Optimizing bariatric surgery outcomes: a novel preoperative protocol in a bariatric population with gastroesophageal reflux disease.

BACKGROUND: The Roux-en-Y gastric bypass (RYGB) isuery ID="Q1" Text="Author:Kindly check the edit made in the article title." -->the most efficacious procedure of choice for obese patients with gastroesophageal reflux disease (GERD). The laparoscopic sleeve gastrectomy (LSG) has high rates of worsening GERD post operatively. Little evidence exists as to whether the use of objective foregut investigations has a meaningful impact on surgical procedure selection. This study examined whether a standard preoperative foregut evaluation protocol effected procedure selection in bariatric patients presenting for surgical evaluation with subjective symptoms of GERD. METHODS: Patients presenting for bariatric surgery evaluation with subjective symptoms of GERD entered into a predetermined protocol of foregut evaluation. Patients initially underwent upper endoscopy and esophagram. If the patient desired a LSG, further testing with esophageal pH testing and high-resolution manometry was ordered. If significant pathology was discovered on any of these investigations RYGB was recommended, if investigations were normal LSG was felt to be permissible. Data were collected prospectively from July 2016 to December 2018 and reviewed. RESULTS: One hundred and thirty-three patients were identified as being eligible to have progressed through the protocol. Pathology was commonly discovered on preoperative evaluations. On EGD Barrett's esophagus was discovered in 4%, grade C or D esophagitis in 18% and hiatal hernia in 36% of patients. On esophagram, hiatal hernia was discovered in 42.3% of patients. Abnormal esophageal motility was discovered in 41% and abnormal DeMeester scores in 83% of tested patients. Of the 133 patients evaluated, the final procedure the patient ultimately underwent was primarily determined based on protocol test results in 24.8% of cases. CONCLUSIONS: Foregut pathology is common in bariatric patients with subjective symptoms of GERD. Implementing a comprehensive protocol to objectively assess these patients leads to a significant clinical impact on which procedure these patients ultimately undergo.

A Comparison of the Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Body Mass Composition as Measured by Air Displacement Plethysmography.

BACKGROUND: The laparoscopic sleeve gastrectomy (LSG) is now the most commonly performed bariatric surgery in the world. Multiple studies have demonstrated the equivalence between the LSG and Roux-en-Y gastric bypass (RYGB) with regard to weight loss and comorbidity resolution. Few studies have examined the differences in body mass composition change between the two procedures. METHODS: Sixty-three patients undergoing either LSG or RYGB underwent calculation of total body mass, ideal body mass, lean mass, and fat mass by air displacement plethysmography (BodPodtm) prior to surgery and at 12 months postoperatively. Calculations of excess body weight, % excess weight loss, change in % fat mass, and change in % lean mass were then performed at each time interval. RESULTS: Thirty-three patients underwent LSG and 30 patients underwent RYGB. Mean percent excess weight loss in the LSG and RYGB group was 47.2% and 53.4% respectively (p = 0.165, 95% CI - 14.8-2.6). Mean percent change in fat mass for the LSG group and RYGB group was 9.2% and 10.51% respectively (p = 0.249, 95% CI - 0.86-3.2). Mean percent change in lean mass for the LSG group and RYGB group was 9.4% and 10.49% respectively (p = 0.383, 95% CI 2.85-1.13). CONCLUSION: The LSG and RYGB both impart dramatic meaningful loss in excess body weight. In addition, both the LSG and RYGB impart dramatic reductions in fat mass. However, both procedures induce loss of lean mass and there appears to be no difference between the two procedures in this regard despite their anatomic and physiologic differences.

Differential Octopaminergic Modulation of Olfactory Receptor Neuron Responses to Sex Pheromones in Heliothis virescens.

Octopamine is an important neuromodulator of neural function in invertebrates. Octopamine increases male moth sensitivity to female sex pheromones, however, relatively little is known as to the role of octopamine in the female olfactory system, nor its possible effects on the reception of non-pheromone odorants. The purpose of this study was to determine relative effects of octopamine on the sensitivity of the peripheral olfactory system in male and female Heliothis virescens. Single sensillum recording was conducted in both sexes following injection with octopamine or Ringer solution, and during odorant stimulation with conspecific female sex pheromone or host plant volatiles. Results indicate that octopamine plays a significant modulatory role in female sex pheromone detection in female moths; and that male and female pheromone detection neurons share distinct pharmacological and physiological similarities in H. virescens despite sexual dimorphism at the antennal level.