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Zidan MH, El-Masry H, Amgad A, Altabbaa H, Abdou ME, Amer SA, Zayed N, Ismail HO, Alokl M, Abokhozima A. Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) Checklist: A New Reporting Checklist Based on Evidential Assessment of the Number of Trocars and Positions. Obes Surg 2025; 35:1086-1108. [PMID: 39903416 PMCID: PMC11906533 DOI: 10.1007/s11695-025-07694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 12/11/2024] [Accepted: 01/14/2025] [Indexed: 02/06/2025]
Abstract
Since the early 1980s, efforts to standardize ergonomic practices in laparoscopic surgeries have aimed to improve procedural efficiency and reduce complications, but clinical validation remains limited. In metabolic and bariatric surgeries (MBS), innovations in trocar site placements, driven by the popularity of laparoscopic sleeve gastrectomy (LSG), have advanced surgical techniques. However, practices often vary based on individual surgeon preferences rather than standardized evidence-based criteria. This study introduces the Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) checklist, aiming to standardize port placements and improve reporting consistency. A systematic review and meta-analysis of LSG studies were conducted following PRISMA guidelines. Data were extracted from 34 studies involving 7173 cases. Key variables included port configurations, manipulation angles, and outcomes such as operative time and excess weight loss percentage (EWL%). Innovative methods were used to estimate manipulation and azimuth angles from available intraoperative images. Statistical analyses and meta-regression were performed to identify associations between port configurations and surgical outcomes. Findings revealed substantial variability in port placements, with no significant effect of manipulation angles or port numbers on operative time or EWL% at 6, 12, and 24 months (p-values > 0.05). High residual heterogeneity suggests that factors beyond manipulation angles and port counts contribute to outcome variability. The PSPOSO checklist provides a framework for standardizing port placement and ergonomic parameters in MBS, enhancing reproducibility and safety. Future studies should validate the checklist across diverse clinical settings to refine surgical approaches and improve patient outcomes. PROSPERO: CRD42024598674.
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Affiliation(s)
- Mohamed H Zidan
- Alexandria University, Alexandria, Egypt.
- The Research Papyrus Lab, Alexandria, Egypt.
- El-Ekbal Hospital, Alexandria, Egypt.
| | - Hassan El-Masry
- Alexandria University, Alexandria, Egypt
- The Research Papyrus Lab, Alexandria, Egypt
- El-Ekbal Hospital, Alexandria, Egypt
| | - Ahmed Amgad
- The Research Papyrus Lab, Alexandria, Egypt
- Helwan University, Cairo, Egypt
| | - Hashem Altabbaa
- Alexandria University, Alexandria, Egypt
- The Research Papyrus Lab, Alexandria, Egypt
| | - Marwan Emad Abdou
- Alexandria University, Alexandria, Egypt
- The Research Papyrus Lab, Alexandria, Egypt
- Department of Surgery, Medical Research Institute, Alexandria, Egypt
| | | | - Nour Zayed
- Alexandria University, Alexandria, Egypt
- The Research Papyrus Lab, Alexandria, Egypt
| | - Haidy Osama Ismail
- Alexandria University, Alexandria, Egypt
- The Research Papyrus Lab, Alexandria, Egypt
| | - Mohammed Alokl
- Alexandria University, Alexandria, Egypt
- El-Ekbal Hospital, Alexandria, Egypt
| | - Ahmed Abokhozima
- Alexandria University, Alexandria, Egypt.
- El-Ekbal Hospital, Alexandria, Egypt.
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Farah A, Tatakis A, Malshy K, Mahajna A, Sayida S. Real-Time Perfusion and Leak Assessment in Bariatric Surgery: Bridging Traditional and Advanced Techniques. Cureus 2024; 16:e71919. [PMID: 39564049 PMCID: PMC11576053 DOI: 10.7759/cureus.71919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2024] [Indexed: 11/21/2024] Open
Abstract
This comprehensive literature review explores the efficacy of real-time perfusion and leak assessment methods in bariatric surgery, comparing traditional techniques with advanced imaging modalities. As the global incidence of obesity and related comorbidities rises, the demand for bariatric surgeries such as Roux-en-Y gastric bypass and sleeve gastrectomy has increased, along with the risk of serious complications like anastomotic and staple line leaks. Traditional intraoperative leak testing methods, including the air leak and methylene blue dye tests, are commonly employed but exhibit inconsistent sensitivity in leak detection. Intraoperative endoscopy, although underutilized, offers enhanced visualization and has been associated with reduced leak and complication rates in certain cases. Emerging technologies such as indocyanine green (ICG) fluorescence, laser speckle contrast imaging (LSCI), and hyperspectral imaging (HSI) provide real-time assessment of tissue perfusion, potentially improving surgical outcomes. ICG fluorescence enables visualization of blood flow to detect ischemia, while LSCI offers immediate, dye-free perfusion mapping, and HSI assesses tissue oxygenation without the need for contrast agents. Despite their promise, these technologies are limited by high costs, technical complexity, and varying accessibility, with current evidence insufficient to confirm their superiority over traditional methods. Future research should focus on large-scale, multicenter trials to validate these advanced techniques and refine their application in clinical practice. Integrating traditional and emerging methods may optimize intraoperative decision-making, reduce complications rates, and enhance patient outcomes in bariatric surgery.
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Affiliation(s)
- Amir Farah
- Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Anna Tatakis
- General Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Kamil Malshy
- Urology, University of Rochester Medical Center, Rochester, USA
| | - Ahmad Mahajna
- General Surgery, Division of Advanced Laparoscopic and Bariatric Surgery, Rambam Medical Center, Haifa, ISR
| | - Sa'd Sayida
- General Surgery, Edinburgh Medical Missionary Society (EMMS) Nazareth Hospital, Nazareth, ISR
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3
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Farah A, Malshy K, Tatakis A, Abboud W, Mari A, Sayida S. Nonoperative Management Strategies for Anastomotic Leaks After One Anastomosis Gastric Bypass (OAGB): A Literature Review. Cureus 2024; 16:e69708. [PMID: 39429265 PMCID: PMC11489929 DOI: 10.7759/cureus.69708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2024] [Indexed: 10/22/2024] Open
Abstract
One Anastomosis Gastric Bypass (OAGB) has gained widespread acceptance as an effective bariatric surgery due to its relative simplicity and favorable outcomes in weight loss and metabolic improvement. However, anastomotic leaks, though uncommon, present a significant complication with the potential for severe morbidity and mortality if not managed appropriately. This review examines the range of nonoperative strategies currently employed to manage anastomotic leaks and fistulae following OAGB. The focus is on endoscopic techniques, including the use of clips, stents, suturing systems, internal drainage, vacuum therapy, and tissue sealants, which have been successfully used in various gastrointestinal surgeries. Although a proportion of patients will require surgical treatments, these strategies offer less invasive alternatives to surgical intervention and can be tailored to the specific characteristics of the leak and patient condition. However, the application of these techniques specifically for OAGB-related leaks is not as well-documented. This review lists the available evidence on these nonoperative approaches, highlighting some of their potential benefits and limitations. While these methods show promise, there is a clear need for further research to establish standardized protocols and optimize their use in the context of OAGB-related leaks and fistulae.
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Affiliation(s)
- Amir Farah
- General Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Kamil Malshy
- Urology, University of Rochester Medical Center, Rochester, USA
| | - Anna Tatakis
- General Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Wisam Abboud
- General Surgery, Edinburgh Medical Missionary Society (EMMS) Nazareth Hospital, Nazareth, ISR
| | - Amir Mari
- Gastroenterology and Hepatology, Edinburgh Medical Missionary Society (EMMS) Nazareth Hospital, Nazareth, ISR
| | - Sa'd Sayida
- General Surgery, Edinburgh Medical Missionary Society (EMMS) Nazareth Hospital, Nazareth, ISR
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Farup PG. Changes in bone turnover markers 6-12 months after bariatric surgery. Sci Rep 2024; 14:14844. [PMID: 38937532 PMCID: PMC11211350 DOI: 10.1038/s41598-024-65952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/25/2024] [Indexed: 06/29/2024] Open
Abstract
A rise in bone turnover markers (BTM) after bariatric surgery predicts poor bone health years later. This study explored factors associated with BTM and changes in BTM after bariatric surgery. Inclusion criteria were subjects 18 to 65 years of age with morbid obesity undergoing bariatric surgery. All data were measured before and 6 and 12 months after surgery. The study included 104 subjects: women/men: 83/21; mean age 43.1 (SD 8.4) years; BMI: 38.8 kg/m2 (SD 3.8). Surgery with Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) was performed in 84 (81%) and 20 (19%) subjects, respectively. From before to 6-12 months after surgery, procollagen type 1 N-terminal propeptid (P1NP) increased by 45.6 µg/L (95% CI 41.5-50.0, p < 0.001), and alkaline phosphatase (ALP) by 10 U/L (95% CI 7-14, p < 0.001). The increases were significantly larger after RYGB than after SG. The APOE- Ɛ3 allele was associated with low levels of BTM and high levels of leptin. There was an unfavourable increase in BTM after bariatric surgery. SG compared to RYGB and the presence of the APOE-Ɛ3 allele were associated with less unfavourable effects. The study emphasises the importance of optimal prophylactic interventions after bariatric surgery to prevent osteoporosis.
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Affiliation(s)
- Per G Farup
- Department of Research, Innlandet Hospital Trust, PB 104, 2381, Brumunddal, Norway.
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El Masry MAMA, Attia MS. A comparative study between staple line reinforcement during laparoscopic sleeve gastrectomy and no reinforcement: an Egyptian experience. Surg Endosc 2023; 37:9318-9325. [PMID: 37891370 PMCID: PMC10709468 DOI: 10.1007/s00464-023-10497-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become an increasingly popular bariatric procedure. LSG still conveys some risks, including early staple line complications such as bleeding and leaks. It has been proposed that staple line complications can be reduced by staple line reinforcement (SLR). This study aimed to compare the short-term efficacy and safety of the SLR during LSG by oversewing versus no SLR in an Egyptian cohort over a period of 11 years. PATIENTS AND METHODS This is a retrospective study that analyzed data from patients undergoing LSG by the same surgeon over a period of 11 years. The patients' early postoperative complications were compared according to performing SLR. RESULTS The SLR group showed significantly longer surgery time (p = 0.021) and a lower rate of postoperative bleeding (p = 0.027). All leakage cases occurred in the non-SLR group (0.7% vs. 0.0%) without statistical significance (p = 0.212). The two mortality cases occurred in the non-SLR group. The LOS was comparable in the two groups (p = 0.289). CONCLUSION This study confirms the short-term benefits of SLR by oversewing during LSG in terms of a lower incidence of 30-day morbidity, particularly bleeding, and lower rates of reoperation, with a clinically questionable longer operation time.
