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1.
Rev Gastroenterol Peru ; 44(1): 52-62, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-38734912

RESUMO

Obesity has become a growing global epidemic, demanding effective solutions for its management. Bariatric-metabolic surgery is currently the best therapeutic option for patients with morbid obesity and associated comorbidities. This review article addresses the importance of endoscopy in the preoperative and postoperative evaluation, as well as in the detection and management of complications associated with bariatric surgery.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Complicações Pós-Operatórias , Humanos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Endoscopia Gastrointestinal/métodos , Resultado do Tratamento
2.
Rev Gastroenterol Peru ; 44(1): 63-66, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38734913

RESUMO

After bariatric surgery one of the most common complications is dysphagia. The etiology of this disease has not been fully elucidated but it is known that it may be due to structural changes due to surgery. This case describes a 65-year-old female with early and severe onset of dysphagia following laparoscopic sleeve gastrectomy. The patient's final diagnosis was postobesity surgery esophageal dysfunction and laparoscopic proximal gastrectomy with esophagojejunal Roux-en-Y anastomosis was performed. Physicians should be aware of this condition in order to offer early diagnosis and treatment.


Assuntos
Gastrectomia , Laparoscopia , Humanos , Feminino , Idoso , Laparoscopia/efeitos adversos , Gastrectomia/efeitos adversos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/diagnóstico , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Índice de Gravidade de Doença
3.
Langenbecks Arch Surg ; 409(1): 156, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38730065

RESUMO

INTRODUCTION: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed techniques in bariatric surgery. The aim of this study is to compare two surgical procedures in terms of weight loss and the development of comorbidities such as type II diabetes mellitus T2D, arterial hypertension, sleep apnea (OSAS), and gastroesophageal reflux disease (GERD). METHODS: Data from the German Bariatric Surgery Registry (GBSR) from 2005 to 2021 were used. 1,392 RYGB and 1,132 SG primary surgery patients were included. Minimum age 18 years; five-year follow-up data available. Tests were performed with a 5% significance level. RESULTS: Loss of follow-up 95.41% within five years. Five years after surgery, the RYGB showed significant advantages in terms of excess weight loss (%EWL 64.2% vs. 56.9%) and remission rates of the studied comorbidities: hypertension (54.4% vs. 47.8%), OSAS (64.5% vs. 50.1%), and GERD (86.1% vs. 66.9%). Compared to the pre-test, individuals diagnosed with insulin-dependent T2D showed significant improvements with RYGB over a five-year period (remission rate: 75% vs. 63%). In contrast, non-insulin-dependent T2D showed no significant difference between the two approaches (p = 0.125). CONCLUSION: Both surgical procedures resulted in significant weight loss and improved comorbidities. However, the improvement in comorbidities was significantly greater in patients who underwent RYGB than in those who underwent SG, suggesting that the RYGB technique is preferable. Nevertheless, RYGB requires a high degree of surgical skill. Therefore, acquiring expertise in the technical facets of the surgery is essential to achieving favorable outcomes.


Assuntos
Gastrectomia , Derivação Gástrica , Obesidade Mórbida , Redução de Peso , Humanos , Obesidade Mórbida/cirurgia , Masculino , Derivação Gástrica/métodos , Derivação Gástrica/efeitos adversos , Gastrectomia/métodos , Gastrectomia/efeitos adversos , Feminino , Adulto , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/cirurgia , Diabetes Mellitus Tipo 2/complicações , Resultado do Tratamento , Sistema de Registros , Alemanha , Estudos Retrospectivos
4.
BMJ Open ; 14(5): e080257, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38692726

