Peng
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Du
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China.
- Department of General Surgery, Yaan People's Hospital, Yaan, China.
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Abstract
Roux-en-Y gastric bypass has been considered the gold standard bariatric procedure for decades. The surgical technique for Roux-en-Y gastric bypass and perioperative management for patients who undergo the procedure are still being improved for better clinical outcomes, shorter hospitalization, and faster return to normal activity. In the past 15 years there have been similar improvements and further development of novel surgical weight loss procedures. As data on other surgical alternatives emerge, the data need to be compared with Roux-en-Y gastric bypass to determine noninferiority. Further long-term investigations are needed to determine superiority of one bariatric procedure over another.
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Nuzzo A, Czernichow S, Hertig A, Ledoux S, Poghosyan T, Quilliot D, Le Gall M, Bado A, Joly F. Prevention and treatment of nutritional complications after bariatric surgery. Lancet Gastroenterol Hepatol 2021; 6:238-251. [PMID: 33581762 DOI: 10.1016/s2468-1253(20)30331-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
Obesity and the corresponding burden of related diseases is a major public health issue worldwide that is reaching pandemic proportions. Bariatric surgery is the only intervention that has been shown to result in substantial and lasting weight loss, and a decrease in overall mortality for patients with severe obesity. Consequently, the population of patients having undergone this procedure is increasing. Multifactorial weight-dependent and independent mechanisms underlying metabolic diseases could also drive preventable, but potentially life-threatening, long-term nutritional complications. However, given post-bariatric patients are prone to functional gastrointestinal symptoms and substantial weight loss, nutritional complications might be challenging. This Review is focused on the prevention and treatment of nutritional complications after bariatric surgery in the clinical setting.
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Affiliation(s)
- Alexandre Nuzzo
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France; Université de Paris, Paris, France
| | - Sebastien Czernichow
- Université de Paris, Paris, France; AP-HP, Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Paris, France
| | - Alexandre Hertig
- AP-HP, Department of Nephrology, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Séverine Ledoux
- Université de Paris, Paris, France; AP-HP, Service des Explorations Fonctionnelles, Centre Spécialisé Obésité, Hôpital Louis Mourier, Colombes, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - Tigran Poghosyan
- Université de Paris, Paris, France; Service de Chirurgie Digestive, Oncologique et Bariatrique, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - Didier Quilliot
- Unité Multidisciplinaire de Chirurgie de l'Obésité, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre les Nancy Cedex, France
| | - Maude Le Gall
- Université de Paris, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - André Bado
- Université de Paris, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - Francisca Joly
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France; Université de Paris, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France.
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Elbasan O, Sisman P, Peynirci H, Yabaci A, Ersoy C. Comparison Between Sleeve Gastrectomy and Exenatide on Type 2 Diabetic Patients. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Onur Elbasan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Pinar Sisman
- Department of Endocrinology and Metabolism, Medicana Hospital, Bursa, Turkey
| | - Hande Peynirci
- Department of Endocrinology and Metabolism, Istanbul Health Sciences, University Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ayşegul Yabaci
- Department of Biostatics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Canan Ersoy
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Guideline No. 391-Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1623-1640. [PMID: 31640864 DOI: 10.1016/j.jogc.2019.03.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on pre-conception and pregnancy care. Part II will focus on team planning for delivery and Postpartum Care. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION Women with obesity who are pregnant or planning pregnancies. EVIDENCE Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committee peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings, at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affected pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE SOGC guidelines will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
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Outcomes of reoperative surgery in severely obese patients after sleeve gastrectomy: a single-institution experience. Surg Obes Relat Dis 2020; 16:983-990. [DOI: 10.1016/j.soard.2020.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 11/20/2022]
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Thakur U, Bhansali A, Gupta R, Rastogi A. Liraglutide Augments Weight Loss After Laparoscopic Sleeve Gastrectomy: a Randomised, Double-Blind, Placebo-Control Study. Obes Surg 2020; 31:84-92. [PMID: 32656729 DOI: 10.1007/s11695-020-04850-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Both laparoscopic sleeve gastrectomy (LSG) and liraglutide cause a significant weight loss. We evaluated the effect of liraglutide in comparison with placebo on total weight loss (TWL) and excess body weight loss (EWL) and when added in initial weight loss period after LSG in obese individuals. MATERIAL AND METHODS Participants with BMI > 30 kg/m2 undergoing LSG were randomised to receive either liraglutide (subcutaneous) in increasing does of 0.6 mg/day until maximum tolerated dose of 3.0 mg (L-L group) or placebo (L-P group) from 6 weeks post-operative until 6 months. Weight, BMI, %TWL, %EWL, HbA1c, fasting plasma glucose, HOMA-IR, resolution of type 2 diabetes mellitus, hypertension, dyslipidaemia, sleep apnea and quality of life were evaluated. Primary end point was %TWL and % EWL at post-operative 6 months. RESULTS Thirty participants underwent LSG, and 23 were randomised to receive liraglutide (n = 12) or placebo (n = 11).The mean dose of liraglutide in L-L group was 1.41 ± 0.49 mg/day. Patients in L-L group had %TWL of 28.2 ± 5.7 and %EWL of 58.7 ± 14.3 as compared with 23.2 ± 6.2 (p = 0.116) and 44.5 ± 8.6 (p = 0.043) in L-P group at 24 weeks, respectively. BMI decreased by 11.7 ± 3.5 in L-L group compared with 9.5 ± 4.0 in L-P group (p = 0.287). All patients with diabetes or pre-diabetes had resolution of dysglycemia in the L-L group as compared with 50% in L-P group. However, there was no significant difference in resolution of other obesity-related comorbidities between two groups at 24-week follow-up. CONCLUSION Liraglutide added early after LSG significantly augments weight loss from LSG in obese individuals. TRIAL REGISTRATION The study protocol was registered at clinical trials.gov.in with NCT: 04325581.