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Ergin A, Ergin E, Atasever A, Çiyiltepe H, Fersahoğlu MM, Esen Bulut N, Taşdelen İ, Güneş Y, Teke E, Yılmaz C, İlleez Ö, Usta B, Sancak S. Investigatıon of the effect of weight loss after laparoscopic sleeve gastrectomy on cobb angle, waist and back pain: a prospective study. Surg Obes Relat Dis 2023; 19:1357-1365. [PMID: 37673710 DOI: 10.1016/j.soard.2023.07.010] [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: 03/09/2023] [Revised: 06/19/2023] [Accepted: 07/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND In many studies, it has been stated that obesity causes severe increases in the risks of disc degeneration, vertebral fracture, low back, and back pain. One of the most effective treatment options for obesity is bariatric surgery. OBJECTIVES In this study, the effect of weight loss on these parameters was investigated by evaluating the Cobb angle, low back, and back pain. SETTING University Hospital METHODS: A total of 89 patients were included in the study. Laparoscopic sleeve gastrectomy (SG) was performed on all patients. In addition, Cobb angle, height, weight, and body mass index (BMI) measurements were recorded at each visit. Investigating the quality and quantity of low back pain and the loss of function caused by the patients; visual analog scale (VAS), Oswestry Low Back Pain Disability Questionnaire (OLBPDQ), Roland-Morris Disability Questionnaire (RMDQ), and SF-36 Quality of Life Questionnaire (SF36) were administered. RESULTS According to the preoperative Cobb angles, the decrease in the 6th month (P = .029) and 12th month (P = .007) measurements after the operation was found to be statistically significant (P < .05), but it was found to be clinically insignificant. When the changes in RMDQ, OLBPDQ, VAS, and SF-36 scores were examined, the decrease in the 6th month (P = .001) and 12th month (P = .001) scores after the operation was found to be significant compared to the preoperative scores (P < .01). CONCLUSIONS In this study, weight loss after SG improved for patients with chronic low back and back pain and significantly improved their quality of life.
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Affiliation(s)
- Anıl Ergin
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Elifnur Ergin
- Anatomy Department, Medipol Unıversity Health Sciences Institute, İstanbul, Turkey
| | - Alper Atasever
- Anatomy Department, Medipol Unıversity Health Sciences Institute, İstanbul, Turkey
| | - Hüseyin Çiyiltepe
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Mehmet M Fersahoğlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Nuriye Esen Bulut
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - İksan Taşdelen
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Yasin Güneş
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Emre Teke
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Cem Yılmaz
- İstanbul Breast Center, Breast Surgery Clinic, Istanbul, Turkey
| | - Özge İlleez
- Physical Therapy and Rehabilitation Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Burcu Usta
- Radiology Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Seda Sancak
- Endocrinology Department, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Kuzmar I, Consuegra JR, Rangel T, Barroso JL, Cuentas YM, Ibáñez S, Rizo-Baeza MM, Cortés-Castell E. Medical supervised duodenal-enteral feeding for the treatment of overweight and obesity: MESUDEFT. NUTR HOSP 2023. [PMID: 38047411 DOI: 10.20960/nh.04731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND the development of specialised nutritional support techniques allows the maintenance of an adequate supply of nutrients in those patients in whom oral feeding is not possible or is insufficient in relation to their requirements, trying to improve the quality of life, especially in those with chronic diseases. METHODS single-center clinical study carried out in a clinical-nutritional center consisting of a medically supervised nasogastric-duodenal tube feeding treatment for overweight, obesity and increased body fat percentage in patients requiring it by means of duodeno-enteral feeding, expecting losses of more than 10 %. RESULTS twenty-nine patients completed the protocol (20.4 % male and 79.6 % female) with a mean age of 38 years (SD: 12.4); 87.2 kg (SD: 18.5) mean weight; 37.9 kg (SD: 4.8) mean iFat%; 32.4 (SD: 5.4) iMean body mass index (BMI); 100 cm (SD: 16.0) iMean waist; 113.6 cm (SD: 10.4) iMean hip; 33.8 cm (SD: 3.9) iMean upper arm circumference; 65.5 cm (SD: 7.5) iMean thigh circumference; 9.7 (SD: 4.8) iVisceral fat index; and 22.9 days (SD: 13.9) mean treatment. A mean of 22.9 (SD: 13.9) days of MESUDEFT influences weight loss, fat loss, visceral fat loss and decreased arm, hip and thigh circumferences (p < 0.05) (i: initial). CONCLUSIONS MESUDEFT is shown to be an effective alternative as a sole treatment or as an adjunct prior to bariatric surgery for obesity or overweight treatment with a minimum of 10 % loss of BMI and fat mass at completion and 3-6 months follow-up.
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Affiliation(s)
- Isaac Kuzmar
- Health Sciences Faculty. Universidad Simón Bolívar. BiomediKcal - Advanced Medical Nutrition & Lifestyle Center
| | | | | | | | | | - Sofía Ibáñez
- Health Sciences Faculty. Universidad Simón Bolívar
| | | | - Ernesto Cortés-Castell
- Departamento de Farmacología, Pediatría y Química Orgánica. Universidad Miguel Hernández
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Zheng LQ, Kosai NR, Ani MFC, Maaya M. The Impact of Laparoscopic Intraperitoneal Instillation of Ropivacaine in Enhancing Respiratory Recovery and Reducing Acute Postoperative Pain in Laparoscopic Sleeve Gastrectomy: a Double-Blinded Randomised Control; RELiEVE Trial. Obes Surg 2023; 33:3141-3146. [PMID: 37667104 DOI: 10.1007/s11695-023-06777-y] [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: 02/27/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Laparoscopic intraperitoneal instillation of local anaesthetic in bariatric surgery proven to reduce postoperative pain. Limited data are available regarding the use of instillation ropivacaine and its impact on the recovery of respiratory effort. This study aims to evaluate the efficacy of laparoscopic intraperitoneal instillation of ropivacaine in reducing acute postoperative pain and enhancing the recovery of respiratory effort in laparoscopic sleeve gastrectomy. MATERIALS AND METHODS This double-blinded RCT enrolled 110 patients who underwent laparoscopic sleeve gastrectomy at Hospital Canselor Tuanku Muhriz UKM from November 2020 to May 2021. Any patients with previous abdominal surgery, chronic kidney disease, or liver disease were excluded. The patients were randomised into two groups: (i) the IPLA group which received ropivacaine intraperitoneal instillation at the dissected left crus and (ii) the placebo group (sterile water instillation). Perioperative analgesia was standardised. The first 24-h postoperative pain was assessed using a VAS. The respiratory effort was assessed using incentive spirometry simultaneously. RESULTS Total of 110 patients were recruited. The VAS score was lower with an enhanced recovery of respiratory effort in the local anaesthetic group compared to the placebo group (P < 0.05) within the first 24 h postoperatively. In addition, the placebo group required additional postoperative analgesia (P < 0.05). No side effects were reported with the use of intraperitoneal instillation of ropivacaine. CONCLUSION The use of intraperitoneal instillation of ropivacaine in laparoscopic sleeve gastrectomy is recommended as it is safe, effectively reduces acute postoperative pain, and enhances the recovery of respiratory effort postoperatively.
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Affiliation(s)
- Lee Qi Zheng
- Upper-Gastrointestinal Surgery Unit, MIS, Bariatric Surgery Unit, Department of Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia.
| | - Nik Ritza Kosai
- Upper-Gastrointestinal Surgery Unit, MIS, Bariatric Surgery Unit, Department of Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Mohd Firdaus Che Ani
- Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Jalan Ilmu 1/1, 40450, Shah Alam, Selangor, Malaysia
| | - Muhammad Maaya
- Department of Anaesthesiology & Critical Care, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
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Jiang Z, Zhang Z, Feng T, Cheng Y, Zhang G, Zhong M, Hu S. Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis. Int J Surg 2023; 109:1783-1795. [PMID: 37068794 PMCID: PMC10389429 DOI: 10.1097/js9.0000000000000402] [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: 12/22/2022] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1) placing the trocar; and (2) how many trocars should be used. Single-incision laparoscopic sleeve gastrectomy (SLSG), a newly emerged technique in 2008, has been proposed as an alternative to CLSG in recent years, however, there is no definite evidence for this. MATERIALS AND METHODS A systematic literature search was performed using the PubMed, Embase, Web of Science, and Cochrane Library databases for laparoscopic sleeve gastrectomy cases from January 2006 to October 2022. We then summarized the trocar numbers and placement patterns among these studies. A meta-analysis was conducted to compare the difference between SLSG and CLSG in the perioperative and postoperative indices. RESULTS A total of 61 studies involving 20 180 patients who underwent laparoscopic sleeve gastrectomy for treating morbid obesity were included in the systematic review, including 11 on SLSG, 35 on CLSG, and 15 studies comparing SLSG and CLSG. A systematic review showed that the trocar number varied in different CLSG studies, mainly using four or five trocars. The trocars were mainly placed in position, presenting an inverted trapezoid pattern and a left-predominant pattern. Meta-analysis showed that the operative time in the SLSG was significantly higher than that in the CLSG, and the pain Visual Analog Scale rating on postoperative day 1 in the CLSG was significantly higher than in the SLSG. There were no statistical significances in the other complications or surgical efficiency. CONCLUSIONS In the CLSG, the majority of the trocars were arranged in an inverted trapezoid pattern and were of the left-predominant type. Although SLSG is a feasible technique in selected patients, there is insufficient evidence to recommend its widespread use compared with CLSG. High-quality randomized controlled trials with large study populations and long follow-up periods will be required in the future.
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Affiliation(s)
- Zhengchen Jiang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Zhao Zhang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Tianyi Feng
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Yugang Cheng
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Mingwei Zhong
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Sanyuan Hu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
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Jansen A, Aaseth JO, Lyche JL, Berg JP, Müller MHB, Lydersen S, Farup PG. Do changes in persistent organic pollutants after bariatric surgery cause endocrine disruption? CHEMOSPHERE 2023; 313:137461. [PMID: 36470361 DOI: 10.1016/j.chemosphere.2022.137461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Bariatric surgery results in weight loss, marked endocrine changes and the release of persistent organic pollutants (POPs). The release of POPs might cause endocrine disruption. The study aimed to explore associations between POPs and adiponectin, leptin and ghrelin in subjects undergoing bariatric surgery. METHODS The study included 63 subjects with severe obesity (men/women: 13/50), age (years): 45.0 (8.5), and BMI (kg/m2) 39.1 (3.4). Analyses of adiponectin, leptin and ghrelin and POPs (hexachlorobenzene (HCB), dichlorodiphenyldichloroethylene (p,p'-DDE), polychlorinated biphenyl (PCB) 118 (dioxin-like compound; dl), and sum 6 PCB (PCB 28, -52, -101, -138, -153, and -180) were performed before and 12 months after bariatric surgery. RESULTS There were significant increases in adiponectin and all POPs and a fall in leptin after surgery. The main finding was the highly significant associations between adiponectin and all POPs. The increase in HCB explained 38% of the variation in adiponectin. CONCLUSIONS If the POP-associated increase in adiponectin is a causal effect, the release of POPs might have important clinical consequences. Adiponectin has both positive and negative clinical effects exerted by essentially unknown mechanisms. The effects of released POPs on the metabolic functions in subjects undergoing bariatric surgery deserve further evaluation.
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Affiliation(s)
- Aina Jansen
- Department of Surgery, Innlandet Hospital Trust, N-2819 Gjøvik, Norway
| | - Jan O Aaseth
- Department of Research, Innlandet Hospital Trust, N-2381Brumunddal, Norway; Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, N-2418 Elverum, Norway
| | - Jan L Lyche
- Department of Paraclinical Sciences, Norwegian University of Life Sciences (NMBU), N-1433 Ås, Norway
| | - Jens P Berg
- Department of Medical Biochemistry, Oslo University Hospital, N-0450 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, N-0316 Oslo, Norway
| | - Mette H B Müller
- Section for Experimental Biomedicine, Norwegian University of Life Sciences (NMBU), N-1433 Ås, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
| | - Per G Farup
- Department of Research, Innlandet Hospital Trust, N-2381Brumunddal, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491Trondheim, Norway.
