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1
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Guglielmi V, Capoccia D, Russo B, Lubrano C, Mariani S, Poggiogalle E, Furia G, Alizadeh AH, Patrizi C, Sapienza M, Damiani G, Tarsitano MG, Conte C, Frontoni S. Knowledge, experiences, and perceptions relating to obesity management among primary care physicians in the Lazio Region, Italy. Front Endocrinol (Lausanne) 2023; 14:1249233. [PMID: 38027122 PMCID: PMC10668048 DOI: 10.3389/fendo.2023.1249233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Primary care providers (PCPs) play an essential role in obesity care as they represent the first contact for patients seeking weight loss interventions. Objective This study explored the knowledge, experiences, and perceptions of PCPs in the Lazio Region of Italy in the management of obesity. Design and subjects We conducted an anonymous survey delivered from March to July 2022 via the newsletter of Rome Provincial Order of Physicians and Dentists and at the annual meeting of the regional section of the Italian Obesity Society. Approach The survey consisted of 24 closed-ended questions grouped into 5 sections: sociodemographic and work information; assessment of obesity; management of obesity; connections with regional Centres for Obesity Management; attitudes towards obesity. Key results A total of 92 PCPs accessed the survey. Of those, 2.2% were excluded because they did not see any patients with obesity. A total of 68 PCPs (75.6%) had complete questionnaires and were included in this analysis. All participants reported asking their patients about their eating habits, lifestyle, and clinical complications at the first assessment. Body weight and blood pressure were measured by 98.5% of participants and 82% calculate body mass index (BMI), while a small proportion of PCPs analysed body composition and fat distribution. Over 80% prescribed laboratory tests and ECG. Approximately 40% of PCPs did not refer patients for nutritional counselling, and most prescribed a low-calorie diet. Sixty-three percent referred patients to an endocrinologist, 48.5% to a psychotherapist, and a minority to specialists for obesity complications. Twenty-three percent prescribed anti-obesity medications and 46.5% referred patients for bariatric surgery only in severe cases. Ninety-one percent stated that obesity is "a complex and multifactorial disease" and 7.4% considered obesity to be secondary to other conditions. Conclusions Despite most PCPs adopt a correct approach to manage patients with obesity, many aspects could be improved to ensure optimal and multidisciplinary management.
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Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Internal Medicine Unit - Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
- Italian Obesity Society (SIO), Pisa, Italy
| | - Danila Capoccia
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Medical Surgical Sciences and Biotechnologies, Sapienza University of Rome, Santa Maria Goretti Hospital, Latina, Italy
| | - Benedetta Russo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Italian Obesity Society (SIO), Pisa, Italy
- Unit of Endocrinology, Diabetes and Metabolism, Fatebenefratelli Gemelli Isola Hospital, Rome, Italy
| | - Carla Lubrano
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Stefania Mariani
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Eleonora Poggiogalle
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Furia
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Local Health Authority Roma 1, Hospital Management Area, Rome, Italy
| | - Aurora Heidar Alizadeh
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Patrizi
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
| | - Martina Sapienza
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Damiani
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maria Grazia Tarsitano
- Directive Council of Order of Physicians and Dentists of the Province of Rome, Rome, Italy
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Caterina Conte
- Italian Obesity Society (SIO), Pisa, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Sesto San Giovanni, Italy
| | - Simona Frontoni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Italian Obesity Society (SIO), Pisa, Italy
- Unit of Endocrinology, Diabetes and Metabolism, Fatebenefratelli Gemelli Isola Hospital, Rome, Italy
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Ba-Shammakh SA, Haj-Freej HM, Al-Naggar YS, Ghanem W, Haij MZ, Al-Mohd F, Hijazi E, Amr SS. Massive Localized Lymphedema: Two Case Studies and Diagnostic Challenges. Cureus 2023; 15:e47092. [PMID: 38021692 PMCID: PMC10646702 DOI: 10.7759/cureus.47092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Massive localized lymphedema (MLL) is an emerging clinical phenomenon predominantly observed in morbidly obese individuals. It presents both diagnostic and therapeutic challenges to clinicians due to its characterization by large, pendulous masses in the abdomen or thigh. MLL may resemble malignant conditions, such as liposarcoma, leading to unnecessary invasive interventions. This study presents two case studies: a 74-year-old male who succumbed to postoperative complications and a 56-year-old female who experienced successful recovery. These cases highlight the urgent need for robust diagnostic criteria and evidence-based management approaches for MLL. In addition, further research exploring the pathogenesis, risk factors, and potential connections among MLL, hypothyroidism, and angiosarcoma is essential.
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Affiliation(s)
- Saleh A Ba-Shammakh
- Department of General Surgery, Princess Rahma Teaching Hospital, Irbid, JOR
- Department of General Surgery, The Islamic Hospital, Amman, JOR
| | - Hasn M Haj-Freej
- Department of General Surgery, Princess Rahma Teaching Hospital, Irbid, JOR
| | | | - Waleed Ghanem
- Department of General Surgery, Princess Rahma Teaching Hospital, Irbid, JOR
| | - Manal Z Haij
- Department of General Surgery, The Islamic Hospital, Amman, JOR
| | - Fahmi Al-Mohd
- Department of General Surgery, The Islamic Hospital, Amman, JOR
| | - Eman Hijazi
- Department of Pathology and Microbiology, The Islamic Hospital, Amman, JOR
| | - Samir S Amr
- Department of Pathology and Laboratory Medicine, Istishari Hospital, Amman, JOR
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3
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Moolenaar LR, de Waard NE, Heger M, de Haan LR, Slootmaekers CPJ, Nijboer WN, Tushuizen ME, van Golen RF. Liver Injury and Acute Liver Failure After Bariatric Surgery: An Overview of Potential Injury Mechanisms. J Clin Gastroenterol 2022; 56:311-323. [PMID: 35180151 DOI: 10.1097/mcg.0000000000001662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The obesity epidemic has caused a surge in the use of bariatric surgery. Although surgery-induced weight loss is an effective treatment of nonalcoholic fatty liver disease, it may precipitate severe hepatic complications under certain circumstances. Acute liver injury (ALI) and acute liver failure (ALF) following bariatric surgery have been reported in several case series. Although rare, ALI and ALF tend to emerge several months after bariatric surgery. If so, it can result in prolonged hospitalization, may necessitate liver transplantation, and in some cases prove fatal. However, little is known about the risk factors for developing ALI or ALF after bariatric surgery and the mechanisms of liver damage in this context are poorly defined. This review provides an account of the available data on ALI and ALF caused by bariatric surgery, with emphasis on potential injury mechanisms and the outcomes of liver transplantation for ALF after bariatric surgery.
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Affiliation(s)
- Laura R Moolenaar
- Departments of Gastroenterology and Hepatology
- Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang Province, P.R. China
| | | | - Michal Heger
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht
- Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang Province, P.R. China
| | - Lianne R de Haan
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht
- Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang Province, P.R. China
| | - Caline P J Slootmaekers
- Department of Gastroenterology and Hepatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | | | - Rowan F van Golen
- Departments of Gastroenterology and Hepatology
- Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang Province, P.R. China
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Deghan Manshadi S, Dehghan K, Robertson DI, Reimer C, Zevin B. Safety and outcomes of performing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy at an ambulatory site of a tertiary care hospital in Ontario. Can J Surg 2022; 65:E38-E44. [PMID: 35042719 PMCID: PMC8900739 DOI: 10.1503/cjs.007120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In Ontario, bariatric surgery is publicly funded and is performed only in accredited tertiary care hospitals. The purpose of our study was to report on the safety and outcomes of performing bariatric surgery at an ambulatory site of a tertiary care hospital in southern Ontario. METHODS We conducted a retrospective cohort study of all adult (age ≥ 18 yr) patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) at the ambulatory site of our tertiary care hospital between September 2016 and August 2018. The 2 sites are 1.4 km apart. Patient demographic characteristics, duration of surgery, intraoperative and 90-day postoperative complications, number of transfers and readmission to the tertiary care hospital, and emergency department visits were collected. RESULTS A total of 314 patients (285 women [90.8%] and 29 men [9.2%] with a mean age of 41.8 yr [standard deviation (SD) 8.9 yr]) underwent surgery: LRYGB in 295 cases (93.9%) and LSG in 19 (6.0%). The mean body mass index was 45.3 (SD 5.1), the median American Society of Anesthesiologists score was 3 (range 2-4), and the median Edmonton Obesity Staging System score was 2 (range 0-4). The mean operative time was 119.8 (SD 23.1) minutes for LRYGB and 96.2 (SD 22.0) minutes for LSG, and the mean length of stay was 2.1 (SD 0.6) days and 2.1 (SD 0.2) days, respectively. Thirteen patients (4.1%) required transfer to the tertiary care hospital for a postoperative complication. Of 312 patients, 29 (9.3%) presented to emergency department within 90 days after surgery, and 8 (2.6%) required readmission to hospital; no deaths were reported. CONCLUSION The findings suggest that LRYGB and LSG can be performed safely at an ambulatory site of a tertiary care hospital. However, caution should be exercised in performing these procedures at an ambulatory site without a tertiary care hospital affiliation, as patients may require urgent transfer for a serious postoperative complication.