RESUMO

OBJECTIVES: The objective is to develop a pragmatic framework, based on value-based healthcare principles, to monitor health outcomes per unit costs on an institutional level. Subsequently, we investigated the association between health outcomes and healthcare utilisation costs. DESIGN: This is a retrospective cohort study. SETTING: A teaching hospital in Rotterdam, The Netherlands. PARTICIPANTS: The study was performed in two use cases. The bariatric population contained 856 patients of which 639 were diagnosed with morbid obesity body mass index (BMI) <45 and 217 were diagnosed with morbid obesity BMI ≥45. The breast cancer population contained 663 patients of which 455 received a lumpectomy and 208 a mastectomy. PRIMARY AND SECONDARY OUTCOME MEASURES: The quality cost indicator (QCI) was the primary measures and was defined asQCI = (resulting outcome * 100)/average total costs (per thousand Euros)where average total costs entail all healthcare utilisation costs with regard to the treatment of the primary diagnosis and follow-up care. Resulting outcome is the number of patients achieving textbook outcome (passing all health outcome indicators) divided by the total number of patients included in the care path. RESULTS: The breast cancer and bariatric population had the highest resulting outcome values in 2020 Q4, 0.93 and 0.73, respectively. The average total costs of the bariatric population remained stable (avg, €8833.55, min €8494.32, max €9164.26). The breast cancer population showed higher variance in costs (avg, €12 735.31 min €12 188.83, max €13 695.58). QCI values of both populations showed similar variance (0.3 and 0.8). Failing health outcome indicators was significantly related to higher hospital-based costs of care in both populations (p <0.01). CONCLUSIONS: The QCI framework is effective for monitoring changes in average total costs and relevant health outcomes on an institutional level. Health outcomes are associated with hospital-based costs of care.


Assuntos
Neoplasias da Mama , Hospitais de Ensino , Obesidade Mórbida , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Mama/economia , Neoplasias da Mama/cirurgia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitais de Ensino/economia , Mastectomia/economia , Países Baixos , Obesidade Mórbida/economia , Obesidade Mórbida/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Cuidados de Saúde Baseados em Valores
5.
J Med Invest ; 71(1.2): 187-190, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38735720

RESUMO

We report a case of retroperitoneal laparoscopic radical nephrectomy (LRN) in which the addition of a hand port was necessary and effective. A 52-year-old man with obesity (BMI 40.6 kg/m2) was diagnosed with a 52-mm left renal cell carcinoma (cT1bN0M0). To avoid thick subcutaneous and visceral fat in the abdomen, we selected LRN using a retroperitoneal approach with four ports in the kidney position. During surgery, a large amount of flank pad and perirenal fat prevented us from securing a sufficient surgical field through traction of the kidney with a retractor. A pure laparoscopic procedure was not feasible;therefore, we added a hand port. Subsequently, we removed the flank pad from the hand port and secured the surgical field by tracing the kidney manually. Finally, hand-assisted LRN was completed without an open conversion. In retroperitoneal LRN, we rarely encounter patients for whom a pure laparoscopic procedure is not feasible because of the large amount of flank pad or perirenal fat. It is important to preoperatively confirm not only the BMI but also the amount of flank pad and perirenal fat on imaging. Hand-assisted LRN via the retroperitoneal approach can be safely performed even in extremely obese patients. J. Med. Invest. 71 : 187-190, February, 2024.


Assuntos
Carcinoma de Células Renais , Laparoscopia Assistida com a Mão , Neoplasias Renais , Nefrectomia , Humanos , Masculino , Nefrectomia/métodos , Pessoa de Meia-Idade , Neoplasias Renais/cirurgia , Espaço Retroperitoneal/cirurgia , Carcinoma de Células Renais/cirurgia , Laparoscopia Assistida com a Mão/métodos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Laparoscopia/métodos
6.
BMJ Open ; 14(5): e078853, 2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38719323

RESUMO

INTRODUCTION: By implementation of Enhanced Recovery After Bariatric Surgery protocols and day-care surgery, early discharge poses a challenge if excessive bleeding occurs after bariatric surgery. Tranexamic acid (TXA) has demonstrated efficacy in other surgical fields and in bariatric pilot studies. This trial aims to assess the efficacy of peroperative administration of TXA in reducing haemorrhage in patients undergoing gastric bypass surgery. METHOD AND ANALYSIS: This is a multicentre, phase III, double-blind randomised controlled trial in six high-volume bariatric centres in the Netherlands. A total of 1524 eligible patients, aged 18 years or older, undergoing primary gastric bypass surgery (either Roux-en-Y gastric bypass or one-anastomosis gastric bypass) will be randomised between TXA and placebo (1:1, variable block, stratified for centre, day-care/overnight stay and type of surgery) after obtaining informed consent (2.5% less haemorrhage, power 80%, 2-sided-α 0.05 and 10% dropout). Exclusion criteria are pregnancy, amedical history of acute bleeding (without cause), venous thrombotic events (VTEs), epilepsy, anticoagulant use and iatrogenic bleeding during surgery (aside from staple line). The primary outcome is postoperative haemorrhage requiring intervention within 30 days postoperatively. Secondary outcome measures are staple line reinforcement, blood loss, duration of surgery, postoperative haemoglobin, vital parameters, minor and major complications, side effects of TXA (nausea, hypotension and VTE), length of hospital stay and directly made costs. ETHICS AND DISSEMINATION: Written informed consent will be obtained from all participants. The protocol has been approved by the Medical Research Ethics Committees United, Nieuwegein, on 7 February 2023 (registration number: R22.102). Results will be disseminated through peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER: NCT05464394.