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Affiliation(s)
- Uttam Thakur
- Department of Gastro-intestinal Surgery, PGIMER, Chandigarh, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, Room-1011, Nehru Hospital Extension Block, Chandigarh, 160012, India
| | - Rajesh Gupta
- Department of Gastro-intestinal Surgery, PGIMER, Chandigarh, Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, Room-1011, Nehru Hospital Extension Block, Chandigarh, 160012, India.
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Seyit H, Alis H. Five-year outcomes for laparoscopic sleeve gastrectomy from a single center in Turkey. Ann Saudi Med 2020; 40:310-315. [PMID: 32757987 PMCID: PMC7410219 DOI: 10.5144/0256-4947.2020.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are no long-term results for laparoscopic sleeve gastrectomy (LSG) from Turkey. OBJECTIVES Assess the outcomes of LSG at 5 years. DESIGN Retrospective. SETTING Training and research hospital. PATIENTS AND METHODS The study included patients with LSG performed from August 2012 to December 2013. The data was prospectively collected with the aim of providing 5-year outcomes. MAIN OUTCOME MEASURES Changes in percentage excessive weight loss (%EWI) and BMI. Changes in the pharmacological treatment status of patients with type 2 diabetes mellitus and hypertension. SAMPLE SIZE AND CHARACTERISTICS 120 patients (89 female) completed follow up; mean age 37 years (range, 19-63 years), mean preoperative BMI 48.3 kg/m2 (range 40-80.4 kg/m2). RESULTS After a mean 5.6-year follow-up, the mean (SD) postoperative weight loss was 43.5 (11.8) kg and the mean (SD) BMI loss was 16.1 (4.4). The mean %EWL value was 62.9% (range, 30-101%). Most patients (87.5%, n=105) achieved satisfactory %EWL values. The major complication rate was 6.6%. After surgery, 74.2% of patients taking medication for hypertension were able to stop treatment, while 12.9% reduced the dose, of patients that took medication for diabetes, all had a dosage reduction. CONCLUSIONS We showed that LSG is an acceptable bariatric procedure, but in the long-term there may be weight gain and frequent reflux symptoms. We think renewed weight gain can be partially prevented by close clinical follow-up. There is a need for long-term randomized controlled studies with long-term follow-up to clearly define the indications for LSG. LIMITATIONS Retrospective, incomplete clinical visits, GERD symptoms not objectively assessed. CONFLICT OF INTEREST None.
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Affiliation(s)
- Hakan Seyit
- From the Department of General Surgery, Bakirkoy Dr. SadiKonuk Training and Research Hospital, Istanbul, Turkey
| | - Halil Alis
- From the Department of General Surgery, Istanbul Aydin University Medical School, Istanbul, Turkey
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Liu C, Han Z, Zhang N, Peng J, Zhu B, Amin B, Du D, Yan W, Zhang D, Gong K. Laparoscopic Sleeve Gastrectomy Affects Coagulation System of Obese Patients. Obes Surg 2020; 30:3989-3996. [PMID: 32557391 DOI: 10.1007/s11695-020-04769-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is nowadays the most popular bariatric procedure for obesity. However, whether LSG increases the risk of thrombosis remains unclear. The aim of this study was to investigate potential effects of LSG on coagulation system. METHODS Fifty-five obese patients underwent LSG between 2016 and 2018. The LSG was performed with pneumoperitoneum pressure maintained at 13 mmHg. Venous blood specimens were collected from each patient before surgery, at the end of pneumoperitoneum (i.e., 0 h after surgery), and at 24 h after surgery to determine prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), platelet count (PLT), D-dimer (D-D), red blood cell count (RBC), hematocrit (HCT), plateletcrit (PCT), cholesterol (CHOL), triglyceride (TRIG), and serum calcium (Ca). All patients were examined on the veins of the lower limbs by color Duplex sonography (CDS) before surgery and at 24 h after surgery, respectively. RESULTS All patients successfully underwent LSG. No severe surgery-related complications were observed during 1-month follow-up after operation. Preoperative BMI was 43.6 ± 8.3 kg/m2. The levels of coagulation factors were within the normal range before surgery, except a relatively higher PLT. The PT and D-D were increased at 0 h and 24 h after surgery (P < 0.05), whereas APTT was decreased (P < 0.05). The postoperative FIB remained similar to the preoperative one (P > 0.05). The CDS identified no thrombus in the veins of the lower limbs, either before surgery or at 24 h after surgery. CONCLUSIONS LSG may cause postoperative hypercoagulability of patients with obesity.