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Affiliation(s)
- Shaidah Deghan Manshadi
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - Kooroush Dehghan
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - David I Robertson
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - Cara Reimer
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - Boris Zevin
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
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5
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Salman MA, Salman AA, El Sherbiny M, Elkholy S, Youssef A, Labib S, El-Din MT, Monazea KA, Tourky MS, Mikhail HMS, Maurice KK, Abdallah A, Mostafa MS, Hussein AM, Abdelsalam AM, Allah NA, Ismaeel Saadawy AM, Shaaban HED, Sarhan MD. Changes of Carotid Intima-Media Thickness After Sleeve Gastrectomy in High Cardiovascular Risk Patients: a Prospective Study. Obes Surg 2021; 31:3541-3547. [PMID: 33844173 DOI: 10.1007/s11695-021-05419-5] [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: 12/22/2020] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE There are insufficient data showing the impact of laparoscopic sleeve gastrectomy (LSG) on carotid intima-media thickness (CIMT). Therefore, in the current work, we investigated the improvement of metabolic syndrome and CIMT in patients with obesity after LSG. METHODS This study involved 120 consecutively selected Egyptian patients with a high cardiovascular risk who underwent LSG and were followed up for 12 months. RESULTS CIMT declined from 0.95 ± 0.17 mm to 0.83 ± 0.12 (p < 0.001) after 12 months. In addition, the mean fasting blood glucose and fasting inulin level dropped significantly from 153.3 ± 63.6 to 108.8 ± 33.8 mg/dl and from 23.1 ± 7.1 mU/ml to 14.1 ± 6.4 respectively (p < 0.001). Furthermore, glycated hemoglobin (HbA1c) declined from 7.02 ± 1.7 to 5.5 ± 0.96 (p < 0.001). At the end of the follow-up period, metabolic parameters such as HOMA-IR, C-reactive protein (CRP), fibrinogen, total cholesterol, LDL cholesterol, triglycerides, AST, and ALT decreased significantly from their respective baselines (p value < 0.001). Moreover, the reduction in CIMT showed a strong positive correlation with the degree of weight loss at 6 months and 12 months of follow-up. CONCLUSION LSG led to a substantial decrease in CIMT. Moreover, it significantly impacted cardiovascular risk factors such as obesity, hypertension, insulin resistance, lipid profile, and inflammatory markers.
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Affiliation(s)
| | | | - Mohammad El Sherbiny
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shaimaa Elkholy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Youssef
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Safa Labib
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Tag El-Din
- General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Khaled A Monazea
- General Surgery Department, Al-Azhar Faculty of Medicine for Boys - Assiut, Al-Azhar University, Assiut, Egypt
| | | | | | - Karim K Maurice
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdallah
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | - Nesrin Abd Allah
- Anatomy and Embryology Department, Faculty of Medicine, Menoufia University, Shibin Al Kawm, Egypt
| | | | - Hossam El-Din Shaaban
- Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohamed D Sarhan
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ebrahimi B, Hosseini SV, Haghighat N, Moeinvaziri N, Amini M, Sobhani Z, Hosseini B. Presence of Parasite in the Gastrointestinal Tract of a Patient Undergoing Single Anastomosis Sleeve Ileal Bypass (SASI) Surgery: Case Report. Obes Surg 2021; 31:4640-4642. [PMID: 34081273 DOI: 10.1007/s11695-021-05504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Bahareh Ebrahimi
- Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Neda Haghighat
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Moeinvaziri
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, 32279711-071, Iran
| | - Masoud Amini
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, 32279711-071, Iran
| | - Zahra Sobhani
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Hosseini
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, 32279711-071, Iran.
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7
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Poublon N, Chidi I, Bethlehem M, Kuipers E, Gadiot R, Emous M, van Det M, Dunkelgrun M, Biter U, Apers J. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass, remedy for insufficient weight loss and weight regain after failed restrictive bariatric surgery. Obes Surg 2021; 30:3287-3294. [PMID: 32307669 PMCID: PMC7378100 DOI: 10.1007/s11695-020-04536-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Failure occurs in up to 60% of the patients that were treated with primary restrictive bariatric operations such as Laparoscopic Adjustable Gastric Banding (LAGB), or restrictive/metabolic operations like Laparoscopic Sleeve Gastrectomy (LSG). Insufficient weight loss and weight regain are the most commonly reported reasons of failure. The aim of this retrospective multicenter study was to compare One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) as a revisional procedure in terms of weight loss, procedure time, complication rate and morbidity. Methods 491 patients operated on between 2012 and 2017 for failed restrictive surgery were included in this study (OAGB (n=185) or RYGB (n=306)). Failure was defined as total weight loss (TWL) less than 25%, excess weight loss (EWL) less than 50% and/or a remaining body mass index (BMI) larger than 40 kg/m2 at two years of follow up. Primary outcome measures were %TWL and % excess BMI loss (EBMIL) at 12, 24 and 36 months of follow-up. Secondary outcomes were procedure time, reduction of comorbidity, early and late complication rate, and mortality. Results %TWL was significantly larger in the OAGB group at 12 months (mean 24.1±9.8 vs. 21.9±9.7, p = 0.023) and 24 months (mean 23.9±11.7 vs. 20.5±11.2, p = 0.023) of follow-up. %EBMIL was significantly larger in the OAGB group at 12 months (mean 69.0±44.6 vs. 60.0±30.1, p = 0.014) and 24 months (mean 68.6±51.6 vs. 56.4±35.4, p = 0.025) of follow-up. Intra-abdominal complications (leakage, bleeding, intra-abdominal abscess and perforation) occurred less frequently after revisional OAGB (1.1% vs. 4.9%, p = 0.025). Surgical intervention for biliary reflux (5.4% vs. 0.3%, p < 0.001) was more prevalent in the OAGB group. Surgical intervention for internal herniation (0.0% vs. 4.9%, p = 0.002) was more prevalent in the RYGB group. Conclusions This study suggests that OAGB is superior to RYGB as a remedy for insufficient weight loss and weight regain after failed restrictive surgery with more weight loss and a lower early complication rate. To substantiate these findings, further research from prospective randomized controlled trials is needed.