Assuntos
Antifibrinolíticos , Derivação Gástrica , Obesidade Mórbida , Ácido Tranexâmico , Humanos , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/uso terapêutico , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/uso terapêutico , Método Duplo-Cego , Hemorragia Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Feminino , Estudos Multicêntricos como Assunto , Adulto , Países Baixos , Ensaios Clínicos Fase III como Assunto , Masculino
7.
Langenbecks Arch Surg ; 409(1): 163, 2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38775865

RESUMO

PURPOSE: Although bariatric surgery is an effective intervention for obesity, it comes with risks such as early postoperative bleeding (EPB). Identifying preoperative risk factors for this complication can help patients' risk stratification and optimization. We performed a systematic review and meta-analysis to find predictors for early postoperative bleeding after Roux-en-Y gastric bypass (RYGB). METHODS: We conducted a systematic review, searching PubMed, Cochrane Library, and Web of Science until November 2023. We performed a random-effects meta-analysis to explore preoperative risk factors associated with early postoperative bleeding after RYGB. Sources of heterogeneity were explored by leave-one-out analyses. RESULTS: 23 studies were included, comprising 232,488 patients. Male gender (meta-analytical RR = 1.42, 95%CI = 1.21-1.66, I2 = 18%, Q Cochran test p-value = 0.29) and revisional surgery (meta-analytical RR = 1.35, 95%CI = 1.12-1.62, I2 = 22%, Q Cochran test p = 0.21) were associated with higher risk of EPB. On average, patients with EPB were older than the remainder (MD for the mean age = 2.82 years, 95%CI = 0.97-4.67, I2 = 0.00%, Q Cochran test p = 0.46). Except for hypertension (meta-analytical RR = 1.33, 95%CI = 1.02-1.73, I2 = 66%, Q Cochran test p < 0.0001), comorbidities were not associated with a higher risk of EPB. CONCLUSION: Preoperative risk factors, including age, gender, hypertension, and revisional bariatric surgery, are associated with early postoperative bleeding after RYGB. Further primary studies, with higher methodological quality, are required to detail more risk factors.


Assuntos
Derivação Gástrica , Hemorragia Pós-Operatória , Humanos , Derivação Gástrica/efeitos adversos , Fatores de Risco , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/epidemiologia , Obesidade Mórbida/cirurgia , Medição de Risco
8.
Langenbecks Arch Surg ; 409(1): 162, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38771517

RESUMO

PURPOSE: The laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the standard procedures in metabolic surgery. Different limb lengths have been proposed in the past to maximize weight loss (WL) and reduce metabolic complications. Distal gastric bypass surgery with a very short common channel (CC) (up to 100 cm) has been often criticized due to frequent side effects such as malnutrition, bone weakening and short-bowel syndrome. We introduced a modified version of a distal LRYGB with a 50-70 cm long biliopancreatic limb (BPL) and an intermediate short CC (120-150 cm). Our primary goal was to compare the long-term WL between distal and proximal LRYGB in two cohorts of patients. Secondary outcomes were weight regain (WR), insufficient weight loss (IWL), postoperative complications and metabolic changes 5 years after surgery. METHODS: In this retrospective study we collected data from 160 patients operated between 2014 and 2015, with a BMI of 37-44 Kg/m2. 101 patients underwent a distal and 59 patients a proximal LRYGB in two bariatric centers. WL was calculated as percent of excess of BMI loss (%EBMIL), loss of body mass index (Delta-BMI), percent of excess weight loss (%EWL) and percent of total weight loss (%TWL). Data were collected 3, 6, 9, 12, 24, 48 and 60 months after surgery. RESULTS: The distal LRYGB resulted in significantly better 5-year-WL compared to the proximal bypass in terms of %EBMIL (median at 5 years: 83% vs. 65%, p = 0.001), %TWL (median at 5 years: 32% vs. 26%, p = 0.017) and %EWL (median at 5 years: 65% vs. 51%, p = 0.029), with equal major complications and metabolic alterations. In addition, WR was significantly lower in patients with distal bypass (18% vs. 35%, p = 0.032). CONCLUSIONS: Distal LYRGB with a 120-150 long CC results in better WL and WL-maintenance compared to proximal LRYGB without major side effects after five years.