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Affiliation(s)
- Chen Liu
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ziliang Han
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Nengwei Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jirun Peng
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Bin Zhu
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Buhe Amin
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Dexiao Du
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wei Yan
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Dongdong Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ke Gong
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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Effectiveness of Laparoscopic Sleeve Gastrectomy in Super-obese and Non–Super-obese Patients. Surg Laparosc Endosc Percutan Tech 2020; 30:403-409. [DOI: 10.1097/sle.0000000000000801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy. Obes Surg 2020; 29:3165-3173. [PMID: 31388962 DOI: 10.1007/s11695-019-03917-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified. PURPOSE We present the mid-term outcomes of SADI bypass surgery after SG. METHOD A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50 kg/m2). Incidence of complications was divided into < 30 days and > 30 days. RESULT Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3 years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24 months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient's population at 24 months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication. CONCLUSION The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.
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Palumbo D, Socci C, Martinenghi C, Guazzarotti G, Leone R, Nicoletti R, Rosati R, De Cobelli F. Leakage Risk Stratification After Laparoscopic Sleeve Gastrectomy (LSG): Is There a Role for Routine Postoperative CT Scan? Obes Surg 2020; 30:3370-3377. [PMID: 32291703 DOI: 10.1007/s11695-020-04586-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Leakage of the gastric remnant after laparoscopic sleeve gastrectomy (LSG) represents an unpredictable, dreadful occurrence. Our aim was to assess whether routine postoperative CT scan is an effective tool for early prediction of leakage after LSG. MATERIALS AND METHODS From a prospectively acquired database, all consecutive patients who underwent LSG between January 2015 and December 2018 were identified; within this database, all patients who were evaluated with at least one contrast-enhanced CT scan within 48 h from surgery were enrolled in this retrospective study. The selected CT findings included twisting of the gastric remnant, perigastric air bubbles, and hematoma; the antral segment proximal from the pylorus to the first staple firing was also analyzed in terms of distance (StP, stapler to pylorus distance) and linearity (LI, linearity index). RESULTS After exclusions, 250 patients were included; 10 patients suffered from gastric leakage. Patients with perigastric hematoma and/or twisting of the distal part of the gastric remnant on routine postoperative CT scan were found to be more likely to develop leakage after LSG (p = 0.005 and p < 0.001, respectively). The mean StP was 45 ± 19.1 mm; the mean LI was 1.54 ± 0.4. Patients with subsequent development of leakage had significantly lower StP (26.7 ± 12.5 mm vs. 45.9 ± 18.9 mm; p = 0.001) and LI values (1.16 ± 0.11 vs. 1.55 ± 0.39; p = 0.002). CONCLUSION Routine postoperative CT scan after LSG permits early stratification of leakage risk, thus providing an actual aid for patients' management.
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Affiliation(s)
- Diego Palumbo
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy. .,San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy.
| | - Carlo Socci
- Metabolic, Bariatric and Transplant Surgery Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Carlo Martinenghi
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Giorgia Guazzarotti
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Leone
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Roberto Nicoletti
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Rosati
- San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy.,GastroIntestinal Surgery Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
| | - Francesco De Cobelli
- Radiology Unit, San Raffaele Scientific Institute, San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy.,San Raffaele Vita Salute University, via Olgettina 60, 20132, Milan, Italy
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Mohan BP, Asokkumar R, Khan SR, Kotagiri R, Sridharan GK, Chandan S, Ravikumar NPG, Ponnada S, Jayaraj M, Adler DG. Outcomes of endoscopic sleeve gastroplasty; how does it compare to laparoscopic sleeve gastrectomy? A systematic review and meta-analysis. Endosc Int Open 2020; 8:E558-E565. [PMID: 32258380 PMCID: PMC7089787 DOI: 10.1055/a-1120-8350] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/23/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background and study aims Endoscopic sleeve gastroplasty (ESG) is a novel moderately invasive technique in endo-bariatrics as compared to laparoscopic sleeve gastrectomy (LSG). Data is limited as to its efficacy and safety.
Methods We searched multiple databases from inception through August 2019 to identify studies that reported on ESG in the treatment of obesity. Our goals were to calculate the pooled rates of total weight loss (%TWL), excess weight loss (%EWL), and body mass index (BMI) at 1 month, 6 months, and 12 months with ESG. We included studies that reported on LSG, in a similar time frame as ESG, and compared the 12-month outcomes.