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Affiliation(s)
- Nathan Poublon
- Department of Surgery, Franciscus Gasthuis & Vlietland, Locatie Gasthuis, Afdeling Heelkunde, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
| | - Ibtissam Chidi
- Department of Surgery, Franciscus Gasthuis & Vlietland, Locatie Gasthuis, Afdeling Heelkunde, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Martijn Bethlehem
- Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Ellen Kuipers
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Ralph Gadiot
- Department of Surgery, Franciscus Gasthuis & Vlietland, Locatie Gasthuis, Afdeling Heelkunde, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Marloes Emous
- Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Marc van Det
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Martin Dunkelgrun
- Department of Surgery, Franciscus Gasthuis & Vlietland, Locatie Gasthuis, Afdeling Heelkunde, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Ulas Biter
- Department of Surgery, Franciscus Gasthuis & Vlietland, Locatie Gasthuis, Afdeling Heelkunde, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Jan Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Locatie Gasthuis, Afdeling Heelkunde, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
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8
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Salman A, Shaaban HED, Salman M, M Seif El Nasr S, Soliman A, Salem A, Tag El-Din M, Mikhail HMS, El Domiaty H, Abd Allah N, GabAllah GMK, Youssef A. Changes in Plasma Growth Differentiation Factor-15 After Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients: A Prospective Study. J Inflamm Res 2021; 14:1365-1373. [PMID: 33880052 PMCID: PMC8052116 DOI: 10.2147/jir.s304929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to assess the potential changes of Growth differentiation factor 15 (GDF15) after laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients. METHODS We conducted a prospective study on 68 patients who underwent LSG and 58 cases, who were enrolled as a control group, to whom conservative measures of weight loss were adopted. Both groups were followed for 12 months. RESULTS At the baseline, the serum GDF15 was comparable between LSG and conservative groups (409.93±119 versus 385.8±120.2 pg/mL, p =0.246). However, at 12 months after the operation, the serum GDF15 was significantly higher in the LSG than conservative groups (699.941 ±193.5 versus 559 ±159.7; p <0.001). The degree of serum GDF15 increase was higher in the LSG group (290.01 ±189.9 versus 173.14 ±116.7; p <0.001). The degree of serum GDF15 increase correlated negatively with the final BMI (r = -0.352, p =0.001) and weight loss (r = -0.793, p =0.001) at 12 months after the operation. The correlation analysis demonstrated that the initial GFD15 did not correlate with any baseline parameters. Multiple regression analysis of change in serum GDF15 showed a statistical significance of the weight loss after 12 months. CONCLUSION The present work confirms the impact of successful weight loss on the circulating level of GDF15. Our study demonstrated that the circulating GDF15 increased significantly after LSG and it was correlated to the degree of weight loss.
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Affiliation(s)
- Ahmed Salman
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam El-Din Shaaban
- Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohamed Salman
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sayed M Seif El Nasr
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Soliman
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Abdoh Salem
- General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Tag El-Din
- General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Heba El Domiaty
- Clinical Physiology Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Nesrin Abd Allah
- Anatomy and Embryology Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Ghada M K GabAllah
- Medical Biochemistry Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Ahmed Youssef
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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9
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Zevin B, Martin M, Dalgarno N, Chan L, Sivapalan N, Houlden R, Birtwhistle R, Smith K, Barber D. Survey of perceptions and educational needs of primary care providers regarding management of patients with class II and III obesity in Ontario, Canada. BMC FAMILY PRACTICE 2021; 22:14. [PMID: 33422014 PMCID: PMC7797146 DOI: 10.1186/s12875-020-01356-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary care providers (PCPs) are typically the primary contact for patients with obesity seeking medical and surgical weight loss interventions; however, previous studies suggest that fewer than 7% of eligible adult patients are referred to publically funded medical and surgical weight loss interventions (MSWLI). METHODS We performed an anonymous survey study between October 2017 and June 2018 to explore the knowledge, experiences, perceptions, and educational needs of PCPs in Southeastern Ontario in managing patients with class II and III obesity. RESULTS Surveys were distributed to 591 PCPs (n = 538 family physicians; n = 53 nurse practitioners) identified as practicing in the Southeastern Ontario and 92 (15.6%) participated. PCPs serving a rural population estimated that 14.2 ± 10.9% of patients would qualify for MSWLI compared to 9.9 ± 8.5% of patients of PCPs serving an urban population (p = .049). Overall, 57.5% of respondents did not feel competent prescribing MSWLI to patients with class II/III obesity, while 69.8% stated they had 'good' knowledge of the referral criteria for MSWLI. 22.2% of respondents were hesitant to refer patients for bariatric surgery (BS) due to concerns about postoperative surgical complications and risks associated with surgery. Only 25% of respondents were comfortable providing long-term follow up after BS, and only 39.1% had participated in continuing education on management of patients with class II/III obesity in the past 5 years. CONCLUSION The majority of PCPs believe there is a need for additional education about MSWLI for patients with class II/III obesity. Future studies are needed to develop and compare the effectiveness of additional education and professional development around risks of contemporary BS, indications to consider referral for MSWLI, management and long-term follow-up of patients after BS.
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Affiliation(s)
- Boris Zevin
- Department of Surgery, Queen's University, Kingston, ON, Canada.
| | - Mary Martin
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Linda Chan
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | | | - Robyn Houlden
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Richard Birtwhistle
- Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Karen Smith
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, Canada
| | - David Barber
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
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10
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Ergun S, Ergun DD, Akinci O, Taskin HE, Simsek G, Taskin M, Uzun H. The role of laparoscopic sleeve gastrectomy on inflammatory parameters in morbidly obese patients. J Visc Surg 2020; 159:31-38. [PMID: 33303392 DOI: 10.1016/j.jviscsurg.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obesity is an excessive increase in body fat mass and triggers chronic inflammation which causes increased fat accumulation in the visceral fat tissue. The aim of this study was to analyze serum zinc (Zn), Zn-alpha 2 glycoprotein (ZAG), peroxisome proliferator-activated receptor-γ (PPAR-γ) and nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB) levels in morbidly obese patients before and after laparoscopic sleeve gastrectomy (LSG) and determine the association between alteration in body mass index (BMI), the % Excess Weight Loss (% EWL) and the biochemical parameters. METHODS Thirty healthy individuals as a control group and 30 morbidly obese patients who had undergone LSG were enrolled in this study. Routine anthropometric and laboratory biochemical parameters in venous blood samples of groups at baseline and 1 and 12 months after LSG were recorded. RESULTS Significant weight loss was achieved at 1 and 12 months after LSG. At baseline serum ZAG and PPAR-γ levels were lower, while NF-кB levels were higher in morbidly obese patients compared with the control group. Serum ZAG and PPAR-γ levels increased while NF-кB levels decreased 1 month and 12 months after LSG. Decreased %EWL was negatively correlated with changes in NF-кB, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), fasting plasma glucose and insulin at 12 months after LSG in morbidly obese patients. However, %EWL was positively correlated with changes in ZAG. CONCLUSIONS Obesity was associated with down-regulated serum ZAG and PPAR-γ levels while up-regulated serum NF-кB. Our findings suggest that LSG ameliorates upregulating PPAR-γ expression, thereby inhibiting NF-κB-mediated inflammation by weight loss.
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Affiliation(s)
- S Ergun
- Department of General Surgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - D D Ergun
- Department of Biophysics, Medicine Faculty, Istanbul Aydın University, Istanbul, Turkey
| | - O Akinci
- Department of General Surgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - H E Taskin
- Department of General Surgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - G Simsek
- Department of Physiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - M Taskin
- Department of General Surgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - H Uzun
- Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34303 Cerrahpasa-İstanbul, Turkey.
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11
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Erawijantari PP, Mizutani S, Shiroma H, Shiba S, Nakajima T, Sakamoto T, Saito Y, Fukuda S, Yachida S, Yamada T. Influence of gastrectomy for gastric cancer treatment on faecal microbiome and metabolome profiles. Gut 2020; 69:1404-1415. [PMID: 31953253 PMCID: PMC7398469 DOI: 10.1136/gutjnl-2019-319188] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Recent evidence points to the gut microbiome's involvement in postoperative outcomes, including after gastrectomy. Here, we investigated the influence of gastrectomy for gastric cancer on the gut microbiome and metabolome, and how it related to postgastrectomy conditions. DESIGN We performed shotgun metagenomics sequencing and capillary electrophoresis time-of-flight mass spectrometry-based metabolomics analyses on faecal samples collected from participants with a history of gastrectomy for gastric cancer (n=50) and compared them with control participants (n=56). RESULTS The gut microbiota in the gastrectomy group showed higher species diversity and richness (p<0.05), together with greater abundance of aerobes, facultative anaerobes and oral microbes. Moreover, bile acids such as genotoxic deoxycholic acid and branched-chain amino acids were differentially abundant between the two groups (linear discriminant analysis (LDA) effect size (LEfSe): p<0.05, q<0.1, LDA>2.0), as were also Kyoto Encyclopedia of Genes and Genomes modules involved in nutrient transport and organic compounds biosynthesis (LEfSe: p<0.05, q<0.1, LDA>2.0). CONCLUSION Our results reveal alterations of gut microbiota after gastrectomy, suggesting its association with postoperative comorbidities. The multi-omic approach applied in this study could complement the follow-up of patients after gastrectomy.