Assuntos
Índice de Massa Corporal , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Redução de Peso , Humanos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Resultado do Tratamento , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia
9.
PLoS One ; 19(5): e0302099, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38748634

RESUMO

Recent national trends in the United States indicate a significant increase in childhood obesity, a major public health concern with documented physical and mental comorbidities and sociodemographic disparities. We aimed to estimate the prevalence of obesity and severe obesity among youth in New York City (NYC) before the COVID-19 pandemic and examine time trends overall and by key characteristics. We included all valid height and weight measurements of kindergarten through 8th grade public school students aged 5 to 15 from school years 2011-12 through 2019-20 (N = 1,370,890 unique students; 5,254,058 observations). Obesity and severe obesity were determined using age- and sex-specific body mass index percentiles based on the Centers for Disease Control and Prevention growth charts. Analyses were performed using multivariate logistic regression models with repeated cross-sectional observations weighted to represent the student population for each year and clustered by student and school. Among youth attending public elementary and middle schools in NYC, we estimate that 20.9% and 6.4% had obesity and severe obesity, respectively, in 2019-20. While consistent declines in prevalence were observed overall from 2011-12 to 2019-20 (2.8% relative decrease in obesity and 0.2% in severe obesity, p<0.001), increasing trends were observed among Black, Hispanic, and foreign-born students, suggesting widening disparities. Extending previous work reporting prevalence estimates in this population, nearly all groups experienced significant increases in obesity and severe obesity from 2016-17 to 2019-20 (relative change = 3.5% and 6.7%, respectively, overall; p<0.001). Yet, some of the largest increases in obesity were observed among those already bearing the greatest burden, such as Black and Hispanic students and youth living in poverty. These findings highlight the need for greater implementation of equity-centered obesity prevention efforts. Future research should consider the influence of the COVID-19 pandemic and changes in clinical guidance on childhood obesity and severe obesity in NYC.


Assuntos
COVID-19 , Obesidade Infantil , Instituições Acadêmicas , Humanos , Cidade de Nova Iorque/epidemiologia , Masculino , Criança , Feminino , Adolescente , Prevalência , Obesidade Infantil/epidemiologia , COVID-19/epidemiologia , Pré-Escolar , Obesidade Mórbida/epidemiologia , Estudantes/estatística & dados numéricos , Estudos Transversais , Índice de Massa Corporal , Disparidades nos Níveis de Saúde
10.
N Z Med J ; 137(1594): 43-53, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38696831

RESUMO

AIM: Bariatric surgery is an effective tool for weight loss and for improving weight related co-morbidities. Changes in medication usage after a silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) are unknown. METHODS: This was a single-centre, double-blind, randomised controlled trial. Patients were randomised to either SR-LRYGB or LSG. A medication history was obtained at regular follow-up intervals, and mean numbers of prescribed medications were analysed over 5 years. Poisson regression and generalised estimating equations were used to test for statistically significant changes in usage. RESULTS: After eight patients were lost to follow-up, data from 52 patients in each group were available for analysis. There was no difference between the SR-LRYGB or LSG groups in the number of medications prescribed, with the exception of oral glucose-lowering medications, where there was a greater decrease after SR-LRYGB compared to LSG (79% vs 55% respectively) from baseline to 5 years. At 5 years, total medication prescribed was down 10% from pre-operative levels. Prescribed insulin decreased by 72%, and cardiovascular medication decreased by 56% compared to baseline. Prescriptions for analgesia increased by 50%, psychiatric medications by 133% and proton-pump inhibitors by 81%. CONCLUSION: Both SR-LRYGB and LSG reduced requirement for diabetic and cardiovascular medications, but increased requirement for nutritional supplementation, analgesia and psychiatric medications. There was a greater reduction in oral anti-diabetic medication prescriptions following SR-LRYGB compared to LSG, but no other difference in medication usage between surgical groups was found.