Results From eight studies on ESG (1815 patients), the pooled rates of %TWL at 1 month, 6 months, and 12 months were 8.7 (7.2–10.2), 15.3 (14.1–16.6) and 17.1 (15.1–19.1), respectively. The pooled rates of %EWL at 1 month, 6 months, and 12 months were 31.7 (29.3–34.1), 59.4 (57–61.8) and 63 (51.3–74.6), respectively. The pooled rates of BMI at 1 m, 6 m, and 12 m were 32.6 (31–34.3), 30.4 (29–31.8) and 30 (27.7–32.3, I2 = 97), respectively. At 12 months, the pooled %TWL, %EWL and BMI with LSG (7 studies, 2179 patients) were 30.5 (27.4–33.5), 69.3 (60.1–78.4) and 29.3 (27.1–31.4) respectively. On comparison analysis, %TWL with LSG was superior to ESG (P = 0.001). %EWL and BMI were comparable. All adverse events, bleeding and gastro-esophageal reflux disease were significantly lower with ESG when compared to LSG.
Conclusion ESG demonstrates acceptable weight loss parameters and seems to have a better safety profile when compared to LSG.
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Affiliation(s)
- Babu P. Mohan
- Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, United States
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Shahab R. Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
| | - Rajesh Kotagiri
- Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, United States
| | | | - Saurabh Chandan
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Naveen PG. Ravikumar
- Internal Medicine, University at Buffalo, Buffalo General Hospital, Buffalo, New York, United States
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States
| | - Mahendran Jayaraj
- Department of Gastroenterology and Hepatology, University of Nevada, Las Vegas, Nevada, United States
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Lamoshi A, Chernoguz A, Harmon CM, Helmrath M. Complications of bariatric surgery in adolescents. Semin Pediatr Surg 2020; 29:150888. [PMID: 32238287 DOI: 10.1016/j.sempedsurg.2020.150888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Over the past decade, outcomes data have demonstrated the benefit of bariatric surgery in achieving both sustained weight loss and reversal of co-morbidities. Comparing these data to contemporary known risks of adolescent bariatric surgery informs the patients and providers considering bariatric procedures and provides insight into potential ways to reduce and manage complications. The goal of this article is to review the common surgical and postoperative complications following bariatric procedures and discuss approaches to improve their safety. A systematic review identifying bariatric surgery complications in adolescents was conducted. The review focused on the data relevant to adolescent bariatric surgery. However, when necessary, adult studies were used to address the gaps in available pediatric information. The data pertaining to the intraoperative, short term, and long term surgically related and nutritional related complications show that complication are declining with increasing experience. Specific recommendations and strategies to avoid major complications of bariatric surgery in adolescents are offered.
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Affiliation(s)
- Abdulrouf Lamoshi
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Artur Chernoguz
- Floating Hospital for Children at Tufts Medical Center, Pediatric Surgery Division, Boston, MA, USA
| | - Carroll M Harmon
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Michael Helmrath
- Cincinnati Children's Hospital Medical Center, Pediatric Surgery Division, Cincinnati, OH, USA.
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Gentileschi P, Bianciardi E, Siragusa L, Tognoni V, Benavoli D, D'Ugo S. Banded Sleeve Gastrectomy Improves Weight Loss Compared to Nonbanded Sleeve: Midterm Results from a Prospective Randomized Study. J Obes 2020; 2020:9792518. [PMID: 32566276 PMCID: PMC7285409 DOI: 10.1155/2020/9792518] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Weight regain after laparoscopic sleeve gastrectomy (LSG) is nowadays a growing concern. Sleeve dilatation and loss of food restriction is considered the main mechanism. The placement of a silicon ring around the gastric tube seems to give benefits in the short term. We report the results of a randomized study comparing LSG and laparoscopic banded sleeve gastrectomy (LBSG) over a 4-year follow-up. OBJECTIVES To evaluate the efficacy of banded sleeve gastrectomy compared to standard sleeve in the midterm. METHODS Between 01/2014 and 01/2015, we randomly assigned 50 patients to receive one of the two procedures. Patients' management was exactly the same, apart from the band placement. We analyzed differences in weight loss, operative time, complication rate, and mortality, with a median follow-up of 4 years. RESULTS Twenty five patients were assigned to receive LSG (Group A) and 25 LBSG (Group B). The mean preoperative BMI (body mass index) was 47.3 ± 6.58 kg/m2 and 45.95 ± 5.85 kg/m2, respectively. There was no significant difference in the operative time. No intraoperative or postoperative complications occurred. At 12-month follow-up, the mean BMI was 29.72 ± 4.40 kg/m2 in Group A and 27.42 ± 4.47 kg/m2 in Group B (p=0.186). After a median follow-up of 4 years, the mean BMI in Group B was significantly lower than Group A (24.10 ± 4.52 kg/m2 vs 28.80 ± 4.62 kg/m2; p=0.00199). CONCLUSIONS LBSG is a safe procedure, with no impact on postoperative complications. The banded sleeve showed a significant greater weight loss in the midterm follow-up. Considering the issue of weight regain observed after LSG, the placement of a perigastric ring during the first procedure may be a strategy to improve the results. This trial is registered with NCT04228185.
