Nutritional and behavioral factors related to weight gain after bariatric surgery.

BACKGROUND: Weight regain (WR) after bariatric surgery is common. Several factors involved in WR have been identified, but there has been little research on specific eating habits such as eating snacks rather than regular meals and being a "sweet-eater". AIM: To determine whether nutritional status, energy and macronutrient intake, eating behaviors and habits were associated with WR in the postoperative period. MATERIAL AND METHODS: We conducted a case-control study of patients who had undergone bariatric surgery. Cases were defined as those patients who gained ≥ 15% of weight in the first two years after surgery and controls as those who gained < 15% of weight. Participants completed a 24-hour dietary recall by phone; weight history was obtained from the medical chart. Logistic regression was used to identify nutritional and behavioral factors significantly related to WR. RESULTS: Fifty-four cases (77% female, 57% had undergone sleeve gastrectomy) and 50 controls (70% female, 58% had undergone Roux-en-Y gastric bypass surgery) participated. Their mean age was 43 and 40 years, respectively. We observed four eating and lifestyle habits independently associated with greater odds of post-surgery WR, namely being a "sweet-eater", a "grazer", sedentarism and consuming more daily calories. CONCLUSIONS: Eating more daily calories, being a "sweet-eater", a "grazer", and sedentarism were factors related with a greater risk of regaining weight after surgery.

Nutritional and behavioral factors related to weight gain after bariatric surgery

ABSTRACT Background: Weight regain (WR) after bariatric surgery is common. Several factors involved in WR have been identified, but there has been little research on specific eating habits such as eating snacks rather than regular meals and being a "sweet-eater". Aim: To determine whether nutritional status, energy and macronutrient intake, eating behaviors and habits were associated with WR in the postoperative period. Material and Methods: We conducted a case-control study of patients who had undergone bariatric surgery. Cases were defined as those patients who gained ≥ 15% of weight in the first two years after surgery and controls as those who gained < 15% of weight. Participants completed a 24-hour dietary recall by phone; weight history was obtained from the medical chart. Logistic regression was used to identify nutritional and behavioral factors significantly related to WR. Results: Fifty-four cases (77% female, 57% had undergone sleeve gastrectomy) and 50 controls (70% female, 58% had undergone Roux-en-Y gastric bypass surgery) participated. Their mean age was 43 and 40 years, respectively. We observed four eating and lifestyle habits independently associated with greater odds of post-surgery WR, namely being a "sweet-eater", a "grazer", sedentarism and consuming more daily calories. Conclusions: Eating more daily calories, being a "sweet-eater", a "grazer", and sedentarism were factors related with a greater risk of regaining weight after surgery.

Antecedentes: La ganancia de peso después de la cirugía bariátrica es común. Se han identificado varios factores involucrados en la recuperación de peso, pero existe poca evidencia sobre hábitos alimentarios específicos tales como el patrón picoteador o ser un comedor de dulces. Objetivo: Determinar si el estado nutricional, ingesta calórica y de macronutrientes, patrones de ingesta alimentaria, y conducta alimentaria estuvieron asociados con la recuperación de peso en el período postoperatorio en pacientes de cirugía bariátrica. Material y Métodos: Estudio de casos y controles de pacientes sometidos a cirugía bariatrica. Los casos fueron definidos como aquellos pacientes que aumentaron ≥ 15% de peso en los dos años siguientes a la cirugía, y los controles fueron aquellos que no tuvieron ganancia de peso. Los participantes respondieron telefónicamente un recordatorio de ingesta. El historial de peso se obtuvo de la ficha clínica. Se utilizó una regresión logística para identificar factores nutricionales y de comportamiento relacionados significativamente con la recuperación de peso. Resultados: Participaron 54 casos (77% mujeres; 58% sometidos a manga gástrica) y 50 controles (70 % mujeres; 58% sometidos a baipás gástrico). La edad promedio de ellos fue 43 y 40 años, respectivamente. Se observó cuatro hábitos alimentarios y de estilo de vida asociados independientemente con mayores probabilidades de ganancia de peso postcirugía: comedor de dulces, picoteador, sedentarismo y mayor ingesta calórica diaria. Conclusiones: Una mayor ingesta energética diaria, el consumo de dulces, los picoteos y el sedentarismo se relacionan con una mayor probabilidad de ganancia de peso en el postoperatorio de cirugía bariátrica.