Assuntos
Diabetes Mellitus Tipo 2 , Gastrectomia , Derivação Gástrica , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/cirurgia , Derivação Gástrica/métodos , Feminino , Masculino , Gastrectomia/métodos , Método Duplo-Cego , Pessoa de Meia-Idade , Adulto , Obesidade Mórbida/cirurgia , Hipoglicemiantes/uso terapêutico , Redução de Peso , Laparoscopia/métodos , Resultado do Tratamento
11.
Diab Vasc Dis Res ; 21(3): 14791641241252553, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38702054

RESUMO

OBJECTIVE: To evaluate the association between GGT/HDL-C ratio and resolution of MetS in adults after sleeve gastrectomy (SG). METHODS: We conducted a retrospective cohort study using secondary data from a Peruvian bariatric center. The study population consisted of adults aged 18 and above who underwent laparoscopic SG and were diagnosed with MetS prior to the surgery. The main outcome measured was MetS resolution 6 months post-surgery and the exposure variable was the GGT/HDL-C ratio. RESULTS: We analyzed 137 patients with a mean age of 38.9 ± 10.9 years; 64.2% were females. The median GGT/HDL-C ratio was 1.1 [0.7 - 1.5], and 83.9% of patients experienced resolution of MetS. Furthermore, both the middle tertile of GGT/HDL-C (aRR: 1.28; 95% CI: 1.04 - 1.58; p = .019) and the lowest tertile (aRR: 1.27; 95% CI: 1.01 - 1.60; p = .038) showed a significant association with the resolution of MetS. CONCLUSION: Eight out of 10 patients undergoing SG experience resolution of MetS within 6 months after surgery. Patients in the middle and lower tertiles of the GGT/HDL-C were more likely to achieve this outcome. Therefore, the GGT/HDL-C ratio should be considered a valuable and efficient biomarker for preoperative assessment of bariatric surgery candidates.


Assuntos
Biomarcadores , HDL-Colesterol , Gastrectomia , Síndrome Metabólica , gama-Glutamiltransferase , Humanos , Feminino , Adulto , Masculino , Estudos Retrospectivos , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Biomarcadores/sangue , HDL-Colesterol/sangue , Resultado do Tratamento , gama-Glutamiltransferase/sangue , Fatores de Tempo , Gastrectomia/efeitos adversos , Peru , Valor Preditivo dos Testes , Obesidade Mórbida/cirurgia , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Indução de Remissão , Redução de Peso , Laparoscopia/efeitos adversos , Fatores de Risco , Cirurgia Bariátrica/efeitos adversos
12.
Langenbecks Arch Surg ; 409(1): 151, 2024 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-38703235

RESUMO

INTRODUCTION: Suboptimal weight loss or weight regain may occur after Roux-en-Y gastric bypass (RYGB). For this reason, revisional surgery has gained increasing interest. We aimed to compare the percentage of total body weight loss (%TBWL) at one-year follow-up among three different techniques: Jejuno-jejunostomy distalization (JJD), Sleeve resection of the gastrojejunostomy and gastric pouch (SRGJP), and the combination of both (JJD + SRGJP). METHODS: This retrospective cohort study included all patients who underwent revisional surgery after RYGB (2020-2021). The cohort was stratified by the type of revisional technique performed. Postoperative bariatric outcomes and nutritional deficiencies were compared among groups. RESULTS: A total of 78 patients underwent revisional surgery after RYGB: JJD was performed in 8 (10.3%), SRGJP in 34 (43.6%), and JJD + SRGJP in 36 (46.1%) patients. The most common indication for surgery was weight regain, in 72 (92.3%) patients. The median lengths of the BP limbs before and after distalization, were 50 cm (IQR 40-75 cm) and 175 cm (IQR 150-200 cm), respectively. The median length of the new common limb (NCL) and total alimentary limb length (TALL) were 277 cm (IQR 250-313 cm) and 400 cm (IQR 375-475 cm), respectively. Median percentage of total body weight loss (%TBWL) at one year was 15% (IQR 15-19%) for JJD, 20% (IQR 13-26%) for SRGJP, and 21% (IQR 15- 28%) for JJD + SRGJP (p = 0.40). CONCLUSIONS: In this study, the combined procedure (JJD + SRGJP) exhibited higher %TBWL at one year, however no statistically significant difference was identified among the three techniques.