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Affiliation(s)
- Paolo Gentileschi
- Department of Surgery, Obesity Unit, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Leandro Siragusa
- Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Valeria Tognoni
- Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Domenico Benavoli
- Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Stefano D'Ugo
- Department of General Surgery, “Vito Fazzi” Hospital, Piazza Muratore 1–73100, Lecce, Italy
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Al Watban ZH, Al Sulaiman OA, Al Suhaibani MS, Al Nafisah IY, Al Ateiq IM, Al Samil YA, Al Turki YA. Patient awareness about the indications and complications of sleeve gastrectomy. J Family Med Prim Care 2020; 9:321-326. [PMID: 32110612 PMCID: PMC7014853 DOI: 10.4103/jfmpc.jfmpc_806_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/22/2019] [Accepted: 12/04/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To assess patients' awareness of the indications and complications of sleeve gastrectomy in King Khalid University Hospital, Riyadh, Saudi Arabia. METHODS The cross-sectional study conducted from December 2017 to May 2018 in KKUH, Riyadh, Saudi Arabia included all patients aged 18 years and older. Data collection was conducted through self-administered questionnaires. Chi-square test was performed to determine the significant differences between variables. A P value of < 0.05 was considered statistically significant. RESULT Of 480 participants, 247 (51.5%) of them were male. The educational level of most was bachelor's degree (253; 52.7%). Most of the participants (326; 67.9%) are not aware about BMI. However, 80 (16.7%) participants knew the true answer to obese BMI. Of the total participants, 283 (59.0%) did not knew about sleeve gastrectomy indications; however, 311 (64.8%) of the participants had heard about the complications of sleeve gastrectomy. All these results are correlated with the educational level of the participants. CONCLUSION Our study shows a lack of awareness of sleeve gastrectomy indications and complications among study population. We need to increase public awareness about sleeve gastrectomy indications and complication by proper scientific health education in the community.
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Affiliation(s)
- Zaki H. Al Watban
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Omar A. Al Sulaiman
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammad S. Al Suhaibani
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Y. Al Nafisah
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ibrahim M. Al Ateiq
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yousef A. Al Samil
- King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yousef A. Al Turki
- Professor and Consultant Family Medicine, Department of Family and Community Medicine, King Saud University, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
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Asokkumar R, Babu MP, Bautista I, Lopez-Nava G. The Use of the OverStitch for Bariatric Weight Loss in Europe. Gastrointest Endosc Clin N Am 2020; 30:129-145. [PMID: 31739959 DOI: 10.1016/j.giec.2019.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Technological advances have permitted minimally invasive treatment of many gastrointestinal diseases. With the advent of endoscopic full-thickness suturing, it has become possible to replicate some of the surgical procedures. Endoluminal bariatric procedures to remodel and reduce the gastric volume similar to surgery is evolving as a treatment option for obesity. Some of these methods also have been extended to treat weight regain after gastric bypass surgery. There is a steep learning curve to gaining proficiency with different endoscopic gastric remodeling or gastroplasty techniques. This article describes a simplified technique of endoscopic sleeve gastroplasty using the OverStitch suturing device.
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Affiliation(s)
- Ravishankar Asokkumar
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, Madrid 28050, Spain; Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
| | - Mohan Pappu Babu
- Department of Internal Medicine, University of Arizona, Banner University Medical Center, 1625 North Campbell Avenue, Tucson, AZ 85719, USA
| | - Inmaculada Bautista
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, Madrid 28050, Spain
| | - Gontrand Lopez-Nava
- Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 10, Madrid 28050, Spain
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Abstract
PURPOSE OF REVIEW The number of bariatric surgeries for patients with type 1 or type 2 diabetes continues to grow. Clinicians are challenged to choose therapies that reach glycemic targets without inducing adverse effects in post-bariatric patients without published guidelines. This review evaluates data supporting the best strategies for diabetes management in patients undergoing bariatric surgery. RECENT FINDINGS Though few clinical trials have evaluated the safety and effectiveness of different glucose-lowering therapies following bariatric surgery, remission of diabetes or reduced medications is an established benefit of bariatric surgery. Adverse events including diabetic ketoacidosis in post-bariatric patients on sodium-glucose co-transporter 2 (SGLT2) inhibitors or inadequate insulin have been reported in patient's with both type 1 and type 2 diabetes. Metformin, glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, SGLT2 inhibitors, insulin, and sulfonylureas have been used successfully in the perioperative period for other surgeries and guidelines recommend adjusting the doses of these medications especially in the perioperative period. Clinicians should favor weight-neutral or weight-loss promoting therapies in post-bariatric surgery patients such as medical nutrition therapy, metformin, GLP-1 agonists, SGLT2 inhibitors, and DPP-4 inhibitors.
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Affiliation(s)
- Christopher M Mulla
- Division of Endocrinology, Landstuhl Regional Medical Center, US Army, Landstuhl, Germany.