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11
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Opstad TB, Farup PG, Rootwelt H, Aaseth JO. Changes in circulating sirtuin 1 after bariatric surgery. Nutr Metab Cardiovasc Dis 2022; 32:2858-2864. [PMID: 36404480 DOI: 10.1016/j.numecd.2022.09.009] [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: 06/10/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Obesity is associated with chronic inflammation and oxidative stress. Weight loss after bariatric surgery improves the inflammatory state and risk of cardiovascular disease. Improvement in metabolic dysfunction might be associated with changes in the activity of sirtuin 1 (SIRT1) and we aimed to investigate the effect of bariatric surgery on its circulating levels. METHODS AND RESULTS This is a sub-study of a prospective cohort study, including 110 subjects with morbid obesity. The surgical procedure was either laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Blood was sampled at inclusion and six and 12 months after surgery. SIRT1 was measured in EDTA plasma with an enzyme-linked immunosorbent assay. The mean age in the population was 43 years, 80% were women and mean body mass index (BMI) was 38.8 kg/m2. RYGB and SG were performed in 89 and 21 subjects, respectively. SIRT1 concentration was significantly reduced from baseline to six and 12 months after surgery, with mean values (SD) 156.8 (82.6), 119.5 (65.6) and 94.9 (45.6) ng/mL, respectively, (p ≤ 0.002, all), accompanied by significant reductions in C-reactive protein (CRP), BMI and triglycerides from inclusion (p < 0.001, all). Type of surgery did not differently modify SIRT1 levels (p = 0.09). CRP and triglycerides were both positively predictive of SIRT1 levels (p ≤ 0.001, both). CONCLUSION SIRT1 concentration was significantly lower six and 12 months after bariatric surgery. CRP and triglycerides independently predicted SIRT1 levels, suggesting that reduction in SIRT1 levels might not intrinsically be related to weight reduction, but to improvement in metaflammation.
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Affiliation(s)
- Trine B Opstad
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, 0240 Oslo, Norway; Faculty of Medicine, University of Oslo, 0315 Oslo, Norway.
| | - Per G Farup
- Department of Research, Innlandet Hospital Trust, PB 104, N-2381 Brumunddal, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
| | - Helge Rootwelt
- Department of Medical Biochemistry, Oslo University Hospital, 0372 Oslo, Norway
| | - Jan O Aaseth
- Department of Research, Innlandet Hospital Trust, PB 104, N-2381 Brumunddal, Norway; Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, PB 400, N-2418 Elverum, Norway
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12
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The Peripheral Kynurenine Pathway and Psychosomatic Comorbidity in Subjects with Morbid Obesity Undergoing Bariatric Surgery. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: The Kynurenine pathway (KP) is involved in various disorders, but little is known about the KP and psychosomatic complaints. The aim was to study the peripheral KP and psychosomatic comorbidity in subjects with morbid obesity. Methods: Psychosomatic comorbidity (perceived general health, muscle-skeletal pain, well-being, mood disorders, fatigue, self-esteem, sleepiness, and sense of humour) was registered, and serum samples were collected six months before and after bariatric surgery. Results: A total of 141 subjects (men/women, 116/25) with a mean age of 43.0 (SD 8.7) years and BMI of 42.1 (SD 3.8) kg/m2 were included. No significant associations were seen between the psychosomatic disorders and the KP. There was a significant downregulation of all KP metabolites after surgery, a reduction in CRP, and strong associations between CRP and the KP, particularly with the ratios of Kynurenine/Tryptophan and Quinolinic acid (QA)/Xanthurenic acid (XA). The QA/XA ratio was negatively associated with diabetes. Conclusions: The peripheral KP seemed to be of minor importance for the psychosomatic comorbidity in subjects with morbid obesity. The downregulation of all KP metabolites after bariatric surgery indicated reduced inflammation. The QA/XA ratio seemed to be a marker of insulin sensitivity and favourable glucose control.
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13
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APOE Polymorphism and Endocrine Functions in Subjects with Morbid Obesity Undergoing Bariatric Surgery. Genes (Basel) 2022; 13:genes13020222. [PMID: 35205269 PMCID: PMC8871864 DOI: 10.3390/genes13020222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obesity is an interplay between genes and the environment, including lifestyle. The genetics of obesity is insufficiently understood. Apolipoprotein E (APOE) genetic polymorphism has been associated with a wide range of disorders. Knowing that some APOE alleles are associated with obesity and endocrine disorders that are common in obesity, the present study aimed at exploring associations between APOE polymorphisms and endocrine functions in subjects with obesity undergoing bariatric surgery. METHODS Analyses of hormones in blood collected before and one year after bariatric surgery were examined. The APOE alleles were grouped as follows: E2 = ε2ε2 + ε2ε3; E3 = ε3ε3 + ε2ε4; E4 = ε3ε4 + ε4ε4. The APOE groups were analysed as nominal and ordered groups (E2-E3-E4) with a linear mixed model to predict the hormonal effects of the groups. RESULTS Forty-nine women (79%) and thirteen (21%) men with a mean age of 47.7 (SD 8.5) years were included in the study. The adiponectin level was significantly lower (p < 0.05) in the E2 group compared with the E4 group. Adiponectin and cortisol were positively and negatively associated, respectively, with the ordered APOE groups. CONCLUSIONS The ordered APOE groups E2-E3-E4 were significantly associated with high and low levels of adiponectin and cortisol, respectively. The findings indicate APOE-mediated effects on body weight and metabolic functions in subjects with morbid obesity.
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Yildiz BD, Alimoğullari M. Efficacy of Tight Sleeve Gastrectomy in Superobesity: Single Surgeon Experience. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03227-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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15
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Yilmaz F, Gedik GK, Yilmaz H. Evaluation of postprandial symptoms in two different laparoscopic sleeve gastrectomy techniques using gastric emptying scintigraphy. Niger J Clin Pract 2022; 25:1875-1882. [DOI: 10.4103/njcp.njcp_315_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Pourfakhr P, Aghabagheri M, Zabihi Mahmoudabadi H, Najjari K, Talebpour M, Khajavi MR. Prophylactic Administration of Diphenhydramine/Acetaminophen and Ondansetron Reduced Postoperative Nausea and Vomiting and Pain Following Laparoscopic Sleeve Gastrectomy: a Randomized Controlled Trial. Obes Surg 2021; 31:4371-4375. [PMID: 34313917 DOI: 10.1007/s11695-021-05589-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) and pain following bariatric surgery are problematic and affect the outcome of patients. Intraoperative multimodal antiemetic prophylaxis is essential to improve postoperative outcomes. This study investigated the effect of adding diphenhydramine to acetaminophen and ondansetron in reducing postoperative nausea and vomiting and pain following laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS Eighty-two patients scheduled for LSG were assigned to receive a single preinduction dose of diphenhydramine 0.4 mg/kg VI (D group) in addition to acetaminophen 1g and ondansetron 4 mg IV at the end of surgery and just acetaminophen 1 g and ondansetron 4 mg IV (C group) in a randomized, double-blind trial. PONV was assessed in recovery and 24 hours after surgery in the ward. Postoperative pain, analgesic requirements, and patients' level of sedation were also assessed. RESULTS The PONV rates in the recovery of the D group and the C group were 30% and 56% (P = .001). It also had a more significant reduction in the D group than in the C group in the first 24 h after surgery (40% vs. 66%). The severity of pain score and level of sedation and analgesic requirements was significantly reduced in this period in the D group. CONCLUSION Prophylactic diphenhydramine 0.4 mg/kg at the induction of general anesthesia in combination with acetaminophen 1 g and ondansetron 4 mg at the end of surgery reduced the incidence of PONV and postoperative severity of pain in laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Pejman Pourfakhr
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Imam Khomeini St, Tehran, 11367-46911, Iran
| | - Mojtaba Aghabagheri
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Imam Khomeini St, Tehran, 11367-46911, Iran
| | | | - Khosrow Najjari
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Talebpour
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Khajavi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Imam Khomeini St, Tehran, 11367-46911, Iran.
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Pg Baharuddin DM, Leik NKO, Hayati F, Mohd Daud MN, See E, Sharif SZ, Nik Lah NAS. Successful pregnancy in morbidly obese lady with polycystic ovary syndrome after bariatric surgery: A case report. Int J Surg Case Rep 2021; 85:106235. [PMID: 34330067 PMCID: PMC8329476 DOI: 10.1016/j.ijscr.2021.106235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Obesity has been proven to have adverse effects on fertility and is one of the predisposing factors for delay in pregnancy even with the use of assisted reproductive technique. There are many pathways in which obesity can affect fertility such as anovulation, poor implantation and low-quality oocyte. CASE PRESENTATION We report a case of a 40-year-old lady with primary infertility for six years with underlying polycystic ovary syndrome (PCOS) and BMI 45.7 whom was successfully conceived twice following bariatric surgery procedure in which reduction of 70% of her BMI prior to bariatric surgery lead to her spontaneous conception without fertility intervention and successful live birth. CLINICAL DISCUSSION Obese PCOS needs multidisciplinary approaches which include weight loss program such as dietary advice, exercise intervention as part of preliminary treatment prior to ovulation induction and counselling. CONCLUSION Bariatric surgery has been a mainstay treatment in patients with morbid obesity and those with BMI more than 35 associated with obesity related problems such as joint pain, hypertension or diabetes mellitus. Bariatric surgery such as laparoscopic sleeve gastrectomy should be considered more often in contrast to lifestyle modification for morbidly obese lady with PCOS and infertility prior to the use of standard ovulation induction regime for treating infertility.
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Affiliation(s)
- Dg Marshitah Pg Baharuddin
- Reproductive Health Department, Faculty of Medicine and Science Health, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Nang Kham Oo Leik
- Reproductive Health Department, Faculty of Medicine and Science Health, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Science Health, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Mohd Nazri Mohd Daud
- Department of Family Medicine, Faculty of Medicine and Science Health, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Edwin See
- Department of Surgery, Hospital Queen Elizabeth 2, Kota Kinabalu, Sabah, Malaysia
| | - Siti Zubaidah Sharif
- Department of Surgery, Hospital Queen Elizabeth 2, Kota Kinabalu, Sabah, Malaysia
| | - Nik Amin Sahid Nik Lah
- Department of Surgery, Faculty of Medicine and Science Health, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
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Abdelbary M, Marzaban R, Gamal Eldeen H, Khairy M, Menesy M, Fahmy M, Ayad A, Mouheb B, Yosry A. Clinical utility of transient elastography as an imaging tool to assess the short-term impact of laparoscopic sleeve gastrectomy, together with clinical and biochemical parameters and clinico-biochemical indices, on obese patients with nonalcoholic fatty liver disease: An Egyptian pilot study. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2021. [DOI: 10.1016/j.rgmxen.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Are Faecal Microbiota Analyses on Species-Level Suitable Clinical Biomarkers? A Pilot Study in Subjects with Morbid Obesity. Microorganisms 2021; 9:microorganisms9030664. [PMID: 33806783 PMCID: PMC8005088 DOI: 10.3390/microorganisms9030664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND An abnormal faecal microbiota could be a causal factor for disease. This study evaluated a new method for faecal microbiota analysis in subjects with obesity and irritable bowel syndrome. METHODS The study had a matched case-control design. Forty-six subjects with morbid obesity (defined as BMI > 40 or >35 kg/m2 with obesity-related complications) of whom 23 had irritable bowel syndrome (IBS), were compared with 46 healthy volunteers. The faecal microbiota was analysed with Precision Microbiome Profiling (PMP™) which quantified 104 bacteria species. The primary aim was comparisons between the cases and controls. RESULTS Two men and 44 women with a mean age of 43.6 years were included in each of the groups; BMI in the groups was (mean and SD) 41.9 (3.5) and 22.5 (1.5) kg/m2, respectively. Seventeen bacterial species showed statistically significant differences between the groups after adjusting for multiple testing. In a post hoc analysis, the sensitivity and specificity were 78%. Alpha diversity was lower in the group with obesity. In subjects with morbid obesity, no clinically significant differences were seen between subjects with and without IBS or from before to six months after bariatric surgery. CONCLUSIONS The results encourage further evaluation of the new microbiome profiling tool.