Assuntos
Derivação Gástrica , Obesidade Mórbida , Reoperação , Redução de Peso , Humanos , Derivação Gástrica/métodos , Feminino , Masculino , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Estudos de Coortes
13.
J Gastrointest Surg ; 28(5): 621-633, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38704199

RESUMO

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide, whereas one-anastomosis gastric bypass (OAGB) is the third most performed procedure. Both procedures have reported good weight loss (WL) and low complications. However, should both have differences in the durability of WL and malnutrition? METHODS: A single-blinded, randomized controlled trial of 300 patients was conducted to compare the outcomes of LSG and OAGB over a 5-year follow-up. The primary endpoint was WL in percentages of total WL (%TWL) and excess WL (%EWL). The secondary endpoints were complications, gastroesophageal reflux disease (GERD), associated medical problems, bariatric analysis and reporting outcome system (BAROS) assessment, and weight recurrence (WR). RESULTS: Overall, 201 patients (96 in the LSG group and 105 in the OAGB group) completed 5 years of follow-up. OAGB had significantly higher %TWL and %EWL than those of LSG throughout the follow-up. LSG had significantly higher WR and GERD. Both procedures had significant improvement in associated medical problems and BAROS scores compared with baseline, with no significant difference. WR was associated with higher relapse of associated medical conditions after initial remission and with lower BAROS scores regarding WL scores. CONCLUSION: OAGB had significantly higher WL, less WR, and less GERD. However, it had a higher incidence of bile reflux. Both procedures had comparable complication rates, excellent remissions in associated medical problems, and improved quality of life. WR was associated with significantly more relapse of associated medical problems and significantly lower BAROS scores.


Assuntos
Gastrectomia , Derivação Gástrica , Refluxo Gastroesofágico , Laparoscopia , Obesidade Mórbida , Redução de Peso , Humanos , Feminino , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Masculino , Gastrectomia/métodos , Gastrectomia/efeitos adversos , Método Simples-Cego , Adulto , Seguimentos , Derivação Gástrica/métodos , Derivação Gástrica/efeitos adversos , Pessoa de Meia-Idade , Refluxo Gastroesofágico/cirurgia , Refluxo Gastroesofágico/etiologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/efeitos adversos , Recidiva
14.
J Gastrointest Surg ; 28(5): 640-650, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38704201

RESUMO

BACKGROUND: Single-anastomosis metabolic/bariatric surgery procedures may lessen the incidence of anastomotic complications. This study aimed to evaluate the feasibility and safety of performing side-to-side duodenoileal (DI) bipartition using magnetic compression anastomosis (MCA). In addition, preliminary efficacy, quality of life (QoL), and distribution of food through the DI bipartition were evaluated. METHODS: Patients with a body mass index (BMI) of ≥35.0 to 50.0 kg/m2 underwent side-to-side DI bipartition with the magnet anastomosis system (MS) with sleeve gastrectomy (SG). By endoscopic positioning, a distal magnet (250 cm proximal to the ileocecal valve) and a proximal magnet (first part of the duodenum) were aligned with laparoscopic assistance to inaugurate MCA. An isotopic study assessed transit through the bipartition. RESULTS: Between March 14, 2022 to June 1, 2022, 10 patients (BMI of 44.2 ± 1.3 kg/m2) underwent side-to-side MS DI. In 9 of 10 patients, an SG was performed concurrently. The median operative time was 161.0 minutes (IQR, 108.0-236.0), and the median hospital stay was 3 days (IQR, 2-40). Paired magnets were expelled at a median of 43 days (IQR, 21-87). There was no device-related serious advanced event within 1 year. All anastomoses were patent with satisfactory diameters after magnet expulsion and at 1 year. Respective BMI, BMI reduction, and total weight loss were 28.9 ± 1.8 kg/m2, 15.2 ± 1.8 kg/m2, and 34.2% ± 4.1%, respectively. Of note, 70.0% of patients reported that they were very satisfied. The isotopic study found a median of 19.0% of the meal transited through the ileal loop. CONCLUSION: Side-to-side MCA DI bipartition with SG in adults with class II to III obesity was feasible, safe, and efficient with good QoL at 1-year follow-up. Moreover, 19% of ingested food passed directly into the ileum.


Assuntos
Anastomose Cirúrgica , Duodeno , Estudos de Viabilidade , Gastrectomia , Imãs , Humanos , Gastrectomia/métodos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Duodeno/cirurgia , Anastomose Cirúrgica/métodos , Seguimentos , Obesidade Mórbida/cirurgia , Íleo/cirurgia , Qualidade de Vida , Laparoscopia/métodos , Índice de Massa Corporal , Duração da Cirurgia , Cirurgia Bariátrica/métodos , Resultado do Tratamento , Trânsito Gastrointestinal
17.
BMC Surg ; 24(1): 156, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38755612