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Harris M Baloch
- Division of Endocrinology, Landstuhl Regional Medical Center, US Army, Landstuhl, Germany
| | - Samar Hafida
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Directive clinique N o 391 - Grossesse et obésité maternelle Partie 1 : Préconception et soins prénataux. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1641-1659. [PMID: 31640865 DOI: 10.1016/j.jogc.2019.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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An Analysis of Mid-Term Complications, Weight Loss, and Type 2 Diabetes Resolution of Stomach Intestinal Pylorus-Sparing Surgery (SIPS) Versus Roux-En-Y Gastric Bypass (RYGB) with Three-Year Follow-Up. Obes Surg 2019; 28:2894-2902. [PMID: 29790130 DOI: 10.1007/s11695-018-3309-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND For many years, the Roux-en-Y Gastric Bypass (RYGB) was considered a good balance of complications and weight loss. According to several short-term studies, single anastomosis duodenal switch or stomach intestinal pylorus sparing surgery (SIPS) offers similar weight loss to RYGB with fewer complications and better diabetes resolution. No one has substantiated mid-term complication and nutritional differences between these two procedures. This paper seeks to compare complication and nutritional outcomes between RYGB and SIPS. METHODS A retrospective analysis of 798 patients who either had SIPS or RYGB from 2010 to 2016. Complications were gathered for each patient. Nutritional outcomes were measured for each group at 1, 2, and 3 years. Regression analysis was applied to interpolate each patient's weight at 3, 6, 9, 12, 18, 24, and 36 months. These were then compared with t tests, Fisher's exact tests, and chi-squared tests. RESULTS RYGB and SIPS have statistically similar weight loss at 3, 6, 9, 12, and 36 months. They statistically differ at 18 and 24 months. At 36 months, there is a trend for weight loss difference. There were only statistical differences in nutritional outcomes between the two procedures with calcium at 1 and 3 years and vitamin D at 1 year. There were statistically significantly more long-term class IIIb-V complications, class I-IIIa complications, reoperations, ulcers, small bowel obstructions, nausea, and vomiting with the RYGB than the SIPS. CONCLUSION With comparable weight loss and nutritional outcomes, SIPS has fewer short- and long-term complications than RYGB and better type 2 diabetes resolution rates.
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Bhandari M, Fobi MAL, Buchwald JN. Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement. Obes Surg 2019; 29:309-345. [PMID: 31297742 DOI: 10.1007/s11695-019-04032-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
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Affiliation(s)
- Mohit Bhandari
- Department of Surgery, Sri Aurobindo Medical College and Postgraduate Institution, Mohak Bariatric and Robotic Surgery Centre, Indore, MP, India.
| | - M A L Fobi
- Department of Surgery, Sri Aurobindo Medical College and Postgraduate Institution, Mohak Bariatric and Robotic Surgery Centre, Indore, MP, India
| | - Jane N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA
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Roebroek YGM, Talib A, Muris JWM, van Dielen FMH, Bouvy ND, van Heurn LWE. Hurdles to Take for Adequate Treatment of Morbidly Obese Children and Adolescents: Attitudes of General Practitioners Towards Conservative and Surgical Treatment of Paediatric Morbid Obesity. World J Surg 2019; 43:1173-1181. [PMID: 30478687 DOI: 10.1007/s00268-018-4874-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bariatric surgery is regarded as the most effective treatment of morbid obesity in adults. Referral patterns for bariatric surgery in adults differ among general practitioners (GPs), partially due to restricted knowledge of the available treatment options. Reluctance in referral might be present even stronger in the treatment of morbidly obese children. OBJECTIVES The aim of this study was to investigate the current practice of GPs regarding treatment of paediatric morbid obesity and their attitudes towards the emergent phenomenon of paediatric weight loss surgery. METHODS All GPs enlisted in the local registries of two medical centres were invited for a 15-question anonymous online survey. RESULTS Among 534 invited GPs, 184 (34.5%) completed the survey. Only 102 (55.4%) reported providing or referring morbidly obese children for combined lifestyle interventions. A majority (n = 175, 95.1%) estimated that conservative treatment is effective in a maximum of 50% of children. Although 123 (66.8%) expect that bariatric surgery may be effective in therapy-resistant morbid obesity, only 76 (41.3%) would consider referral for surgery. Important reasons for reluctance were uncertainty about long-term efficacy and safety. The opinion that surgery is only treatment of symptoms and therefore not appropriate was significantly more prevalent amongst GPs who would not refer (58.3% vs. 27.6%, p < 0.001). CONCLUSION There is a potential for undertreatment of morbidly obese adolescents, due to suboptimal knowledge regarding guidelines and bariatric surgery, as well as negative attitudes towards surgery. This should be addressed by improving communication between surgeons and GPs and providing educational resources on bariatric surgery.