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Affiliation(s)
- Pande Putu Erawijantari
- School of Life Science and Technology, Tokyo Institute of Technology, Meguro-ku, Tokyo, Japan
| | - Sayaka Mizutani
- School of Life Science and Technology, Tokyo Institute of Technology, Meguro-ku, Tokyo, Japan,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Hirotsugu Shiroma
- School of Life Science and Technology, Tokyo Institute of Technology, Meguro-ku, Tokyo, Japan
| | - Satoshi Shiba
- Division of Cancer Genomics, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Takeshi Nakajima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Tokyo, Japan
| | - Shinji Fukuda
- Institute for Advanced Biosciences, Keio University, Tsuruoka, Yamagata, Japan,Intestinal Microbiota Project, Kanagawa Institute of Industrial Science and Technology, Ebina, Kanagawa, Japan,Transborder Medical Research Center, University of Tsukuba, Ibaraki, Japan
| | - Shinichi Yachida
- Division of Cancer Genomics, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan .,Department of Cancer Genome Informatics, Graduate School of Medicine/Faculty of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takuji Yamada
- School of Life Science and Technology, Tokyo Institute of Technology, Meguro-ku, Tokyo, Japan
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12
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The risk of developing breast, ovarian, and endometrial cancer in obese women submitted to bariatric surgery: a meta-analysis. Surg Obes Relat Dis 2020; 16:1596-1602. [PMID: 32690459 DOI: 10.1016/j.soard.2020.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
This article performs a systematic review and meta-analysis to investigate the impact of bariatric surgery and the risk of developing breast, ovarian, and endometrial cancer in obese women. MEDLINE, EMBASE, LILACS, and Cochrane databases were searched from inception until January 2019 to retrieve studies that assessed the risk of breast, ovarian, or endometrial cancer in obese women submitted to bariatric surgery. There was no language restriction. We extracted and combined data from studies to assess the risk ratio (RR) of developing these neoplasms. A random-effects meta-analytic model was applied in all calculations. The New Castle Ottawa and GRADE were used to assess quality of the included studies and certainty of the evidence, respectively. This study is registered in PROSPERO (CRD42019112927). We found 188 articles and 7 of those were included in our meta-analysis, which incorporated a total of 150,537 patients in the bariatric surgery arm and 1,461,938 women in the control arm. The total RR of breast, ovarian, and endometrial cancer was .41 (95% confidence interval [CI]: .31-.56]; I2 = 90%; 7 studies). The risk of breast cancer was reduced by 49% (RR: .51; 95%CI: .31-.83]; I2 = 92%; 6 studies). The risk of ovarian cancer was reduced by 53% (RR: .47; 95%CI: .27-81; I2 = 0%; 3 studies). The risk of endometrial cancer was reduced by 67% (RR: .33; 95%CI: .21-.51; I2 = 88%; 7 studies). Bariatric surgery may have a protective effect reducing the risk of breast, ovarian, and endometrial cancer in obese women. The high heterogeneity and other issues justify the need for further studies to deepen our knowledge.
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13
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Kenngott HG, Nickel F, Wise PA, Wagner F, Billeter AT, Nattenmüller J, Nabers D, Maier-Hein K, Kauczor HU, Fischer L, Müller-Stich BP. Weight Loss and Changes in Adipose Tissue and Skeletal Muscle Volume after Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: a Prospective Study with 12-Month Follow-Up. Obes Surg 2020; 29:4018-4028. [PMID: 31309523 DOI: 10.1007/s11695-019-04087-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aimed to evaluate changes in body tissue composition with obesity surgery regarding visceral fat, subcutaneous fat, and skeletal muscle. DESIGN Prospective non-randomized single-center cohort study METHODS: Whole-body magnetic resonance imaging (MRI) measured volumes of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle (SM) in 31 patients with laparoscopic sleeve gastrectomy (LSG, 20) or Roux-en-Y gastric bypass (RYGB, 11) preoperatively, at three- and 12-months follow-up. RESULTS Body mass index (BMI) went down from 45.2 ± 6.5 preoperatively to 37.2 ± 5.6 (p < 0.001) at three months and 32.2 ± 5.3 kg/m2 (p < 0.001) at 12 months. SAT went down from 55.0 ± 14.0 L (liter) to 42.2 ± 13.3 L (p < 0.001) at three months and 31.7 ± 10.5 L (p < 0.001) at 12 months (- 42.3%). VAT went down from 6.5 ± 2.3 to 4.5 ± 1.7 (p < 0.001) at three months and 3.1 ± 1.7 L (p < 0.001) at 12 months (- 52.3%). SM went down from 22.7 ± 4.8 to 20.4 ± 3.6 (p = 0.008) at three months and remained 20.2 ± 4.6 L at 12 months (p = 0.17 relative three-month; p = 0.04 relative preop, - 11.1%). Relative loss was higher for VAT than that for SAT (52.3 ± 18.2% vs. 42.3 ± 13.8%; p = 0.03). At 12 months, there was no difference between LSG and RYGB for relative changes in BMI or body tissue composition. CONCLUSION Postoperatively, there was higher net loss of SAT but higher relative loss of VAT with weight loss. SM was lost only during the first three months. MRI provides accurate evaluation of surgeries' effect on individual patients' tissue composition. This can benefit risk assessment for related cardiovascular and metabolic health but cost-related factors will likely reserve the used methods for research.
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Affiliation(s)
- Hannes Götz Kenngott
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Philipp Anthony Wise
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Wagner
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Adrian Theophil Billeter
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Diana Nabers
- Division of Medical Image Computing, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Lars Fischer
- Department of Surgery, Hospital Mittelbaden, Balgerstrasse 50, 76532, Baden-Baden, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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14
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Wu T, Wong SKH, Law BTT, Grieve E, Wu O, Tong DKH, Leung DKW, Lam CLK, Wong CKH. Five-year effectiveness of bariatric surgery on disease remission, weight loss, and changes of metabolic parameters in obese patients with type 2 diabetes: A population-based propensity score-matched cohort study. Diabetes Metab Res Rev 2020; 36:e3236. [PMID: 31912598 DOI: 10.1002/dmrr.3236] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/09/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
Abstract
AIMS To compare disease remission rates, weight loss, and changes of metabolic parameters of patients after bariatric surgery with nonsurgical patients. METHODS Based on the 2006-2017 Hospital Authority database, a population-based retrospective cohort of obese type 2 diabetes mellitus (T2DM) patients with and without bariatric surgery were identified. Surgical patients were matched with nonsurgical patients on 1-to-5 propensity score. Remission rates of diabetes, hypertension, and dyslipidaemia were reported annually up to 60 months. Changes in weight loss measurements (Body Mass Index [BMI], percentage of total weight loss [%TWL], percentage of excess weight loss [%EWL], and percentage of rebound in excess weight loss [%REWL]) and metabolic parameters (haemoglobin A1c [HbA1c ], systolic blood pressure [SBP], diastolic blood pressure [DBP], and low-density lipoprotein cholesterol [LDL-C]) were measured for both groups. RESULTS Four hundred one surgical patients (310 restrictive surgeries; 91 bypass surgeries) and 1894 nonsurgical patients were included. Surgical patients had higher remission rates in diabetes and dyslipidaemia and better glycaemic control at 12 to 60 months (all Ps < .01). SBP and DBP were significantly lower for surgical group up to 12 months and similar between two groups after 12 months. Surgical patients had significantly lower BMI during follow-up period. %TWL and %EWL were higher in the surgery group (15.7% vs 3.7%; 48.8% vs 12.0%) at 60 months (P < .001); differences in %REWL between two groups were insignificant. The effectiveness of restrictive and bypass surgeries was similar at 60 months, although restrictive surgeries were slightly more effective in T2DM remission. CONCLUSIONS Bariatric surgery was effective in weight loss, remission of diabetes, and dyslipidaemia in 5-year post-surgery.