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20
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Abdelbary MS, Marzaban R, Gamal Eldeen H, Khairy M, Menesy M, Fahmy MH, Ayad AM, Mouheb BS, Yosry A. Clinical utility of transient elastography as an imaging tool to assess the short-term impact of laparoscopic sleeve gastrectomy, together with clinical and biochemical parameters and clinico-biochemical indices, on obese patients with nonalcoholic fatty liver disease: An Egyptian pilot study. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 86:125-132. [PMID: 33004251 DOI: 10.1016/j.rgmx.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) is a metabolic liver disorder commonly attributed to fatty acid deposition that can induce hepatic necroinflammation, defined as nonalcoholic steatohepatitis (NASH). It is strongly associated with obesity. Laparoscopic sleeve gastrectomy (LSG) is a favorable surgical modality for the treatment of morbid obesity. AIM Our study evaluated the impact of LSG on patients with NAFLD and morbid obesity, 3 months after the operation, through clinical and biochemical characteristics, clinico-biochemical indices, and imaging parameters. PATIENTS AND METHODS Morbidly obese patients with NAFLD±NASH underwent LSG. They were thoroughly evaluated clinically (body weight, body mass index, waist circumference) and biochemically (transaminases and triglycerides), as well as through the fatty liver index (FLI), the hepatic steatosis index (HSI), and ultrasound elastography imaging studies (liver stiffness measurement [LSM] and the controlled attenuation parameter [CAP]), before and 3 months after the LSG. RESULTS Twenty-six obese patients with NAFLD underwent LSG that resulted in a significantly high reduction in all the parameters analyzed, except for liver transaminases. CONCLUSION LSG is considered an efficient surgical modality for the treatment of morbidly obese patients with NAFLD.
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Affiliation(s)
- M S Abdelbary
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - R Marzaban
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto.
| | - H Gamal Eldeen
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - M Khairy
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - M Menesy
- Departamento de Medicina Tropical, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - M H Fahmy
- Departamento de Cirugía General, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - A M Ayad
- Departamento de Cirugía General, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - B S Mouheb
- Departamento de Cirugía General, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
| | - A Yosry
- Departamento de Cirugía General, Facultad de Medicina, Universidad de El Cairo, El Cairo, Egipto
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21
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Ruiz de Angulo D, Jimeno Griño P, Ortiz Escandell MÁ, Munitiz Ruiz V, Gil Vázquez PJ, Pérez Flores D, Martínez de Haro LF, Miguel Hernández A, Parrilla Paricio P. Evolution of gastroesophageal reflux after laparoscopic vertical gastrectomy. A radiographic, manometric and pH-metric study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:662-666. [PMID: 31257899 DOI: 10.17235/reed.2019.5972/2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION the relationship between laparoscopic vertical gastrectomy (LVG) and gastroesophageal reflux (GER) is still controversial. Therefore, its study is of great interest in order to obtain definitive conclusions. The goal of the study was to establish whether LVG modifies pH-metric GER in obese patients and to analyze the associated factors. PATIENTS AND METHODS the first 26 patients who underwent LVG in our institution were enrolled in the study. A barium swallow, 24-hour ambulatory pH-metry and four-channel intraluminal esophageal manometry (IEM) were all performed before and one year after surgery. RESULTS among the pH-metric data, there was a significant increase in the DeMeester index after the procedure (p = 0.028), while other parameters remained unchanged. Furthermore, 50% of patients with preoperative pH-metric GER had normal values at one year after surgery. IEM showed a decrease in lower esophageal sphincter (LES) pressure and in the mean wave amplitude at the distal third of the esophagus (p = 0.007 and p = 0.025, respectively). The rate of newly-developed hiatal hernias in the radiographic study was 36.4%. CONCLUSION LVG mildly increases GER, which is likely related to the development of hiatal hernias and a decrease in LES pressure and esophageal sweep. However, LVG should not be contraindicated for patients with preoperative pH-metric GER, as this may clear after the procedure.
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Affiliation(s)
- David Ruiz de Angulo
- Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, ESPAÑA
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Okida LF, Henrique J, Sarmiento-Cobos M, Lo Menzo E, Szomstein S, Rosenthal RJ. Is bariatric surgery safe in patients with history of cardiac revascularization? Surg Obes Relat Dis 2020; 16:1757-1763. [PMID: 32782121 DOI: 10.1016/j.soard.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The number of patients undergoing bariatric surgery with prior cardiac revascularization (CR) is rising. However, scarce data exist regarding the safety of bariatric procedures in these patients. OBJECTIVES The aim of this study is to compare postoperative cardiovascular and noncardiovascular outcomes among patients with different CR procedures. SETTING Academic hospital, United States. METHODS We retrospectively reviewed 2884 patients undergoing bariatric surgery from 2009-2018. Patients with prior CR were included and stratified into groups: coronary artery bypass graft (CABG), percutaneous coronary intervention with stent (PCI), and CABG + PCI. We described patient demographic characteristics, co-morbidities, smoking status, history of myocardial infarction, type of bariatric surgery, number of vessels grafted/stents, time from CR to bariatric surgery, length of stay, and cardiovascular and noncardiovascular 30-day outcomes. A control group composed of patients without prior CR undergoing bariatric surgery was used to compare the rate of complications to the total patients with prior CR. For continuous and categorical variables, t test and χ2 tests were performed, respectively. RESULTS We identified 76 patients with prior CR undergoing bariatric surgery. The mean patient age was 61.4 ± 7.9 years, the mean body mass index was 41.7 ± 6.5 kg/m2, and male sex was predominant (71.1%). Among these, 50% (n = 38) had PCI, 39.4% (n = 30) had CABG, and 10.5% (n = 8) had CABG + PCI. Early cardiovascular complications rate included ST-segment-elevation myocardial infarction (n = 2), pulmonary embolism (n = 1), supraventricular arrhythmia (n = 2), ventricular arrhythmia (n = 1), and pacemaker/defibrillator-insertion (n = 1). The overall rate of cardiovascular and noncardiovascular complications was 9.2% (n = 7) and 10.5% (n = 8) during the 30 days. Mortality rate was 0%. Comparison of rate of complications between groups did not show any statistical difference; no significant difference was found when comparing patients with prior CR to the 76 patients in the control group (P > .05). CONCLUSIONS Although revascularized individuals have severe co-morbidities and are high-risk patients, bariatric surgery remains safe in this population when outcomes are compared with bariatric patients without prior CR.
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Affiliation(s)
- Luis Felipe Okida
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Juliana Henrique
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Mauricio Sarmiento-Cobos
- 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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Aasbrenn M, Lydersen S, Farup PG. Changes in serum zonulin in individuals with morbid obesity after weight-loss interventions: a prospective cohort study. BMC Endocr Disord 2020; 20:108. [PMID: 32698783 PMCID: PMC7374843 DOI: 10.1186/s12902-020-00594-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Zonulin is a biomarker of impaired intestinal permeability, which has been associated with various disorders. The primary aim was to study serum zonulin (s-zonulin) in individuals with morbid obesity before and after a conservative weight loss intervention followed by bariatric surgery. The secondary aims were to explore predictors of s-zonulin, and the associations between the changes of the predictors and changes in s-zonulin, and to compare the associations in the two treatment periods. METHODS Individuals with morbid obesity were included. Data before any weight loss interventions, after a 6 months' conservative weight loss intervention, and 6 months after bariatric surgery were used. S-zonulin was measured with an ELISA method from Immundiagnostik AB, Bensheim, Germany. Data were analysed with mixed models. RESULTS The mean body mass index was 42.1 kg/m2 (SD 3.8) at inclusion and was reduced to 38.7 kg/m2 (SD 3.8) and 29.8 kg/m2 (SD 3.8) after the conservative treatment and bariatric surgery respectively. S-zonulin was 63 ng/mL (SD 32) at inclusion and was reduced with 19 ng/ml (95% CI 12 to 26, p < 0.001) after conservative treatment and 11 ng/ml (95% CI 0 to 21, p = 0.04) after bariatric surgery. At inclusion, s-zonulin was significantly associated with factors including p-glucose (B = 2.21, 95% CI 1.09 to 3.33, p < 0.001), c-reactive protein (B = 1.02, 95% CI 0.45 to 1.58, p < 0.001) and the intake of proteins (B = 0.23, 95% CI 0.08 to 0.38, p = 0.003) and non-nutritive sweeteners (B = 0.68, 95% CI 0.19 to 1.17, p = 0.007). The reduction in s-zonulin after the conservative weight loss intervention was significantly associated with improvement in diarrhoea (B = 6.6, 95% CI 1.3 to 11.8, p = 0.02), HbA1c (B = 9.7, 95% CI 1.1 to 18.3, p = 0.03), p-glucose (B = 3.5, 95% CI 1.2 to 5.9, p = 0.004) and gamma-GT (B = 0.28, 95% CI 0.09 to 0.47, p = 0.004), but not associated with the change in body mass index (B = 0.9, 95% CI - 1.5 to 3.3, p = 0.46). CONCLUSIONS S-zonulin was markedly reduced after the conservative weight loss intervention, and further reduced after bariatric surgery. The reduction in s-zonulin was associated with improvement of diarrhoea, markers of glucose intolerance and liver disease, but not associated with the change in body mass index.
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Affiliation(s)
- Martin Aasbrenn
- Department of Surgery, Innlandet Hospital Trust, Gjøvik, Norway.
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Trondheim, Norway
| | - Per G Farup
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
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Farup PG. Are the Results of a Combined Behavioural and Surgical Treatment of Morbid Obesity Satisfactory and Predictable? Nutrients 2020; 12:E1997. [PMID: 32635628 PMCID: PMC7400840 DOI: 10.3390/nu12071997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
Treatment of subjects with morbid obesity (Body Mass Index (BMI) > 40 kg/m2 or > 35 kg/m2 with obesity-related complications) often fails. This study explored the biopsychosocial predictors of dropout and weight loss during a combined behavioural and surgical weight-reduction program. Behavioural treatment for six months was followed by bariatric surgery and a visit six months after surgery. The success criterion was the loss of ≥50% of excess BMI above 25 kg/m2 (%EBMIL). Thirty-one men and 113 women with BMI 43.5 kg/m2 (SD 4.3) and 41.8 kg/m2 (SD 3.6), respectively, were included; 115 underwent bariatric surgery (Gastric sleeve: 23; Roux-en-Y gastric bypass: 92), and 98 had a follow-up visit six months after surgery. The mean %EBMIL at follow-up was 71.2% (SD 18.5). Treatment success was achieved in 86 subjects. Assuming success in 17 subjects who did not attend the follow-up visit (best possible outcome), 103 out of 144 subjects (72%) achieved successful weight reduction. Cohabitation was the only predictor of accomplishing surgery. Neither weight loss during behavioural therapy nor biopsychosocial factors were found to be clinically significant predictors of weight loss after surgery. The success rate of less than three in four subjects was unsatisfactory. There is a need to improve the regimen and to determine effective alternative interventions.