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Affiliation(s)
- Yvonne G M Roebroek
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6229 HX, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Ali Talib
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6229 HX, Maastricht, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, NL-6229 HX, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - L W Ernest van Heurn
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Center/VU University Medical Center, Amsterdam, The Netherlands
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Gutierrez Blanco D, Romero Funes D, Giambartolomei G, Lo Menzo E, Szomstein S, Rosenthal RJ. Impact of rapid weight loss on risk reduction of developing arterial hypertension in severely obese patients undergoing bariatric surgery. A single-institution experience using the Framingham Hypertension Risk Score. Surg Obes Relat Dis 2019; 15:920-925. [PMID: 31076366 DOI: 10.1016/j.soard.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Morbid obesity is strongly associated with hypertension. OBJECTIVE The objective of this study is to compare the risk of developing hypertension before and after bariatric surgery. SETTING U.S. university hospital. METHODS We retrospectively reviewed all patients who underwent bariatric surgery from 2010 to 2015 at our institution. Nonhypertensive white individuals without diabetes at baseline were included in our study. The Framingham Hypertension Risk Score was used to predict the near-term incidence of the disease. This calculator predicts 1-, 2-, and 4-year incidence of hypertension. RESULTS A total of 475 patients met the criteria for the hypertension risk score calculation. Females composed 72% (n = 342) of our population with a mean age of 42.6 ± 11.6 years. Laparoscopic sleeve gastrectomy was the most prevalent procedure at 81.89% (n = 389). At 12- month follow-up, the 1-year absolute risk reduction (ARR) and the relative risk reduction (RRR) were 6.2% and 69.2% (P < .01), respectively. The 2-year ARR was 11.9%, with an RRR of 67.9% (P < .01). The 4-year risk was also calculated at 12-month follow-up, resulting in an ARR of 20.1%, and RRR of 63.7% (P < .01). Furthermore, stratifying by type of procedure, the results were comparable between sleeve gastrectomy and Roux-en-Y gastric bypass. Regarding blood pressure values at 12-month follow-up, the systolic blood pressure was reduced 11.4 mm Hg (P < .01) and the diastolic blood pressure was reduced 4.4 mm Hg (P = .07). The percentage of estimated body mass index loss at 12-month follow-up was 71.7%. CONCLUSIONS Sleeve gastrectomy and Roux-en-Y gastric bypass significantly diminish the risk of developing hypertension in morbidly obese patients. Prospective studies are needed to better comprehend these findings.
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Affiliation(s)
- David Gutierrez Blanco
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Romero Funes
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Giulio Giambartolomei
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc 2019; 34:396-407. [PMID: 30993513 PMCID: PMC6946737 DOI: 10.1007/s00464-019-06782-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Staple-line buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher’s exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates. Electronic supplementary material The online version of this article (10.1007/s00464-019-06782-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Hopital du Sacré Coeur, 315 Place D’Youville, Suite 191, Montréal, QC H2Y 0A4 Canada
- Herbert Wertheim School of Medicine, Florida International University, Miami, FL USA
- Westmount Square Surgical Center, Westmount, QC Canada
| | - Paul Kemmeter
- Department of Surgery, Mercy Health Saint Mary’s, 2060 E Paris Ave SE #100, Grand Rapids, MI USA
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Domienik-Karłowicz J, Ziemiański P, Małkowski P, Kosieradzki M, Pruszczyk P, Lisik W. A Retrospective Study of 6-Month Reduction in Risk of Developing Cardiovascular Diseases and Type 2 Diabetes Mellitus in Severely Obese Patients Over 60 Years of Age Following Bariatric Surgery. Med Sci Monit 2019; 25:2577-2582. [PMID: 30958811 PMCID: PMC6467173 DOI: 10.12659/msm.915937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Controversy exists with regard to the effectiveness and reasons for bariatric procedures in patients older than 60 years. The goal of our study was to determine the reduction in risk of developing cardiovascular disease and type 2 diabetes mellitus after undergoing bariatric surgery in obese patients over age 60 at our institution. MATERIAL AND METHODS Patients with severe obesity (BMI >40 kg/m²) were retrospectively included in the study. Risk of cardiovascular disease and type 2 diabetes at baseline and their reduction during the follow-up period were evaluated with the following selected, currently preferred risk algorithms: (1) the Systemic Coronary Risk Evaluation (SCORE) scale; (2) the Framingham Risk Score (of myocardial infarction or coronary death) for patients with no prior history of diabetes, coronary heart disease, or intermittent claudication; and (3) the Framingham Offspring Diabetes Risk Score, which estimates the 8-year risk of developing type 2 diabetes. RESULTS All 33 elderly patients (32 women and 1 man, mean age 62.3±2.7 (BMI 44.3±6.2 kg/m²) significantly reduced their risk levels. We observed a decrease in the 10-year risk of a first fatal cardiovascular event (3.5±0.5 vs. 2.4±0.5, absolute risk reduction [ARR] 1.0); reduced 10-year risk of myocardial infarction or death (5.0±1.6 vs. 3.25±1.6, ARR 1.7); and reduced predicted 8-year risk of developing type 2 diabetes (7.4±7.2 vs. 3.1±0.3, ARR 4.3). No intra- or postoperative complications were observed. CONCLUSIONS Our study showed a significant reduction in risk of developing cardiovascular diseases and type 2 diabetes, as measured by available risk scores, in elderly patients undergoing bariatric procedures.