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Affiliation(s)
- Tingting Wu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | | | - Betty Tsz Ting Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, SAR, China
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, UK
| | - Daniel King Hung Tong
- Surgery Centre, Hong Kong Sanatorium & Hospital, University of Glasgow, Hong Kong SAR, China
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
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15
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Furlan AAC, Junqueira-Franco MVM, Oliveira JCSD, Favaris JWDS, Marchini JS, Cunha SFC. Severe malnutrition after bariatric surgery and clinic manifestations of infection. Rev Assoc Med Bras (1992) 2019; 65:1151-1155. [PMID: 31618329 DOI: 10.1590/1806-9282.65.9.1151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/08/2019] [Indexed: 01/07/2023] Open
Abstract
This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.
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Affiliation(s)
- Alice Avesani Cavotto Furlan
- . Divisão de Nutrologia do Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Marcia Varella Morandi Junqueira-Franco
- . Divisão de Nutrologia do Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Joyce Cristina Santos de Oliveira
- . Divisão de Nutrologia do Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - José Wilson de Souza Favaris
- . Divisão de Nutrologia do Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Julio Sérgio Marchini
- . Divisão de Nutrologia do Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Selma Freire Carvalho Cunha
- . Divisão de Nutrologia do Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
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16
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Asghari G, Khalaj A, Ghadimi M, Mahdavi M, Farhadnejad H, Valizadeh M, Azizi F, Barzin M, Hosseinpanah F. Prevalence of Micronutrient Deficiencies Prior to Bariatric Surgery: Tehran Obesity Treatment Study (TOTS). Obes Surg 2019. [PMID: 29520704 DOI: 10.1007/s11695-018-3187-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Micronutrient deficiencies are major concerns after bariatric surgery, although these conditions often go undiagnosed pre-surgery. OBJECTIVE To assess pre-surgery micronutrient status of an Iranian population of morbidly obese candidates of bariatric surgery in a cross-sectional study. METHODS A cross-sectional analysis of 2008 candidates for bariatric surgery, aged 15-65 years, with either body mass index (BMI) ≥ 40 kg/m2 or 30 < BMI < 35 kg/m2 with a medical comorbidity was conducted. In order to determine the micronutrient status of participants, blood samples were collected to assess serum concentrations of vitamins (B12 and D), minerals (copper, calcium, phosphate, and zinc), and iron profiles (total iron binding capacity, iron concentration, ferritin, and iron saturation), according to standard protocol. RESULTS The mean age and BMI of patients (79.3% female) were 37.8 years and 44.8 kg/m2, respectively. Deficiencies were found for 25(OH) D (53.6%), vitamin B12 (34.4%), serum iron (10.2%), and low levels of hemoglobin (16.6%). The prevalence of other deficiencies were all below 10%. Body mass index had a negative correlation with iron, calcium, vitamin B12, and 25(OH) D and was positively correlated with copper. CONCLUSION Micronutrient deficiencies, including vitamin D, vitamin B12, and iron, are commonly found among morbidly obese subjects who are potential candidates of bariatric surgery.
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Affiliation(s)
- Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Ghadimi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Farhadnejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Amini M, Dehghani R, Zare A. Laparoscopic One-Anastomosis Gastric Bypass in a Patient with Morbid Obesity and Situs Inversus Totalis: a Case Report. Obes Surg 2018; 29:632-635. [PMID: 30515621 DOI: 10.1007/s11695-018-3619-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Laparoscopic one-anastomosis gastric bypass is a new bariatric surgery technique for weight loss in morbid obesity. This technique has come to be associated with suitable weight loss results, low technical complications, short surgery time, low cost, short post-operational period, and low chances of injury comparisons with other bariatric surgical approaches to weight loss in morbid obesity such as sleeve and Roux-en-Y gastric bypass. To the best of our knowledge, there has been no report of such surgery in the case of situs inversus totalis concurrent with morbid obesity. CASE PRESENTATION The patient was a 36-year-old male suffering from morbid obesity (BMI, 56.8) along with situs inversus totalis. In spite of operational complexities due to the reversed location of abdominal and thoracic organs, the operation was performed similarly to routine subjects considering the diverse site of organs. CONCLUSION Given the considerable superiorities of one anastomosis gastric bypass over other bariatric surgical techniques, particularly concerning the simpler procedure, low surgical complication and short surgery time, this approach may guarantee positive outcomes in subjects with concurrent situs inversus totalis and morbid obesity.
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Affiliation(s)
- Masood Amini
- Laparoscopy Research Center, Department of Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Dehghani
- Department of Pharmacology, School of medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Zare
- Laparoscopy Research Center, Department of Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Single-anastomosis duodeno-ileal - new revision procedure in a patient with insufficient weight loss after sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2018; 13:407-411. [PMID: 30302156 PMCID: PMC6174167 DOI: 10.5114/wiitm.2018.76686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/15/2018] [Indexed: 12/18/2022] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) is one of the most popular and effective bariatric surgical procedures worldwide. The effect of LSG is mostly dependent on the restrictive mechanism, which makes it more vulnerable to failure. Failing of bariatric procedure is not uncommon and occurs in 6% to 23%. In case of weight loss failure, there are no hard recommendations on the choice of the redo procedure. One of the most novel options, introduced in 2007, relatively simple to perform following LSG is single-anastomosis duodenoileal bypass. Herein we describe surgical technique and history of a patient with inadequate weight loss after laparoscopic sleeve gastrectomy, who underwent single-anastomosis duodenoileal bypass.
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19
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Wu Z, Li J, Wang C, Yang J, Chen X, Yang W, Xiong Z, Peng X. Characterization of cardiovascular depression effect for propofol during anesthesia induction period on morbidly obese patients. Biomed Pharmacother 2018; 106:618-623. [PMID: 29990851 DOI: 10.1016/j.biopha.2018.06.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 02/08/2023] Open
Abstract
This study aims to determine the pharmacodynamics (PD) effect (measured by cardiovascular depression) of propofol during anesthesia induction period on morbidly obese (MO) patients. Four hemodynamics indexes [i.e., three indexes about blood pressure and cardiac output (CO)] representing cardiovascular function were measured. Pharmacokinetic/pharmacodynamic (PK/PD) modeling was performed by population analysis to obtain PD parameters. Two propofol dosing scalars, namely, dosing based on total body weight (TBW) or lean body weight (LBW), were used for MO subjects. The PD data were well described by a PK/PD model. Blood pressure and CO were rapidly decreased within one minute after intravenous injection of propofol (2 mg/kg). TBW group showed significantly lower blood pressure and CO values at and 1 min after propofol administration compared with the control group, whereas the control and LBW groups had similar PD profiles. In addition, the propofol EC50 value was significantly decreased in MO patients, whereas all other PD parameters were similar between control and MO subjects. This change indicated that propofol potency and/or sensitivity was increased in MO subjects. For MO patients, dosing of propofol based on LBW rather than TBW would be a safer choice due to a less cardiovascular depression effect.
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Affiliation(s)
- Zhufeng Wu
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiayang Li
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China; Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cunchuan Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jingge Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaomei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhiling Xiong
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Harvard Medical School, Boston, MA, 02115, USA.
| | - Xuemei Peng
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Schijns W, Schuurman LT, Melse-Boonstra A, van Laarhoven CJ, Berends FJ, Aarts EO. Do specialized bariatric multivitamins lower deficiencies after RYGB? Surg Obes Relat Dis 2018; 14:1005-1012. [PMID: 29903686 DOI: 10.1016/j.soard.2018.03.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/01/2018] [Accepted: 03/28/2018] [Indexed: 01/07/2023]
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Owen-Smith A, Donovan J, Coast J. Experiences of accessing obesity surgery on the NHS: a qualitative study. J Public Health (Oxf) 2018; 39:163-169. [PMID: 26834194 DOI: 10.1093/pubmed/fdv209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Although surgical treatment is recommended for morbid obesity where other interventions have failed, there is evidence that access to NHS surgery is heavily rationed. This study aimed to investigate how patients experienced accessing referrals for obesity surgery. Methods Data collection was undertaken using in-depth interviews with patients and clinicians working in a specialist secondary care facility, and analysis took a constant comparative approach. Results Twenty-two participants with morbid obesity were followed up for a period of up to 3 years. All participants had made multiple attempts to lose weight prior to consulting their GPs yet felt this was rarely acknowledged by clinicians. Participants were frustrated when they received insufficient support to comply with primary care interventions, and when it came to obtaining a referral to secondary care, most had to raise this issue with GPs themselves. Conclusions There is an urgent need for interventions for morbid obesity in primary care that are accessible to patients to facilitate weight loss and prevent weight re-gain. For those at very high weights, better integration between primary and secondary care is required to ensure appropriate and timely referral for those who need assessment for surgery.