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Affiliation(s)
- Per G Farup
- Department of Research, Innlandet Hospital Trust, N-2381 Brumunddal, Norway
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Stefura T, Kacprzyk A, Droś J, Chłopaś K, Wysocki M, Rzepa A, Pisarska M, Małczak P, Pędziwiatr M, Nowakowski M, Budzyński A, Major P. The hundred most frequently cited studies on sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2020; 15:249-267. [PMID: 32489485 PMCID: PMC7233154 DOI: 10.5114/wiitm.2019.89392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is one of the most popular bariatric operations and one of the most frequently studied areas in bariatric surgery. AIM To summarise the characteristics of the most frequently cited studies focusing on SG. MATERIAL AND METHODS We used the Web of Science database to identify all studies focused on SG published from 2000 to 2018. The term "sleeve gastrectomy" and synonyms were used to reveal the 100 most cited records. RESULTS The most frequently cited publication had 493 citations. The highest mean number of citations per year was 73.00. Studies were most frequently published in the years 2010 and 2012. Articles were most commonly published in bariatric surgery-oriented journals. CONCLUSIONS Our study indicates an increase in medical researchers' interest in the subject of SG and underlines the need to perform studies with a higher level of evidence to further analyse the outcomes and basic science behind SG.
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Affiliation(s)
- Tomasz Stefura
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Kacprzyk
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Droś
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Chłopaś
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Wysocki
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Anna Rzepa
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Pisarska
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Małczak
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Nowakowski
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Budzyński
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Abstract
BACKGROUND Recent studies have suggested that obesity is associated with an increased intestinal permeability as well as an altered microbiota profile. These conditions can promote the translocation of lipopolysaccharide into the circulation and, subsequently, contribute to the observed systemic inflammation. Our aim was to assess gut permeability in patients with obesity compared to non-obese subjects as well as after excessive weight loss following laparoscopic sleeve gastrectomy (LSG). METHODS We analyzed the dietary intake, metabolic and inflammatory markers, gut permeability (four-probe sugar test), and microbiota composition in 17 morbidly obese patients before and after LSG as well as in 17 age- and gender-matched non-obese subjects. Additionally, we compared gut permeability and inflammatory markers in patients of different stages of obesity. RESULTS Patients with obesity showed elevated levels of C-reactive protein and lipopolysaccharide-binding protein as compared to non-obese subjects, but no differences were noted for gut permeability between these two groups. LSG led to improvements in metabolic and inflammatory parameters in the obese patients. Moreover, gastroduodenal as well as small intestinal permeability decreased, whereas colonic permeability increased after surgery. Regarding gut microbiota, differences were noted for main phyla and alpha-diversity between non-obese and obese subjects. After surgery, the composition of the microbiota showed a tendency toward the pattern of the non-obese group. CONCLUSIONS Gut permeability is not dependent on body mass index, whereas weight loss after LSG initiates distinct changes in gastroduodenal, intestinal, and colonic permeability. These changes do not seem to be associated with changes in the microbiota composition. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE The trials were registered at https://www.drks.de/drks_web/ with the number DRKS00009008 and DRKS00006210.
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Farup PG, Valeur J. Changes in Faecal Short-Chain Fatty Acids after Weight-Loss Interventions in Subjects with Morbid Obesity. Nutrients 2020; 12:nu12030802. [PMID: 32197409 PMCID: PMC7146446 DOI: 10.3390/nu12030802] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 02/07/2023] Open
Abstract
The gut microbiota and their metabolites, e.g., short-chain fatty acids (SCFA), are associated with obesity. The primary aims were to study faecal SCFA levels and the changes in SCFA levels after weight-loss interventions in subjects with obesity, and secondarily, to study factors associated with the faecal SCFA levels. In total, 90 subjects (men / women: 15/75) with a mean age of 44.4 (SD 8.4) years, BMI 41.7 (SD 3.7) kg/m2 and morbid obesity (BMI > 40 or > 35 kg/m2 with obesity-related complications) were included. Faecal SCFA and other variables were measured at inclusion and after a six-month conservative weight-loss intervention followed by bariatric surgery (Roux-en-Y gastric bypass or gastric sleeve). Six months after surgery, the total amount of SCFA was reduced, the total and relative amounts of the main straight SCFA (acetic-, propionic-, and butyric- acids) were reduced, and the total and relative amounts of branched SCFA (isobutyric-, isovaleric-, and isocaproic- acids) were increased. The changes indicate a shift toward a proteolytic fermentation pattern with unfavorable health effects. The amount of SCFA was associated with the diet but not with metabolic markers or makers of the faecal microbiota composition. Dietary interventions could counteract the unfavorable effects.
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Affiliation(s)
- Per G Farup
- Department of Research, Innlandet Hospital Trust, N-2381 Brumunddal, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
- Correspondence: ; Tel.: +47-948-18-603
| | - Jørgen Valeur
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, N-0440 Oslo, Norway;
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Assem S, Abdelbaki TN, Mohy-El Dine SH, Ketat AF, Abdelmonsif DA. SERPINE-1 Gene Methylation and Protein as Molecular Predictors of Laparoscopic Sleeve Gastrectomy Outcome. Obes Surg 2020; 30:2620-2630. [PMID: 32170551 DOI: 10.1007/s11695-020-04533-0] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND Body weight is subjected to genetic and epigenetic modifiers that might affect the success of weight loss interventions. Because of its possible complications and disparity in patients' response, identification of predictors to the outcome of bariatric surgery is indispensable. OBJECTIVES This prospective study aims to investigate serpin peptidase inhibitor type 1 (SERPINE-1) protein and gene methylation as molecular predictors to the outcome of bariatric surgery. PATIENTS AND METHODS One hundred participants were enrolled and divided to control group (n = 50) and obese patients who underwent laparoscopic sleeve gastrectomy (LSG) (n = 50). Anthropometric measurements were assessed and blood samples were collected preoperatively and 6 months postoperatively for assessment of SERPINE-1 protein and gene methylation, C-reactive protein (CRP), and homeostatic model assessment of insulin resistance (HOMA-IR). Moreover, subjects were followed for 2 years for weight loss parameters. RESULTS Patients with obesity showed high baseline SERPINE-1 protein and gene hypermethylation where LSG was followed by a drop in SERPINE-1 protein level but not gene hypermethylation. Baseline SERPINE-1 gene methylation was negatively related to postoperative weight loss and was the independent predictor to weight loss after LSG. Likewise, postoperative SERPINE-1 protein was negatively related to weight loss with independent expression from its gene methylation state. Furthermore, postoperative SERPINE-1 gene methylation correlated to CRP and HOMA-IR. CONCLUSION Baseline SERPINE-1 gene methylation might be a predictor of weight loss after LSG. Meanwhile, postoperative SERPINE-1 protein could be a predictor to weight loss maintenance after LSG. Lastly, postoperative SERPINE-1 gene methylation might serve as an index to postoperative changes in obesity-related comorbidities.
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Affiliation(s)
- Sara Assem
- Department of Medical Biochemistry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Tamer N Abdelbaki
- Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Safaa H Mohy-El Dine
- Department of Medical Biochemistry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Amel F Ketat
- Department of Medical Biochemistry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Doaa A Abdelmonsif
- Department of Medical Biochemistry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. .,Molecular Biology Lab. and Nanomedicine Lab., Center of Excellence for Research in Regenerative Medicine and Applications, University of Alexandria, Alexandria, Egypt.
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Sun SD, Wu PP, Zhou JF, Wang ZS, Cai TH, Huang LK, Chen JS, Lin CQ, Wang JX, He QL. Comparison of Single-Incision and Conventional Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Meta-Analysis. Obes Surg 2020; 30:2186-2198. [PMID: 32060852 DOI: 10.1007/s11695-020-04437-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to conventional laparoscopic sleeve gastrectomy (CLSG) in obese patients. This study aims to compare the surgical outcomes of these two techniques. METHODS A meta-analysis of existing literature obtained through a systematic literature search in the PubMed, EMBASE, and Cochrane Library CENTRAL databases from 2009 to 2019 was conducted. RESULTS Eleven articles including 1168 patients were analyzed. Patients in the SILSG group reported greater satisfaction with cosmetic scar outcomes than those in the CLSG group (SMD = 2.47, 95% CI = 1.10 to 3.83, P = 0.00). There was no significant difference between the SILSG group and the CLSG group regarding operative time, intraoperative estimated blood loss, conversion rate, intraoperative complications, length of hospital stay, postoperative analgesia, postoperative complications, excess weight loss (EWL), and improvements in comorbidities (P > 0.05). CONCLUSIONS Compared to CLSG, SILSG resulted in improved cosmetic satisfaction and showed no disadvantages in terms of surgical outcomes; thus, SILSG can serve as an alternative to CLSG for obese patients. Nonetheless, high-quality randomized controlled trials (RCTs) with large study populations and long follow-up periods are needed.
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Affiliation(s)
- Si-Da Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Ping-Ping Wu
- Department of General Medicine, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jun-Feng Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Zhi-Sheng Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Tian-Hong Cai
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Long-Kai Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jian-Sheng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Chang-Qing Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jia-Xing Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Qing-Liang He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
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Sharma G, Nain PS, Sethi P, Ahuja A, Sharma S. Plasma ghrelin levels after laparoscopic sleeve gastrectomy in obese individuals. Indian J Med Res 2020; 149:544-547. [PMID: 31411179 PMCID: PMC6676842 DOI: 10.4103/ijmr.ijmr_984_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Ghrelin is an orexigenic gut hormone expressed by the gastric fundus. Laparoscopic sleeve gastrectomy (LSG) procedure involves resection of the gastric fundus leading to a decreased appetite and weight loss. This study was undertaken to determine the levels of plasma ghrelin after sleeve gastrectomy in obese patients. Methods The study was conducted on 90 morbidly obese patients [body mass index (BMI) >40 kg/m[2]] and severely obese patients (BMI >35/kg/m[2]) who underwent sleeve gastrectomy. The patients were followed up for six months. Weight loss parameters and plasma ghrelin levels were assessed pre- and postoperatively. Results A significant weight loss and decrease in BMI were observed at three and six months postoperatively. A significant decrease in plasma ghrelin levels over six months of follow up postoperatively was also seen. Interpretation & conclusions These preliminary findings indicated inhibition of ghrelin production after LSG leading to a decrease in the plasma ghrelin levels within a few days of surgery and sustainable weight loss in obese patients.