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Affiliation(s)
| | - Paweł Ziemiański
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Małkowski
- Department of Surgical and Transplant Nursing , Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kosieradzki
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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Ko G, Smith A, Cassie S, Zevin B. Incidentally discovered intestinal nonrotation at time of bariatric surgery: Which operation to perform? Surg Obes Relat Dis 2019; 15:424-430. [PMID: 30718108 DOI: 10.1016/j.soard.2018.12.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND An incidental finding of intestinal nonrotation at the time of bariatric surgery poses the following 2 dilemmas: (1) which operation to perform, and (2) whether an appendectomy should be performed concurrently. OBJECTIVES To review the experience of 2 Bariatric Centers of Excellence with laparoscopic sleeve gastrectomy (LSG) in patients with intestinal nonrotation, and to perform a systematic review of the literature on this topic. SETTING Two Bariatric Centers of Excellence as designated by the Ontario Bariatric Network. METHODS A chart review of all LSG cases performed in patients with intestinal nonrotation at 2 centers was performed. A systematic review on performing bariatric surgery in patients with intestinal nonrotation/malrotation was conducted using EMBASE and MEDLINE databases. RESULTS Four patients (.4% of all cases) underwent LSG in the setting of intestinal nonrotation. Two patients underwent a concurrent appendectomy. Three patients developed postoperative gastrointestinal reflux disease and 1 patient required conversion to a laparoscopic Roux-en-Y gastric bypass. A total of 12 retrospective studies with 23 patients were included in the systematic review. Nineteen patients underwent Roux-en-Y gastric bypass, 3 patients underwent a duodenal switch, and 1 patient underwent LSG. Nine patients (41%) underwent a concurrent appendectomy. Reasons cited for not performing an appendectomy include not completely understanding the anatomic defect, being surprised by the discovery of nonrotation, no consent for the procedure, and suboptimal trocar placement for an appendectomy. CONCLUSIONS LSG is a reasonable alternative to laparoscopic Roux-en-Y gastric bypass in patients with intestinal nonrotation. A concurrent appendectomy may not be necessary in the era of modern cross-sectional imaging for diagnosing acute appendicitis.
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Affiliation(s)
- Gary Ko
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Andrew Smith
- Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Scott Cassie
- Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Ontario, Canada.
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Gutierrez-Blanco D, Romero Funes D, Castillo M, Lo Menzo E, Szomstein S, Rosenthal RJ. Bariatric surgery reduces the risk of developing type 2 diabetes in severe obese subjects undergoing sleeve gastrectomy. Surg Obes Relat Dis 2019; 15:168-172. [DOI: 10.1016/j.soard.2018.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/06/2018] [Accepted: 11/16/2018] [Indexed: 02/07/2023]
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Chen MJ, Bhowmick S, Beseler L, Schneider KL, Kahan SI, Morton JM, Goodman SB, Amanatullah DF. Strategies for Weight Reduction Prior to Total Joint Arthroplasty. J Bone Joint Surg Am 2018; 100:1888-1896. [PMID: 30399084 DOI: 10.2106/jbjs.18.00020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael J Chen
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Subhrojyoti Bhowmick
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Lucille Beseler
- Family Nutrition Center of South Florida, Coconut Creek, Florida
| | - Kristin L Schneider
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Scott I Kahan
- National Center for Weight and Wellness, Washington, DC
| | - John M Morton
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Stuart B Goodman
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
| | - Derek F Amanatullah
- Departments of Orthopaedic Surgery (M.J.C., S.B., S.B.G., and D.F.A.) and Surgery (J.M.M.), Stanford University Medical Center, Stanford, California
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The effects of provider-prescribed obesogenic drugs on post-laparoscopic sleeve gastrectomy outcomes: a retrospective cohort study. Int J Obes (Lond) 2018; 43:1154-1163. [PMID: 30242239 PMCID: PMC6428627 DOI: 10.1038/s41366-018-0207-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/31/2018] [Accepted: 08/04/2018] [Indexed: 12/19/2022]
Abstract
Background: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures and has proven effective in providing weight loss. However, considerable variance has been noted in the degree of weight loss. Physician prescription practices may be negatively affecting weight loss post-LSG and, thus, contributing to the broad range of weight loss outcomes. The aim of our study was to determine whether commonly prescribed obesogenic medications negatively affect weight loss outcomes post-LSG. Subjects/Methods: This single center retrospective cohort study performed at a University hospital included 323 patients (≥18 years) within University California, San Diego Healthcare System who underwent LSG between 2007 and 2016. We identified a list of 32 commonly prescribed medications that have weight gain as a side effect. We compared the percent excess weight loss (%EWL) of patients divided into two groups based on post-LSG exposure to obesogenic medications. A linear regression model was used to analyze %EWL at 12 months post-LSG while controlling for age, initial body mass index (BMI), and use of leptogenic medications. Results: 150 patients (Meds group) were prescribed obesogenic medications within the one-year post-LSG follow up period, whereas 173 patients (Control group) were not prescribed obesogenic medications. The Meds group lost significantly less weight compared to the Control group (%EWL ± SEM at 12 months 53.8 ± 2.4 n=78, 65.0 ± 2.6, n=84 respectively, P = 0.002). This difference could not be attributed to differences in age, gender, initial BMI, co-morbidities, or prescription of leptogenic medications between the two groups. Conclusions: The use of provider-prescribed obesogenic medications was associated with worse weight loss outcomes post-LSG. Closer scrutiny of patient medications may be necessary to help improve outcomes of weight loss treatments.
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