RESUMO

PURPOSE: Hypoalbuminemia and anemia are commonly observed indications for one anastomosis gastric bypass (OAGB) reversal and remain significant concerns following the procedure. Sufficient common channel limb length (CCLL) is crucial to minimize nutritional complications. However, limited literature exists regarding the impact of CCLL on OAGB outcomes. This study aimed to assess the effect of CCLL on weight loss and nutritional status in patients who underwent OAGB. METHODS: A prospective cohort study was conducted from August 2021 to July 2022, involving 64 patients with a body mass index of 40-50 kg/m2. The standardized length of the biliopancreatic limb (BPLL) for all patients in this study was set at 175 cm. Additionally, the measurement of the common channel limb length (CCLL) was performed consistently by the same surgeon for all included patients. RESULTS: The mean age and BMI of the patients were 39.91 ± 10.03 years and 43.13 ± 2.43 kg/m2, respectively, at the time of surgery. There was a statistically significant negative correlation between CCLL and percent total weight loss (%TWL) at the 12-month mark after OAGB (P = 0.02). Hypoalbuminemia was observed in one patient (1.6%), while anemia was present in 17 patients (26.6%) at the one-year follow-up. Statistical analysis revealed no significant difference in the incidence of anemia and hypoalbuminemia between patients with CCLL < 4 m and those with CCLL ≥ 4 m. CONCLUSION: A CCLL of 4 m does not appear to completely prevent nutritional complications following OAGB. However, maintaining a CCLL of at least 4 m may be associated with a reduced risk of postoperative nutritional deficiencies.


Assuntos
Derivação Gástrica , Desnutrição , Complicações Pós-Operatórias , Humanos , Derivação Gástrica/métodos , Derivação Gástrica/efeitos adversos , Feminino , Masculino , Desnutrição/prevenção & controle , Desnutrição/etiologia , Estudos Prospectivos , Adulto , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Pessoa de Meia-Idade , Redução de Peso , Obesidade Mórbida/cirurgia , Hipoalbuminemia/etiologia , Anemia/prevenção & controle , Anemia/etiologia , Estado Nutricional , Índice de Massa Corporal , Anastomose Cirúrgica/métodos
18.
PLoS One ; 19(5): e0303569, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38743756

RESUMO

There is a phenotype of obese individuals termed metabolically healthy obese that present a reduced cardiometabolic risk. This phenotype offers a valuable model for investigating the mechanisms connecting obesity and metabolic alterations such as Type 2 Diabetes Mellitus (T2DM). Previously, in an untargeted metabolomics analysis in a cohort of morbidly obese women, we observed a different lipid metabolite pattern between metabolically healthy morbid obese individuals and those with associated T2DM. To validate these findings, we have performed a complementary study of lipidomics. In this study, we assessed a liquid chromatography coupled to a mass spectrometer untargeted lipidomic analysis on serum samples from 209 women, 73 normal-weight women (control group) and 136 morbid obese women. From those, 65 metabolically healthy morbid obese and 71 with associated T2DM. In this work, we find elevated levels of ceramides, sphingomyelins, diacyl and triacylglycerols, fatty acids, and phosphoethanolamines in morbid obese vs normal weight. Conversely, decreased levels of acylcarnitines, bile acids, lyso-phosphatidylcholines, phosphatidylcholines (PC), phosphatidylinositols, and phosphoethanolamine PE (O-38:4) were noted. Furthermore, comparing morbid obese women with T2DM vs metabolically healthy MO, a distinct lipid profile emerged, featuring increased levels of metabolites: deoxycholic acid, diacylglycerol DG (36:2), triacylglycerols, phosphatidylcholines, phosphoethanolamines, phosphatidylinositols, and lyso-phosphatidylinositol LPI (16:0). To conclude, analysing both comparatives, we observed decreased levels of deoxycholic acid, PC (34:3), and PE (O-38:4) in morbid obese women vs normal-weight. Conversely, we found elevated levels of these lipids in morbid obese women with T2DM vs metabolically healthy MO. These profiles of metabolites could be explored for the research as potential markers of metabolic risk of T2DM in morbid obese women.