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Affiliation(s)
- Garima Sharma
- Department of Physiology, Dayanand Medical College & Hospital, Ludhiana, India
| | - Prabhdeep S Nain
- Department of Surgery, Dayanand Medical College & Hospital, Ludhiana, India
| | - Pulkit Sethi
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences & Research, Kochi, India
| | - Ashish Ahuja
- Department of Surgery, Dayanand Medical College & Hospital, Ludhiana, India
| | - Sarit Sharma
- Department of Community Medicine, Dayanand Medical College & Hospital, Ludhiana, India
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Changes in C-reactive protein, neopterin and lactoferrin differ after conservative and surgical weight loss in individuals with morbid obesity. Sci Rep 2019; 9:17695. [PMID: 31776403 PMCID: PMC6881286 DOI: 10.1038/s41598-019-54107-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/05/2019] [Indexed: 02/06/2023] Open
Abstract
C-reactive protein, neopterin and lactoferrin are biomarkers of atherosclerotic disease. We aimed to assess changes in these biomarkers after conservative and surgical weight loss interventions in individuals with morbid obesity, to evaluate associations between biomarker changes and changes in body mass index and HbA1c, and to study associations between changes in the biomarkers. C-reactive protein, neopterin and lactoferrin were measured before and after conservative weight loss intervention and bariatric surgery. Data were analysed with mixed models. 137 individuals (mean age 43 years) were included. Body mass index decreased from 42.1 kg/m2 to 38.9 kg/m2 after the conservative intervention, and further to 30.5 kg/m2 after bariatric surgery. All biomarkers decreased after the conservative weight loss intervention. C-reactive protein and lactoferrin continued to decrease following bariatric surgery whereas neopterin remained stable. After adjustments for change in body mass index and HbA1c, all biomarkers decreased significantly after the conservative weight loss intervention, whereas none changed after bariatric surgery. There were no consistent correlations between changes in C-reactive protein, neopterin and lactoferrin. In conclusion, biomarkers of atherosclerosis decreased after weight loss interventions but had different trajectories. Neopterin, a marker related to atherosclerotic plaque stability, decreased after conservative weight loss but not following bariatric surgery.
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Sayadishahraki M, Rezaei MT, Mahmoudieh M, Keleydari B, Shahabi S, Allami M. Single-Anastomosis Sleeve Jejunal Bypass, a Novel Bariatric Surgery, Versus Other Familiar Methods: Results of a 6-Month Follow-up-a Comparative Study. Obes Surg 2019; 30:769-776. [PMID: 31768867 DOI: 10.1007/s11695-019-04266-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Obesity and its associated morbidities have become a significant concern all over the world. Bariatric surgery, regardless of its type, is the most effective approach for treating morbid obesity. Single-anastomosis sleeve jejunal (SASJ) bypass is a novel bariatric surgery technique and can be considered for patients with former background of severe gastroesophageal symptoms. The purpose of this research was to compare SASJ bypass outcomes with other techniques during a 6-month follow-up. METHODS This is a non-randomized clinical trial conducted on 100 patients, who underwent four types of bariatric surgery (classic Roux-en-Y bypass, SASJ bypass, omega gastric bypass, and sleeve gastrectomy), and each one of these types contained 25 cases, during the time period of 2 years from 2016 to 2018. Patients' information including age, gender, height, basal weight, body mass index (BMI), serum albumin, and hemoglobin A1C were recorded, within 1, 3, and 6 months after their surgery, and also were compared with each other. RESULTS Members of the four groups were similar due to their age, gender distribution, height, baseline BMI, hemoglobin A1C, albumin, and also excess weight (P value > 0.05); however, the sleeve gastrectomy group baseline weight was significantly higher compared with the other three groups (P value = 0.013). All of the groups significantly lost weight during this 6-month period, but the comparison between them indicated no statistical difference regarding excess weight loss, BMI, hemoglobin A1C, and albumin (P value > 0.05). The excess weight loss mean during 6 months in SASJ bypass was 34.2 ± 5.4%, which was comparable with other groups. CONCLUSIONS The weight loss trend after the SASJ bypass was similar to that of older techniques; consequently this technique can be considered for cases with particular indications due to the reversibility and also more accessible gastric follow-up studies in the SASJ approach. Further researches with longer follow-ups are strongly recommended.
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Affiliation(s)
| | | | | | | | - Shahab Shahabi
- Isfahan University of Medical Sciences, Isfahan, 8174675731, Iran
| | - Mostafa Allami
- Isfahan University of Medical Sciences, Isfahan, 8174675731, Iran
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Alhaj Saleh A, Janik MR, Mustafa RR, Alshehri M, Khan AH, Kalantar Motamedi SM, Rahim S, Patel I, Aryaie A, Abbas M, Rogula T, Khaitan L. Does Sleeve Shape Make a Difference in Outcomes? Obes Surg 2019; 28:1731-1737. [PMID: 29313277 DOI: 10.1007/s11695-017-3087-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is one of the most common procedures performed for weight loss. Many seek the "perfect sleeve" with the notion that the type of calibrating device affects sleeve shape, and this in turn will affect outcomes and complications. Two major concerns after SG are amount of weight loss and acid reflux. Our aim was to determine if the various calibration methods could impact sleeve shape and thereby allow for better outcomes of weight loss and reflux. METHODS A retrospective chart review was performed of 210 patients who underwent SG and had postoperative upper gastrointestinal (UGI) study from 2011 to 2015 in a single center by a single (fellowship-trained) bariatric surgeon. Data regarding demographics, calibrating devices and clinical outcomes at 1 year (weight loss and de novo acid reflux) were collected. UGIs were reviewed by two radiologists blinded to the clinical outcomes. Sleeve shape was classified according to a previously described classification as tubular, dumbbell, upper pouch, or lower pouch. The types of calibrating devices used to guide the sleeve size intraoperatively were endoscopy, large-bore orogastric tube, and fenestrated suction tube. RESULTS One hundred ninety-nine patients met inclusion criteria (11 had no esophagram). Demographics revealed age 45.76 ± 10.6 years, BMI 47 ± 8.6 kg/m2, and 82% female. Calibration devices used were endoscopic guidance (7.6%), large bore orogastric tube (41.4%), and fenestrated suction tube (50.5%). Sleeve shape was reported as 32.6% tubular, 20.6% dumbbell, 39.2% lower pouch, and 7.5% upper pouch (100% interrater reliability). No correlation was seen with type of calibration used. Of patients, 62.0% had > 50% excess weight loss at 1 year. Twenty-three percent of patients remained on PPI at 1 year (of which 43.3% did not have reflux preoperatively). The lower pouch shape showed a trend toward less reflux and more weight loss. CONCLUSION This study showed no clear association between uniformity of sleeve shape and the type of calibration device used. The study showed a trend toward decreased reflux and improved weight loss with the lower pouch shape, regardless of calibration device.
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Affiliation(s)
- Adel Alhaj Saleh
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA.
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA.
| | - Michal R Janik
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów, 04-141, Warszawa, Poland
| | - Rami R Mustafa
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Mohammed Alshehri
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Adil H Khan
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Seyed Mohammad Kalantar Motamedi
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Shiraz Rahim
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Indravadan Patel
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Amir Aryaie
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA
| | - Mujjahid Abbas
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Tomasz Rogula
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA
| | - Leena Khaitan
- Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA.
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Abstract
BACKGROUND/INTRODUCTION Several reports have discussed the potential for reducing port access in laparoscopic sleeve gastrectomy (LSG); however, each approach had its innate setbacks. Aiming at improving the aesthetic outcome, we report a novel approach to the LSG where we place the trocars at the bikini line in what we described as bikini line sleeve gastrectomy (BLSG). METHODS The present work is a prospective, pilot study on the use of BLSG in patients, during the period between April and October 2016. Exclusion criteria included the following: large hiatal hernia, upper abdominal surgery, and xiphi-umbilical, xiphi-symphysis pubis, and xiphi-anterior superior iliac spine distances of > 25,36 and 33 cm, respectively. Four trocars were used: one at the umbilicus and three at the bikini line. All laparoscopic graspers were bariatric length instruments (43 cm). However, camera telescope, endoscopic stapler, and bipolar dissectors were standard length. RESULTS Twenty eight patients underwent BLSG. The mean age was 34.6 ± 3.7 years with a mean BMI of 42.46 kg/m2 ± 3. There were no major intra- or postoperative complications and no conversion to conventional port site placement. Patient's scar satisfaction was favorable. The mean postoperative BMI and weight at 6 m were 28.5 ± 1 kg/m2 and 79.8 kg ± 2, respectively. The mean percentage excess weight loss at 3, 6, and 12 months were 39.5 ± 4.6, 64.5 ± 5, and 69.8 ± 6%, respectively. CONCLUSION BLSG was found to be potentially safe, feasible, and effective with a favorable aesthetic outcome; it could possibly be offered to a select group of patients that are conscious about their scar appearance.
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Affiliation(s)
- Tamer N Abdelbaki
- General Surgery Department, Alexandria University Faculty of Medicine, 11 Hussein Nouh St, Shalalat, Bab Sharki, Alexandria, Egypt.
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Alizadeh RF, Li S, Inaba C, Penalosa P, Hinojosa MW, Smith BR, Stamos MJ, Nguyen NT. Risk Factors for Gastrointestinal Leak after Bariatric Surgery: MBASQIP Analysis. J Am Coll Surg 2018; 227:135-141. [PMID: 29605723 DOI: 10.1016/j.jamcollsurg.2018.03.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastrointestinal leak remains one of the most dreaded complications in bariatric surgery. We aimed to evaluate risk factors and the impact of common perioperative interventions on the development of leak in patients who underwent laparoscopic bariatric surgery. STUDY DESIGN Using the 2015 database of accredited centers, data were analyzed for patients who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass (LRYGB). Emergent, revisional, and converted cases were excluded. Multivariate logistic regression was used to analyze risk factors for leak, including provocative testing of anastomosis, surgical drain placement, and use of postoperative swallow study. RESULTS Data from 133,478 patients who underwent laparoscopic sleeve gastrectomy (n = 92,495 [69.3%]) and LRYGB (n = 40,983 [30.7%]) were analyzed. Overall leak rate was 0.7% (938 of 133,478). Factors associated with increased risk for leak were oxygen dependency (adjusted odds ratio [AOR] 1.97), hypoalbuminemia (AOR 1.66), sleep apnea (AOR 1.52), hypertension (AOR 1.36), and diabetes (AOR 1.18). Compared with LRYGB, laparoscopic sleeve gastrectomy was associated with a lower risk of leak (AOR 0.52; 95% CI 0.44 to 0.61; p < 0.01). Intraoperative provocative test was performed in 81.9% of cases and the leak rate was higher in patients with vs without a provocative test (0.8% vs 0.4%, respectively; p < 0.01). A surgical drain was placed in 24.5% of cases and the leak rate was higher in patients with vs without a surgical drain placed (1.6% vs 0.4%, respectively; p < 0.01). A swallow study was performed in 41% of cases and the leak rate was similar between patients with vs without swallow study (0.7% vs 0.7%; p = 0.50). CONCLUSIONS The overall rate of gastrointestinal leak in bariatric surgery is low. Certain preoperative factors, procedural type (LRYGB), and interventions (intraoperative provocative test and surgical drain placement) were associated with a higher risk for leaks.
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Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Shiri Li
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Colette Inaba
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Patrick Penalosa
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Marcelo W Hinojosa
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Brian R Smith
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA.