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Affiliation(s)
- Amanda Owen-Smith
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Jenny Donovan
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Joanna Coast
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Public Health Building, University of Birmingham, Birmingham B15 2TT, UK
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Vargas GP, Mendes GA, Pinto RD. QUALITY OF LIFE AFTER VERTICAL GASTRECTOMY EVALUATED BY THE BAROS QUESTIONNAIRE. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:248-251. [PMID: 29340547 PMCID: PMC5793141 DOI: 10.1590/0102-6720201700040005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life of the patients. AIM To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy. METHODS Was applied the questionnaire "Bariatric Analysis and Reporting Outcome System" (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy. RESULTS A total of 47 patients between 21-60 years old were evaluated. The total mean of the BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated. CONCLUSION BAROS showed excellent results in 36.17%, very good in 40.43%, good in 21.28% and reasonable in 2.13%. The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities.
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Weiss CR, Kathait AS. Bariatric embolization: a new and effective option for the obese patient? Expert Rev Gastroenterol Hepatol 2017; 11:293-302. [PMID: 28276817 DOI: 10.1080/17474124.2017.1294060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity is a public health epidemic in the United States, which results in significant morbidity, mortality, and cost to the healthcare system. Despite advancements in traditional therapeutic options for the obese patients, there is a treatment gap for patients in whom lifestyle modifications alone have not been successful, but for whom bariatric surgery is not a suitable option. Areas covered: This treatment gap needs to be addressed and thus, complimentary or alternative treatments to lifestyle changes and surgery are urgently needed. Recent evidence suggests that embolization of the gastric fundus ('Bariatric Embolization'), which is predominantly supplied by the left gastric artery, may affect energy homeostasis by decreasing ghrelin production. The purpose of this special report is to discuss the background, rationale and latest data on this topic, as well as provide the latest data from the ongoing BEAT Obesity clinical trial. Expert commentary: A multipronged approach is essential in the treatment of obesity. Bariatric embolization looks to treat the hormonal imbalances which contribute to obesity. If proven successful in the long-term, bariatric embolization represents a potential minimally invasive approach to treat obesity offered by interventional radiologists.
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Affiliation(s)
- Clifford R Weiss
- a Russell H. Morgan Department of Radiology and Radiologic Science , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Anjaneya S Kathait
- a Russell H. Morgan Department of Radiology and Radiologic Science , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Mendes GA, Vargas GP. QUALITY OF LIFE AFTER VERTICAL GASTRECTOMY EVALUATED BY THE BAROS QUESTIONNAIRE. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:14-17. [PMID: 28489161 PMCID: PMC5424679 DOI: 10.1590/0102-6720201700010005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/22/2016] [Indexed: 02/07/2023]
Abstract
Background The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life. Aim To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy. Methods It was applied the questionnaire "Bariatric Analysis and Reporting Outcome System" (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy. Results A total of 47 patients between 21-60 years old were evaluated. The total mean of BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated. Conclusion The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities in patients submitted to sleeve gastrectomy.
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Affiliation(s)
- Giselle Abigail Mendes
- Department of Medicine, Regional University of Blumenau
- Clinic of Surgery of Digestive System - VIDAR, Blumenau, SC, Brazil
| | - Guilherme Pedroso Vargas
- Department of Medicine, Regional University of Blumenau
- Clinic of Surgery of Digestive System - VIDAR, Blumenau, SC, Brazil
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Owen-Smith A, Donovan J, Coast J. "Vicious circles": the development of morbid obesity. QUALITATIVE HEALTH RESEARCH 2014; 24:1212-20. [PMID: 25079501 DOI: 10.1177/1049732314544908] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Although there has been extensive research around the etiology of moderate obesity, there are still important questions relating to the development and lived experience of extreme obesity. We present a synthesis of data from two in-depth qualitative studies in which morbidly obese participants (N = 31) were able to explain the development of the condition in their own terms. We identified consistent themes in the two datasets, and undertook a detailed data synthesis. Particularly salient themes in the development of morbid obesity related to family structures and early socialization experiences, and the role of emotional distress was dominant in both initial weight gain and ongoing cycles of loss and regain. All informants accepted some responsibility for their health state, but identified a number of mitigating factors that limited personal culpability that were often related to the fulfillment of gendered social expectations.
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Affiliation(s)
| | | | - Joanna Coast
- University of Birmingham, Birmingham, United Kingdom
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Cesana G, Uccelli M, Ciccarese F, Carrieri D, Castello G, Olmi S. Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy. World J Gastrointest Surg 2014; 6:101-106. [PMID: 24976903 PMCID: PMC4073220 DOI: 10.4240/wjgs.v6.i6.101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/17/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate laparoscopic re-sleeve gastrectomy as a treatment of weight regain after Sleeve.
METHODS: Laparoscopic sleeve gastrectomy is a common bariatric procedure. Weight regain after long-term follow-up is reported. Patients were considered for laparoscopic re-sleeve gastrectomy when we observed progressive weight regain and persistence of comorbidities associated with evidence of dilated gastric fundus and/or antrum on upper gastro-intestinal series. Follow-up visits were scheduled at 1, 3, 6 and 12 mo after surgery and every 6 mo thereafter. Measures of change from baseline at different times were analyzed with the paired samples t test.
RESULTS: We observed progressive weight regain after sleeve in 11 of the 201 patients (5.4%) who had a mean follow-up of 21.1 ± 9.7 mo (range 6-57 mo). Three patients started to regain weight after 6 mo following Sleeve, 5 patients after 12 mo, 3 patients after 18 m. Re-sleeve gastrectomy was always performed by laparoscopy. The mean time of intervention was 55.8 ± 29.1 min. In all cases, neither intra-operative nor post-operative complications occurred. After 1 year follow-up we observed a significant (P < 0.05) mean body mass index reduction (-6.6 ± 2.7 kg/m2) and mean % excess weight loss (%EWL) increase (+31.0% ± 15.8%). An important reduction of antihypertensive drugs and hypoglycemic agents was observed after re-sleeve in those patients affected by hypertension and diabetes. Joint problems and sleep apnea syndrome improved in all 11 patients.
CONCLUSION: Laparoscopic re-sleeve gastrectomy is a feasible and effective intervention to correct weight regain after sleeve.
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28
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Trachta P, Dostálová I, Haluzíková D, Kasalický M, Kaválková P, Drápalová J, Urbanová M, Lacinová Z, Mráz M, Haluzík M. Laparoscopic sleeve gastrectomy ameliorates mRNA expression of inflammation-related genes in subcutaneous adipose tissue but not in peripheral monocytes of obese patients. Mol Cell Endocrinol 2014; 383:96-102. [PMID: 24291610 DOI: 10.1016/j.mce.2013.11.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 01/07/2023]
Abstract
Low-grade inflammation links obesity, insulin resistance, and cardiovascular diseases. We investigated the effects of laparoscopic sleeve gastrectomy (LSG) on expression profile of genes involved in inflammatory pathways in subcutaneous adipose tissue (SCAT) and peripheral monocytes (PM). At baseline, obese group had significantly increased mRNA expression of proinflammatory chemokines (CCL-3, -17, -22), chemokine receptor CCR1 and cytokines (IL-10, IL-18) in SCAT and chemokine and other proinflammatory receptors (CCR-1, -2, -3, TLR-2, -4) in PM relative to control group. LSG decreased body weight, improved metabolic profile and reduced mRNA expression of up-regulated chemokine receptors, chemokines and cytokines in SCAT. In contrast, expression profiles in PM were largely unaffected by LSG. We conclude that LSG improved proinflammatory profile in subcutaneous fat but not in peripheral monocytes. The sustained proinflammatory and chemotactic profile in PM even 2 years after LSG may contribute to partial persistence of metabolic complications in obese patients after metabolic surgery.