Assuntos
Diabetes Mellitus Tipo 2 , Lipidômica , Obesidade Mórbida , Humanos , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Obesidade Mórbida/sangue , Obesidade Mórbida/metabolismo , Obesidade Mórbida/complicações , Lipidômica/métodos , Pessoa de Meia-Idade , Adulto , Lipídeos/sangue , Metabolômica/métodos , Estudos de Casos e Controles , Triglicerídeos/sangue , Esfingomielinas/sangue , Esfingomielinas/metabolismo , Ceramidas/sangue , Ceramidas/metabolismo , Metabolismo dos Lipídeos
19.
Pol Przegl Chir ; 96(3): 1-5, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38721640

RESUMO

<b><br>Introduction:</b> It is already known that bariatric surgery can improve the health and quality of life of morbidly obese patients of all ages. Our population is getting older. That is why the number of bariatric surgeries among obese people over 65 years of age is systematically increasing.</br> <b><br>Aims:</b> The study aims to analyze the management of patients over 65 years of age in Polish bariatric centers.</br> <b><br>Material and methods:</b> The study was conducted on representatives from the 30 largest bariatric departments in Poland. By collecting surveys, we aimed to analyze changes in qualifications for surgery and care for elderly patients.</br> <b><br>Results:</b> 13 of 30 (43.3%) representatives responded to the survey. The remaining centers did not qualify patients over 65 years old for the surgical treatment of obesity. The mean percentage of patients over 65 who underwent bariatric surgery was 2.75. Most representatives (69.2%) chose SG as the procedure of choice in patients over 65 years of age. According to 84.6% of surgeons, age did not matter when qualifying patients over 65 years of age for BS. The majority of surgeons (53.8%) believed that bariatric surgery in older patients was comparable to the one in younger patients. Nine (69.2%) surgeons believed that there should be no age limit for bariatric surgery.</br> <b><br>Conclusions:</b> Only almost half of the bariatric centers in Poland perform operations on patients over 65 years of age. Most Polish surgeons claim that operations on older and on younger patients have comparable benefits, and that there is no need for age limit.</br>.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Humanos , Polônia , Cirurgia Bariátrica/estatística & dados numéricos , Cirurgia Bariátrica/tendências , Masculino , Idoso , Feminino , Obesidade Mórbida/cirurgia , Qualidade de Vida
20.
Eat Weight Disord ; 29(1): 34, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38714632

RESUMO

PURPOSE: Bariatric surgery (BS), an effective treatment for severe obesity and its comorbidities, may result in micronutrient and vitamin deficiencies. This monocentric prospective observational study aimed at evaluating the efficacy of a specifically designed vitamin/mineral formula (Bariatrifast, BIOITALIA S.r.l., Italy) for preventing and treating micronutrient deficiencies in patients submitted to BS. METHODS: Twenty patients with severe obesity (mean weight and BMI: 123.5 kg (range 88-174) and 43.3 kg/m2 (range 37-54) respectively) underwent BS (10 vertical sleeve gastrectomy VSG, 10 Roux-en-Y gastric bypass, RYGB). The mean age was 49.9 years (range 27-68). After a presurgical visit (V0), follow-up visits were performed at 1, 3, 6 and 12 months after surgery (V1-V4). Recorded data included weight, height and BMI. A complete blood count, measurement of ferritin, folic acid, vitamin B12, ionized calcium, 25 OH vitamin D, parathyroid hormone (PTH) were obtained. Following BS, patients started the daily oral multivitamin and mineral supplement. RESULTS: All patients achieved a significant weight loss (mean - 34.7 ± 11.8 kg). No deficiencies of various vitamins/micronutrients were detected during the entire study period. The serum concentrations of vitamin B12, 25-OH Vitamin D and folic acid increased over the follow-up period compared with V0 (mean increase 243 ng/L, 23 µg /L, 8 µg/L, respectively). Compared to RYGB, patients who underwent sleeve gastrectomy showed higher levels of 25-OH vitamin D at V2, V3 and V4 (all p < 0.05), and higher levels of Vitamin B12 and folic acid at V4 (p < 0.05 and p < 0.005, respectively). No adverse events were reported. CONCLUSION: Following VSG or RYGB, Bariatrifast administration was associated with normal values of essential micronutrients, and it was well-tolerated without evidence of gastrointestinal side effects. Clinical Trial Registration ClinicalTrials.gov, identifiers NCT06152965.


Assuntos
Cirurgia Bariátrica , Vitaminas , Humanos , Pessoa de Meia-Idade , Feminino , Adulto , Masculino , Vitaminas/uso terapêutico , Vitaminas/administração & dosagem , Estudos Prospectivos , Idoso , Resultado do Tratamento , Obesidade Mórbida/cirurgia , Suplementos Nutricionais , Redução de Peso , Micronutrientes/administração & dosagem , Micronutrientes/uso terapêutico
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