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Sethi P, Thillai M, Nain PS, Ahuja A, Aulakh N, Khurana P. Role of Hunger Hormone "Ghrelin" in Long-Term Weight Loss Following Laparoscopic Sleeve Gastrectomy. Niger J Surg 2018; 24:121-124. [PMID: 30283224 PMCID: PMC6158981 DOI: 10.4103/njs.njs_24_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Laparoscopic sleeve gastrectomy (LSG) has become a popular weight loss technique in morbidly obese patients. The aim of our study was to evaluate the changes in plasma ghrelin levels in relation to weight loss following LSG and to study the efficacy of LSG in terms of long-term glycemic control and resolution of diabetes. Methodology The study was conducted on 70 morbidly obese patients (body mass index [BMI] >40 kg/m2) or severely obese patients (BMI >35 kg/m2) with comorbidities who underwent LSG in Dayanand Medical College and Hospital, Ludhiana, India. Ghrelin levels were measured preoperatively and postoperatively at 1 week, 3 months, and 6 months along with measurements of various weight loss parameters and glycosylated hemoglobin. Results A significant decrease in plasma ghrelin levels was observed in relation to the mean weight and percentage excess weight loss at 3 months postoperatively. However, at 6 months, fall in ghrelin reached a plateau phase while weight loss was still sustained and significant. There was a significant fall in glycosylated hemoglobin levels with patients achieving good control/resolution of diabetes Type II. Conclusion LSG is an effective weight loss surgery and brings about excellent weight loss in morbidly obese individuals in addition to achievement of good glycemic control in diabetic individuals. Serum levels of ghrelin fall significantly after sleeve gastrectomy. However, long term implications of ghrelin induced weight loss cannot be elucidated.
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Affiliation(s)
- Pulkit Sethi
- Department of GI Surgery, Amrita Institute of Medical Sciences and Research, Kochi, Kerala, India
| | - Manoj Thillai
- Department of GI Surgery, Amrita Institute of Medical Sciences and Research, Kochi, Kerala, India
| | - Prabhdeep Singh Nain
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashish Ahuja
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Navpreet Aulakh
- Department of Biochemistry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Preetika Khurana
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Solid Organ Infections: Rare Complications After Laparoscopic Sleeve Gastrectomy: a Report of Four Cases. Obes Surg 2017; 27:1374-1380. [PMID: 28271377 DOI: 10.1007/s11695-017-2609-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period of time. LSG is a safe procedure with a low complication rate. The most significant complications are staple-line bleeding, stricture, and staple-line leak. Formation of liver and splenic abscesses is an extremely rare consequence of LSG. Liver abscess has been reported in one case report while splenic abscess has been reported in five case reports after LSG. METHODS This study is a case report and literature review. RESULTS We report two cases of a pyogenic liver abscesses and two cases of splenic abscesses after LSG. CONCLUSIONS As LSG becomes more popular, clinicians need to be aware of uncommon but potentially serious complications related to it.
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Changes in Gastric Volume and Their Implications for Weight Loss after Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 27:303-309. [PMID: 27484976 DOI: 10.1007/s11695-016-2274-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a relatively new surgical technique for the treatment of morbid obesity. It is unclear whether the volume of the gastric remnant can expand after surgery as a result of intraluminal pressure maintained over time. If this were the case, the increased volume could affect weight loss and the improvement in comorbidities. This study aims to assess the evolution of residual gastric volume (RGV) during the first year after LSG and its relationship with weight loss. MATERIAL AND METHODS We conducted a prospective study of 112 patients who underwent LSG from February 2009 to December 2013. In order to measure the RGV after surgery, all patients were evaluated radiologically by an esophagogastroduodenal (EGD) transit at 1 and 12 postoperative months. RESULTS All patients showed a significant reduction in BMI compared with the preoperative measurement (33.48 ± 5.78 vs. 50.54 ± 6.69 kg/m2; p < 0.001). Increased RGV was observed when comparing the results obtained by EGD transit at 1 (68.39 ± 25.89 cm3) and 12 postoperative months (122.58 ± 38.76 cm3; p < 0.001). There was no association between increase in gastric volume and weight loss at 1-year follow-up (r = 0.01; p = 0.910). CONCLUSIONS The volume of the gastric remnant increased significantly during the first year after LSG. However, this increase was not associated with weight loss. Further prospective research with longer follow-up periods is needed to confirm or contrast the present results.
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Monzo-Beltran L, Vazquez-Tarragón A, Cerdà C, Garcia-Perez P, Iradi A, Sánchez C, Climent B, Tormos C, Vázquez-Prado A, Girbés J, Estáñ N, Blesa S, Cortés R, Chaves FJ, Sáez GT. One-year follow-up of clinical, metabolic and oxidative stress profile of morbid obese patients after laparoscopic sleeve gastrectomy. 8-oxo-dG as a clinical marker. Redox Biol 2017; 12:389-402. [PMID: 28319890 PMCID: PMC5357674 DOI: 10.1016/j.redox.2017.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/01/2017] [Accepted: 02/05/2017] [Indexed: 02/07/2023] Open
Abstract
Obesity has grown worldwide over the last few decades. In its different degrees, obesity is accompanied by many clinical and biochemical alterations reflecting the pathological condition of various body tissues. Among the mechanisms underlying the pathogenesis of obesity and associated complications, oxidative stress (OS) may be playing an important role. In the present study, we have characterized at systemic level the degree of OS status in a group of morbid obese patients (BMI>40kg/m2) at basal sate and its modulation during one year after bariatric surgery using the laparoscopic sleeve gastrectomy (LSG) technique. As compared with normal weight subjects matched in age, peripheral blood mononuclear cells (PBMc) of obese patients present a significant reduction of the antioxidant enzyme activities superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) as well as a significant increase of the oxidized/reduced glutathione ratio (GSSG/GSH) in these cells. Lipid peroxidation is significantly increased in the patient group as shown by the increased levels of malondialdehyde (MDA) in PBMc and the amount of F2-Isoprostanes (F2-IsoPs) released in urine. In addition, the DNA damage product 8-oxo-7,8-2'-deoxyguanosine (8-oxo-dG) was also observed to be increased in serum and urine of morbid obese patients as compared with the control group. After LSG, an improvement of their ponderal and metabolic profile was accompanied by a progressive recovery of antioxidant enzyme activities and the decline of oxidative byproducts both in PBMc and biological fluids. The observed changes of urinary 8-oxo-dG levels correlate positively with its serum concentration, the lipid peroxidation products MDA and F2-IsoPs, triglycerides, glucose, insulin, HOMA index and body weight and negatively with the percentage of weight and BMI loss and antioxidant activities. We conclude that the analysis of urinary 8-oxo-dG could be validated as a useful marker for the monitoring of ponderal and metabolic status of morbid obese patients.
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Affiliation(s)
- Lidia Monzo-Beltran
- Dept. of Biochemistry and Molecular Biology, Faculty of Medicine and Odontology-INCLIVA, University of Valencia, Spain.
| | | | - Concha Cerdà
- Service of Clinical Analysis, General University Hospital, Valencia, Spain.
| | - Paula Garcia-Perez
- Dept. of Biochemistry and Molecular Biology, Faculty of Medicine and Odontology-INCLIVA, University of Valencia, Spain.
| | - Antonio Iradi
- Dept. of Physiology, Faculty of Medicine and Odontology, University of Valencia, Spain.
| | - Carlos Sánchez
- Endocrinology and Nutrition Unit, General University Hospital, Valencia, Spain.
| | - Benjamin Climent
- Service of Internal Medicine, General University Hospital, Valencia, Spain.
| | - Carmen Tormos
- Dept. of Biochemistry and Molecular Biology, Faculty of Medicine and Odontology-INCLIVA, University of Valencia, Spain.
| | - Antonio Vázquez-Prado
- Service of General and Digestive Surgery, General University Hospital, Valencia, Spain.
| | - Javier Girbés
- Service of Clinical Analysis, University Hospital Dr. Peset, Valencia, Spain.
| | - Nuria Estáñ
- Service of Clinical Analysis, University Hospital Dr. Peset, Valencia, Spain.
| | - Sebastián Blesa
- Genomic and Genetic Diagnosis Unit, INCLIVA, CIBEREDEM University of Valencia, Spain.
| | - Raquel Cortés
- Genomic and Genetic Diagnosis Unit, INCLIVA, CIBEREDEM University of Valencia, Spain.
| | - Felipe J Chaves
- Genomic and Genetic Diagnosis Unit, INCLIVA, CIBEREDEM University of Valencia, Spain.
| | - Guillermo T Sáez
- Dept. of Biochemistry and Molecular Biology, Faculty of Medicine and Odontology-INCLIVA, University of Valencia, Spain; Service of Clinical Analysis, University Hospital Dr. Peset, Valencia, Spain.
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Five-year results of laparoscopic sleeve gastrectomy for the treatment of severe obesity. Surg Endosc 2016; 31:3251-3257. [DOI: 10.1007/s00464-016-5355-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/12/2016] [Indexed: 12/15/2022]
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Adams LB, Chang C, Pope J, Kim Y, Liu P, Yates A. Randomized, Prospective Comparison of Ursodeoxycholic Acid for the Prevention of Gallstones after Sleeve Gastrectomy. Obes Surg 2016; 26:990-4. [PMID: 26342481 DOI: 10.1007/s11695-015-1858-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several studies have examined the role of ursodeoxycholic acid (UDCA) for the prevention of cholelithiasis (gallstones) following rapid weight loss from restrictive diets, vertical band gastroplasty, and Roux-en-Y gastric bypass. However, to date, there have been no prospective, controlled studies examining the role of UDCA for the prevention of gallstones following sleeve gastrectomy (SG). This study was conducted to identify the effectiveness of UDCA for prevention of gallstones after SG. METHODS Following SG, eligible patients were randomized to a control group who did not receive UDCA treatment or to a group who were prescribed 300 mg UDCA twice daily for 6 months. Gallbladder ultrasounds were performed preoperatively and at 6 and 12 months postoperatively. Patients with positive findings preoperatively were excluded from the study. Compliance with UDCA was assessed. RESULTS Between December 2011 and April 2013, 37 patients were randomized to the UDCA treatment arm and 38 patients were randomized to no treatment. At baseline, the two groups were similar. At 6 months, the UDCA group had a statistically significant lower incidence of gallstones (p = 0.032). Analysis revealed no significant difference in gallstones between the two groups at 1 year (p = 0.553 and p = 0.962, respectively). The overall gallstone formation rate was 29.8%. CONCLUSIONS The incidence of gallstones is higher than previously estimated in SG patients. UDCA significantly lowers the gallstone formation rate at 6 months postoperatively.
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Affiliation(s)
- Lindsay B Adams
- College of Applied and Natural Sciences, Louisiana Tech University, Ruston, LA, 71272, USA
| | - Craig Chang
- , 6502 Nursery Drive Suite 300, Victoria, TX, 77901, USA.
| | - Janet Pope
- College of Applied and Natural Sciences, Louisiana Tech University, Ruston, LA, 71272, USA
| | - Yeonsoo Kim
- College of Applied and Natural Sciences, Louisiana Tech University, Ruston, LA, 71272, USA
| | - Pei Liu
- College of Applied and Natural Sciences, Louisiana Tech University, Ruston, LA, 71272, USA
| | - Amy Yates
- College of Applied and Natural Sciences, Louisiana Tech University, Ruston, LA, 71272, USA
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Elbanna H, Ghnnam W, Negm A, Youssef T, Emile S, El Metwally T, Elalfy K. Impact of preoperative body mass index on the final outcome after laparoscopic sleeve gastrectomy for morbid obesity. Turk J Surg 2016; 32:238-243. [PMID: 28149118 PMCID: PMC5245713 DOI: 10.5152/ucd.2016.3275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/19/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric surgery due to its excellent results and limited morbidity. Our study aims to assess the efficacy of LSG in terms of loss of weight and co-morbidity improvement and to evaluate the impact of preoperative body mass index (BMI) on the final outcome. MATERIAL AND METHODS The data of 173 patients who underwent LSG were analyzed. Laparoscopic sleeve gastrectomy was indicated only for patients with BMI >40. Mean postoperative BMI, co-morbidity improvement, operative data and complications, length of hospital stay and excess weight loss were evaluated and recorded. RESULTS This study included 151 females and 22 males with a mean age of 37.6 years. Patients were divided into two groups according to their BMI (group I <50, group II >50). Mean preoperative BMI was 53.8 kg/m2. Mean operative time was 120 minutes. Mean duration of hospital stay was 3.2 days. Mean postoperative BMI decreased to 47.3 kg/m2 at 1 year. Excess weight loss was 43.1% at 6 months, 71.1% at 1 year, and 87.5% at 5 years. Group I showed a significantly shorter length of hospital stay, more improvement of laboratory parameters and more reduction in BMI as compared to group II. There was one mortality and six cases had gastric staple line leakage. CONCLUSION Laparoscopic sleeve gastrectomy is an efficient treatment to achieve significant weight loss that is maintained up to 5 years of follow up, also it improves some of the obesity related co-morbidities. This beneficial impact of LSG appears to be significantly higher in patients with BMI <50.