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Affiliation(s)
- P Trachta
- Third Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - I Dostálová
- Third Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - D Haluzíková
- Third Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Department of Sports Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Kasalický
- Department of Surgery, 2nd Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - P Kaválková
- Third Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - J Drápalová
- Third Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Urbanová
- Third Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Z Lacinová
- Third Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Mráz
- Third Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Haluzík
- Third Department of Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
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Indications and short-term outcomes of revisional surgery after failed or complicated sleeve gastrectomy. Obes Surg 2013; 22:1903-8. [PMID: 23001572 DOI: 10.1007/s11695-012-0774-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is an upcoming primary treatment modality for morbid obesity. The aim of this study was to report the indications for and the outcomes of revisional surgery after SG. METHODS Four hundred sixteen individuals underwent a SG between August 2006 and July 2010 with a minimum follow-up of 12 months. The patients that needed revision were identified from our prospective registry. Patients were subdivided in a first group undergoing revision as part of a two-step procedure, a second group with failure of a secondary SG, and a third group with failure of a primary SG. RESULTS Twenty-three patients (5.5%) had an unplanned revision. Fourteen (3.4%) had a two-step procedure because of super obesity. A significant additional weight loss was achieved after revision; no complications occurred in this group. Five patients with failure of a secondary SG had no significant additional weight loss after revision. Reflux disease was cured. Eighteen patients in the third group showed significant additional weight loss and remission of diabetes and hypertension. Both reflux disease and dysphagia did not heal in all affected patients after revision. The early complication rate in the whole cohort was 23.4%; staple line leakage was 5.4%, and bleeding was 8.1%. Revision-related mortality was 0%. CONCLUSION In a large series of sleeve gastrectomies, the unplanned revision rate was 5.5%. Revision of a sleeve gastrectomy is feasible in patients that do not achieve sufficient weight loss and in those patients developing complications after the initial sleeve gastrectomy.
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30
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Harris TJ, Murphy TP, Jay BS, Hampson CO, Zafar AM. Visceral blood flow modulation: potential therapy for morbid obesity. Cardiovasc Intervent Radiol 2013; 36:803-8. [PMID: 23381772 DOI: 10.1007/s00270-013-0560-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 12/26/2012] [Indexed: 11/25/2022]
Abstract
We present this preliminary investigation into the safety and feasibility of endovascular therapy for morbid obesity in a swine model. A flow-limiting, balloon-expandable covered stent was placed in the superior mesenteric artery of three Yorkshire swine after femoral arterial cutdown. The pigs were monitored for between 15 and 51 days after the procedure and then killed, with weights obtained at 2-week increments. In the two pigs in which the stent was flow limiting, a reduced rate of weight gain (0.42 and 0.53 kg/day) was observed relative to the third pig (0.69 kg/day), associated with temporary food aversion and signs of mesenteric ischemia in one pig.
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Affiliation(s)
- Tyler J Harris
- Department of Vascular and Interventional Radiology, University of California, Los Angeles, 757 Westwood Blvd., Suite 1638, Los Angeles, CA 90095-7437, USA.
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van Rutte PWJ, Smulders JF, de Zoete JP, Nienhuijs SW. Sleeve gastrectomy in older obese patients. Surg Endosc 2013; 27:2014-9. [PMID: 23344504 DOI: 10.1007/s00464-012-2703-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/01/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND With global aging, obesity will increasingly affect the older population with higher risks of morbidity and mortality, yet full consensus has been obtained for the role of sleeve gastrectomy (SG) in the older obese. OBJECTIVE The aim of this study is to report the outcomes of SG in the older obese. SETTING Bariatric department, large teaching hospital, The Netherlands. METHODS Between August 2006 and December 2011, 135 patients aged 55 years or older underwent SG. Outcomes in terms of perioperative complications, weight loss, remission of comorbidities, and revision were extracted from our prospectively held database. A subanalysis was done comparing three age groups: 55-59 years, 60-64 years, and 65 years and older. RESULTS During mean follow-up of 14.6 months, short-term mortality was 0 %. The 30-day complication rate was 11.1 %, without significant differences between age groups. Late complications occurred in 4.4 %. In 14 patients, revisions were performed because of development of reflux disease or dysphagia. Significant reduction of comorbidities was found in all age groups, except for sleep apnea. Among the total cohort, excellent weight loss was achieved during follow-up. CONCLUSIONS Laparoscopic sleeve gastrectomy (LSG) as a primary treatment modality for the older morbidly obese is an effective and relatively safe procedure in terms of weight loss and remission of comorbidities with an acceptable low complication rate.
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Affiliation(s)
- P W J van Rutte
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
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32
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van Rutte PWJ, Luyer MDP, de Hingh IHJT, Nienhuijs SW. To Sleeve or NOT to Sleeve in Bariatric Surgery? ISRN SURGERY 2012; 2012:674042. [PMID: 22957275 PMCID: PMC3431119 DOI: 10.5402/2012/674042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 08/01/2012] [Indexed: 12/19/2022]
Abstract
Morbid obesity has become a global epidemic during the 20th century. Until now bariatric surgery is the only effective treatment for this disease leading to sustained weight loss and improvement of comorbidities. The sleeve gastrectomy is becoming a promising alternative for the gold standard the gastric bypass and it is gaining popularity as a stand-alone procedure. The effect of the laparoscopic sleeve gastrectomy is based on a restrictive mechanism, but a hormonal effect also seems to play an important role. Similar results are achieved in terms of excess weight loss and resolution of comorbidities compared to the gastric bypass. Inadequate weight loss or weight regain can be treated by revisional surgery. Complication rates after LSG appear to be lower compared with gastric bypass. General guidelines recommend bariatric surgery between the age of 18 and 65. However bariatric surgery in the elderly seems safe with respect to weight loss and resolution of comorbidities. At the same time weight loss surgery is more often performed in adolescent patients failing weight loss attempts. Even though more studies are needed describing long-term effects, there is already enough evidence that this technique is an effective single procedure for a considerable proportion of obese patients.
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Affiliation(s)
- P W J van Rutte
- Department of Surgery, Catharina Hospital Eindhoven, 5602 ZA Eindhoven, The Netherlands
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Vanella S, Brisinda G, Marniga G, Crocco A, Bianco G, Maria G. Botulinum toxin for chronic anal fissure after biliopancreatic diversion for morbid obesity. World J Gastroenterol 2012; 18:1021-1027. [PMID: 22416176 PMCID: PMC3296975 DOI: 10.3748/wjg.v18.i10.1021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/05/2011] [Accepted: 01/22/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate. CONCLUSION Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.
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Affiliation(s)
- Serafino Vanella
- Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, 00168 Rome, Italy
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Patel PH, Slesser AA, Khalil A, Bassett O, Natarajan K, Livingstone JI. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report. J Med Case Rep 2012; 6:78. [PMID: 22397572 PMCID: PMC3379955 DOI: 10.1186/1752-1947-6-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 03/07/2012] [Indexed: 11/30/2022] Open
Abstract
Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.
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Affiliation(s)
- Pranav H Patel
- Department of General Surgery, Watford General Hospital, Vicarage Road, Watford, UK.
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35
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Ayloo SM, Buchs NC, Addeo P, Bianco FM, Giulianotti PC. Traditional versus single-site placement of adjustable gastric banding: a comparative study and cost analysis. Obes Surg 2012; 21:815-9. [PMID: 20809350 DOI: 10.1007/s11695-010-0259-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In bariatric surgery, laparoscopic adjustable gastric banding (LAGB) has proven effective in reducing weight and improving obesity-associated comorbidities. Recently, however, laparoendoscopic single-site (LESS) surgery has been proposed to minimize the invasiveness of laparoscopic surgery. The aim of this study is to compare the operative cost and peri-operative outcomes of these two approaches. We undertook a retrospective review of a prospectively maintained database of patients undergoing either LAGB or LESS between March 2006 and October 2009. The outcomes and cost of 25 LESS gastric bandings were compared to 121 standard LAGB. Costs included operative time, consumables, and laparoscopic tower depreciation. Both groups had similar patient demographics, body mass index, and comorbidities; with the exception of age (37 year for single site vs. 44 years for standard; P=0.002). There were no statistical differences for operative time (78 vs. 76 min, P=0.69), blood loss (8.4 vs. 9 ml, P=0.76), pain score (0.81 vs. 0.84 at 1 week, P=0.95) or complication rates (12% vs. 14%, P=1). Length of stay was shorter for the LESS group (0.5 day vs. 1.5 days, P=0.02). The mean operative cost for the LESS banding was $20,502/case vs. $20,346/case for the standard LAGB, with no statistically significant difference between the approaches (P=0.73). Operative costs and peri-operative outcomes of LESS gastric banding are comparable with those of the standard LAGB procedure. As a result, single-site surgery can be proposed as a valid alternative to the standard procedure with cosmetic advantage and comparable complication rate.