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Affiliation(s)
- Hosam Elbanna
- Department of General Surgery, Mansoura University School of Medicine, Mansoura, Egypt
| | - Wagih Ghnnam
- Department of General Surgery, Mansoura University School of Medicine, Mansoura, Egypt
| | - Ahmed Negm
- Department of General Surgery, Mansoura University School of Medicine, Mansoura, Egypt
| | - Tamer Youssef
- Department of General Surgery, Mansoura University School of Medicine, Mansoura, Egypt
| | - Sameh Emile
- Department of General Surgery, Mansoura University School of Medicine, Mansoura, Egypt
| | - Tito El Metwally
- Department of General Surgery, Mansoura University School of Medicine, Mansoura, Egypt
| | - Khaled Elalfy
- Department of General Surgery, Mansoura University School of Medicine, Mansoura, Egypt
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Midterm Clinical Outcomes of Antrum Resection Margin at Laparoscopic Sleeve Gastrectomy for Morbid Obesity. Obes Surg 2016; 27:910-916. [DOI: 10.1007/s11695-016-2384-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maietta P, Milone M, Coretti G, Galloro G, Conzo G, Docimo G, Ruggiero R, Musella M. Retrieval of the gastric specimen following laparoscopic sleeve gastrectomy. Experience on 275 cases. Int J Surg 2016; 28 Suppl 1:S124-S127. [PMID: 26708855 DOI: 10.1016/j.ijsu.2015.12.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/27/2015] [Accepted: 05/15/2015] [Indexed: 02/07/2023]
Abstract
Severe obesity leads to a high incidence of complications and a decrease in life expectancy, especially among younger adults. Laparoscopic sleeve gastrectomy (LSG) first intended as the first step of biliopancreatic diversion with duodenal switch is gaining a per-se procedure role because of its effectiveness on weight loss and comorbidity resolution. Different techniques have been described for specimen extraction in LSG. In this article we report the technique adopted in 275 LSGs performed in our department. In the first 120 LSGs performed from 2007, the specimen was extracted through a mini laparotomy. In the following 155 cases the technique has been simplified: the grasped specimen has been withdrawn through the 15 mm trocar site. We registered in the fist group six cases of wound infection (5%), ten cases of hematoma (8.3%) and four cases of port site hernia (3.3%). In the second group only one case of hematoma (0.6%, p = 0.01) but no cases of wound infection (p = 0.01) or port site hernia, (p = 0.03) although we registered a specimen perforation during retrieval in 16 patients, were reported. The technique described in the 155 cases of the control group has shown to be more effective than the technique we used in the case group, allowing significantly lower operative time (112.9 ± 1.0 vs 74.9 ± 9.1 p < 0.001) and complications, and providing unchanged costs.
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Affiliation(s)
- P Maietta
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - M Milone
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - G Coretti
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
| | - G Galloro
- Department of Clinical Medicine and Surgery, "Federico II" University, Naples, Italy.
| | - G Conzo
- Department of Anaesthesiologic, Surgical and Emergency Sciences, "SUN" Naples Second University, Naples, Italy.
| | - G Docimo
- Department of Medical, Surgical, Neurological and Metabolical Sciences, "SUN" Naples Second University, Naples, Italy.
| | - R Ruggiero
- Department of Medical, Surgical, Neurological and Metabolical Sciences, "SUN" Naples Second University, Naples, Italy.
| | - M Musella
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy.
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Essential bariatric emergencies for the acute care surgeon. Eur J Trauma Emerg Surg 2015; 42:571-584. [PMID: 26669688 DOI: 10.1007/s00068-015-0621-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/07/2015] [Indexed: 12/19/2022]
Abstract
Bariatric surgery is the most effective treatment for morbid obesity. Due to the high volume of weight loss procedures worldwide, the general surgeon will undoubtedly encounter bariatric patients in his or her practice. Liberal use of CT scans, upper endoscopy and barium swallow in this patient population is recommended. Some bariatric complications, such as marginal ulceration and dyspepsia, can be effectively treated non-operatively (e.g., proton pump inhibitors, dietary modification). Failure of conservative management is usually an indication for referral to a bariatric surgery specialist for operative re-intervention. More serious complications, such as perforated marginal ulcer, leak, or bowel obstruction, may require immediate surgical intervention. A high index of suspicion must be maintained for these complications despite "negative" radiographic studies, and diagnostic laparoscopy performed when symptoms fail to improve. Laparoscopic-assisted gastric band complications are usually approached with band deflation and referral to a bariatric surgeon. However, if acute slippage that results in gastric strangulation is suspected, the band should be removed immediately. This manuscript provides a high-level overview of all essential bariatric complications that may be encountered by the acute care surgeon.
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Portal Vein Thrombosis due to Prothrombin Gene Mutation following Sleeve Gastrectomy. Case Rep Gastrointest Med 2015; 2015:816914. [PMID: 26640725 PMCID: PMC4657072 DOI: 10.1155/2015/816914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/29/2015] [Indexed: 01/07/2023] Open
Abstract
Introduction. Portomesenteric thrombosis is increasingly recognized as a complication of laparoscopic sleeve gastrectomy (LSG). It often presents with abdominal pain. We present a mother and her son who both developed portal vein thrombosis (PVT) after LSG. Case Description. A 43-year-old woman presented complaining of sudden severe abdominal pain, two weeks after she had uncomplicated laparoscopic sleeve gastrectomy. CT scan of the abdomen and pelvis with IV contrast showed portal vein thrombosis and SMV thrombosis. Two weeks later her son had the same LSG for morbid obesity and presented with the same clinical picture. Thrombophilia workup showed heterozygous prothrombin gene mutation. Conclusions. A high index of suspicion is necessary to diagnose PVT; although rare, it can be potentially lethal. Anticoagulation therapy should be initiated immediately to limit the morbidities and improve the outcome. Patients with family history of thrombophilia should be investigated prior to any bariatric surgery and nonsurgical alternative treatments for morbid obesity should be strongly encouraged.
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Sheppard CE, Sadowski DC, de Gara CJ, Karmali S, Birch DW. Rates of reflux before and after laparoscopic sleeve gastrectomy for severe obesity. Obes Surg 2015; 25:763-8. [PMID: 25411120 DOI: 10.1007/s11695-014-1480-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND A current management dilemma in laparoscopic sleeve gastrectomy (LSG) patients is the development of significant gastroesophageal reflux symptoms after surgery. Treatment is typically directed towards reducing acid reflux despite the surgical removal of parietal cell mass. In contrast, laparoscopic Roux-en-Y gastric bypass (LRYGB) has been known to reduce or resolve preoperative reflux symptoms. The objective of this study was to determine the incidence of preoperative and postoperative reflux of LSG and LRYGB patients, and review reflux treatment type and response. METHODS A retrospective chart review was performed for patients undergoing either LSG or LRYGB between January 2010 and December 2012 as part of the Weight Wise program, Royal Alexandra Hospital, Edmonton, Canada. RESULTS A total of 387 cases were included in our review. We observed a significant reduction in BMI postoperatively for both LSG and LRYGB groups (p < 0.001). Between surgical groups, preoperative proton-pump inhibitor (PPI) use was not significantly different; however, at 1 month (p < 0.05) to 1-2 years (p < 0.001), there was significantly increased PPI use in patients after LSG in comparison to LRYGB. Of the LSG patients that continued their PPI treatment after surgery, 58% increased, 42% continued the same, and 0% decreased their dose 1 year after surgery. CONCLUSIONS Reflux symptoms are significantly increased after LSG in comparison to LRYGB patients. In addition, LSG patients more frequently require initiation of reflux treatment after surgery than that of LRYGB patients. Patients reported postoperative reflux symptom relief with acid-suppressant therapies.
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Affiliation(s)
- Caroline E Sheppard
- Centre for the Advancement of Minimally Invasive Surgery, Rm 502 Community Services Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
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Alvarenga ES, Lo Menzo E, Szomstein S, Rosenthal RJ. Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program. Surg Endosc 2015; 30:2673-8. [DOI: 10.1007/s00464-015-4548-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/01/2015] [Indexed: 12/19/2022]
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Cho JM, Kim HJ, Lo Menzo E, Park S, Szomstein S, Rosenthal RJ. Effect of sleeve gastrectomy on type 2 diabetes as an alternative treatment modality to Roux-en-Y gastric bypass: systemic review and meta-analysis. Surg Obes Relat Dis 2015; 11:1273-80. [PMID: 26071847 DOI: 10.1016/j.soard.2015.03.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/21/2015] [Accepted: 03/01/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Until recently, Roux-en-Y gastric bypass (RYGB) was the most frequently performed procedure in bariatric surgery. In the last decade, sleeve gastrectomy (SG) has emerged as a more popular, simpler, and less morbid form of bariatric surgery. OBJECTIVES This study compares the efficacy of SG and RYGB for the treatment of type 2 diabetes mellitus (T2D). SETTING Systemic review and meta-analysis. METHODS MEDLINE, EMBASE, and the Cochrane Library were searched for entries up to December 2013. Search terms included "Sleeve gastrectomy," "Gastric bypass," and "Type 2 diabetes mellitus." The chosen articles described both "Sleeve gastrectomy" and "Gastric bypass" and included over 1 year of follow-up data. Data analysis was performed with Review Manager 5.2 and SPSS version 20. RESULTS The data set is comprised of 3 retrospective clinical studies, 6 prospective clinical studies, and 2 randomized controlled trials (RCTs), which involved 429 patients in the SG group and 428 patients in the RYGB group. In nonrandomized clinical studies, SG displayed similar efficacy in remission of T2D compared with the standard RYGB. In the RCTs, SG had a lower effect than that of RYGB. T2D remission was not correlated with the percent of excess weight loss for either procedure. CONCLUSIONS Based on the current evidence, SG has a similar effect on T2D remission as RYGB.
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Affiliation(s)
- Jun-Min Cho
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Institution for Evidence-Based Medicine, the Korean Branch of Australasian Cochrane Center, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Emanuele Lo Menzo
- Bariatric and Metabolic Institute, Section of Minimally-Invasive Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Sungsoo Park
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea.
| | - Samuel Szomstein
- Bariatric and Metabolic Institute, Section of Minimally-Invasive Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Bariatric and Metabolic Institute, Section of Minimally-Invasive Surgery, Cleveland Clinic Florida, Weston, Florida
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