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Affiliation(s)
- Subhashini M Ayloo
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435 E, Chicago, IL 60612, USA.
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Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass. Obes Surg 2009; 19:1447-55. [PMID: 19655209 DOI: 10.1007/s11695-009-9927-2] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 07/10/2009] [Indexed: 01/07/2023]
Abstract
Bariatric surgery has emerged as an important tool in the fight against morbid obesity. However, reviewers have noted that there is a scarcity of long-term clinical surveillance data for bariatric surgery beyond 1-year follow-up and that a high percentage of patients are lost to follow-up, raising questions regarding the accuracy of current outcomes estimates. A meta-analysis of clinical reports providing bariatric surgery weight loss outcomes for morbidly obese patients was conducted over the period 2003-2007. Studies included were randomized controlled trials, nonrandomized controlled trials, and consecutive case series involving patients receiving either laparoscopic adjustable gastric banding (LAGB) or laparoscopic gastric bypass (LGB) surgery. Included studies involved n = 7,383 patients and were largely academic hospital-based (78.6%) and retrospective in design (71.4%). Weight loss outcome was defined by percent excess weight loss (%EWL). Composite estimates showed a significantly greater %EWL for LGB surgery (62.6%) compared to LAGB (49.4%). The superiority of LGB persisted at all three postsurgical time points examined (1, 2, and >3 years). Problems were identified regarding incomplete or suboptimal data reporting in many studies reviewed, and high patient attrition was evident at 2-year (49.8% LAGB, 75.2% LGB) and >3-year (82.6% LAGB, 89% LGB) end points. This meta-analysis confirms the superiority of LGB to LAGB in %EWL found in earlier studies. Although problems in study quality raised significant concerns regarding the validity of current weight loss estimates in this area, there was no evidence of publication bias.
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Carroll JF, Franks SF, Smith AB, Phelps DR. Visceral Adipose Tissue Loss and Insulin Resistance 6 Months after Laparoscopic Gastric Banding Surgery: A Preliminary Study. Obes Surg 2008; 19:47-55. [DOI: 10.1007/s11695-008-9642-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 07/11/2008] [Indexed: 02/07/2023]
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Bennett J, Rhodes M, Malcolm P, Dainty J, Simpson B, Johnson I, Boddy A, Wickham M, Williams S. Assessment of the relationship between post-meal satiety, gastric volume and gastric emptying after swedish adjustable gastric banding. A pilot study using magnetic resonance imaging to assess postsurgery gastric function. Obes Surg 2008; 19:757-63. [PMID: 18574644 DOI: 10.1007/s11695-008-9596-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 05/23/2008] [Indexed: 01/07/2023]
Abstract
BACKGROUND Swedish adjustable gastric banding (SAGB) is a common weight loss procedure performed worldwide. The exact mechanism by which it achieves appetite suppression, and hence weight loss, is not clear. One possible mechanism is altered meal handling by the post-SAGB stomach. METHODS Five post SAGB patients and five age/sex-matched controls were recruited. Pre- and post-meal magnetic resonance imaging (MRI) was performed with two liquid test meals of differing viscosity-locust bean gum (3.0%) and water. Appetite was assessed using ten-point visual analogue scales. RESULTS There were significant relationships between hunger scores and esophageal, pouch and residual stomach fluid volume changes for the locust bean gum meal (p=0.033, 0.043 and 0.011, respectively). The rate constants for gastric emptying were similar in the two groups for both the gum (0.038+/-0.016 min(-1) for SAGB, 0.041+/-0.032 min(-1) for controls, p=0.44) and water meals (0.068+/-0.044 min(-1) for SAGB, 0.044+/-0.009 min(-1) for controls, p=0.35). An unexpected finding was asymptomatic esophageal meal retention with the locust bean gum meal in the post-SAGB arm (mean 16.9 ml at 15 min). CONCLUSIONS There is no evidence of differences in volume-dependent gastric emptying between the normal and post-SAGB stomach. Further investigation of the phenomenon of esophageal retention, and its role in post-SAGB satiety, is warranted.
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Affiliation(s)
- John Bennett
- Department of Upper GI Surgery, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, NR4 7UY, Norwich, UK
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Massive upper gastrointestinal hemorrhage: an unusual presentation after laparoscopic adjustable gastric banding due to erosion into the celiac axis. Obes Surg 2008; 18:759-60. [PMID: 18392905 DOI: 10.1007/s11695-007-9359-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 09/29/2007] [Indexed: 01/07/2023]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is the most common bariatric surgical procedure done currently. It is the preferred choice as it is adjustable, minimally invasive, easily reversible, and does not cause metabolic complications. However, complications like slippage, leakage, erosion-causing perforation, pouch dilatation, pouch herniation, oesophageal dilatation/dysmotility, port disconnection, and migration of band have been reported. We report a rare case of LAGB who presented with life-threatening upper gastrointestinal hemorrhage due to erosion of band into celiac axis 4 months after the operation. An urgent laparotomy was necessary to control the hemorrhage from the celiac axis.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2008; 15:193-207. [PMID: 18316957 DOI: 10.1097/med.0b013e3282fba8b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Deron J Tessier
- Staff Surgeon, Kaiser Permanente Medical Center, Fontana, California, USA
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Elte JWF, Castro Cabezas M, Vrijland WW, Ruseler CH, Groen M, Mannaerts GHH. Proposal for a multidisciplinary approach to the patient with morbid obesity: the St. Franciscus Hospital morbid obesity program. Eur J Intern Med 2008; 19:92-8. [PMID: 18249303 DOI: 10.1016/j.ejim.2007.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 06/12/2007] [Accepted: 06/28/2007] [Indexed: 01/07/2023]
Abstract
Morbid obesity is a serious disease as it is accompanied by substantial co-morbidity and mortality. The prevalence is increasing to an alarming extent, in Europe as well as in the United States. In the past few decades, bariatric surgery has developed and gained importance. It currently represents the only long-lasting therapy for this group of patients, resulting in an efficient reduction in body weight and obesity-related medical conditions, mostly cardiovascular in nature. The importance of a standardized protocol, the use of selection criteria, and a multidisciplinary approach have been stressed but not yet described in detail. Therefore, in this article, the multidisciplinary approach and the treatment protocol that have been applied in our hospital for more than 20 years are set out in a detailed manner. The application of a strict protocol may help to select and follow-up motivated patients and to organize multidisciplinary research activities.
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Affiliation(s)
- J W F Elte
- Department of Internal Medicine, Center for Diabetes and Cardiovascular Risk Management, St. Franciscus Gasthuis, Rotterdam, The Netherlands.
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Vujovic A, Keoghane S. Management of renal stone disease in obese patients. ACTA ACUST UNITED AC 2008; 4:671-6. [PMID: 18059347 DOI: 10.1038/ncpuro0988] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 10/02/2007] [Indexed: 01/07/2023]
Abstract
Obesity represents an increasing burden to health care resources. Nephrolithiasis is associated with obesity and type 2 diabetes and the consumption of diets rich in protein, fat and carbohydrates; this article addresses some of the pathophysiological mechanisms associated with stone formation in these patients. Management of stone disease can be more difficult in obese patients; even diagnosis can be problematic because imaging techniques are less sensitive in these patients. Treatment with extracorporeal shockwave lithotripsy and surgery in obese patients can be challenging, and outcome data for the different treatments are discussed in this Review.
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