Mammography correlates to better survival rates in breast cancer patients: a 20-year experience in a University health institution.

Breast cancer (BC) is the most common malignancy in women. We retrieved medical records from >2,000 Chilean BC patients over the 1997-2018 period. The objective was to assess changes in clinical presentation or prognosis of our patients throughout these 20 years of practice. Although most variables did not display significant variations, we observed a progressive increase in stage IV BC over this period. Our data showed that tumour stage III/IV or HER2-enriched subtype tumours were associated with poorer prognosis. In contrast, we found that patients diagnosed by mammography had better overall survival. We speculate that better screenings and more sensitive imaging could explain the unexpected rise in stage IV cases. Our results support mammography screenings as an effective measure to reduce BC-related mortality.

Breast lesions with atypia in percutaneous biopsies, managed with surgery in the last 10 years.

INTRODUCTION: The optimal management of breast lesions with atypia (BLA), detected in percutaneous biopsies after screening mammograms, is a controversial issue. The aim of this paper is to compare histological diagnosis by percutaneous biopsy with the results of the surgical biopsy of these lesions and to analyse the changes to clinical approach this would imply. METHOD: A retrospective study was carried out on patients operated on between June 2007 and June 2017 with a diagnosis of BLA. One hundred and forty-seven patients were identified with a pre-operative diagnosis of flat epithelial atypia (FEA), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, lobular carcinoma in situ and other atypia. RESULTS: The average age at diagnosis of BLAs was 52 ± 9.4 years. Radiologically, the lesions presented as microcalcifications in 79%, nodules in 15.6% and other lesions 5.4%. 73.5% of these were biopsied by means of digital stereotaxis. All of the patients analysed underwent a partial mastectomy. Changes in a biologically high-risk lesion were observed in 26.5% of the surgical specimens, of which 75.5% corresponded with ADH and FEA. In the percutaneous biopsies consistent with ADH (40.1%), ductal carcinoma was discovered in 6.8% (5.1% in situ and 1.7% invasive), which implied specific, multi-disciplinary management. Of the FEAs, 84.8% required a second treatment (surgery and/or hormone therapy ± radiotherapy, depending on whether it concerned FEA 59.6%, ADH 21.2% or ductal carcinoma in situ 3.8%). CONCLUSION: These data show the clinical relevance in the diagnosis of ADH and FEA in percutaneous biopsies. For the diagnosis of FEA in particular, the associated risk of biologically high-risk lesions and ductal carcinoma is made evident.

Surgical treatment in oligometastatic breast cancer.

Metastatic breast cancer (MBC) management is based on systemic treatment (ST), while the local therapy role remains controversial. We present the case of a 36-year-old woman with a diagnosis of hormone receptor-positive and human epidermal growth factor receptor type 2-positive breast cancer and isolated sternal metastasis, who received neoadjuvant ST with complete remission and later primary tumour surgery. Oligometastatic patients are a subgroup of MBC that can benefit from aggressive local therapies, even with curative intent.

El ejercicio físico disminuye la pérdida de masa magra en pacientes obesos sometidos a cirugía bariátrica / Exercise reduces lean mass loss in obese patients undergoing bariatric surgery

Objetivo: Caracterizar el efecto de un programa de ejercicio físico en la pérdida de masa magra en pacientes obesos mórbidos durante el primer año después de la cirugía bariátrica. Pacientes y métodos: Estudio de cohorte no concurrente de pacientes obesos mórbidos sometidos a bypass gástrico en Y de Roux (BPGYR) o gastrectomía en manga (GM) que contaran con medición de su composición corporal antes y a los 3, 6 y 12 meses después de la cirugía. Los pacientes se clasificaron como ejercicio físico (+) o ejercicio físico (−) según realizaran o no un programa de ejercicio físico supervisado durante el primer año después de la cirugía. Resultados: Se identificaron 35 pacientes obesos mórbidos sometidos a BPGYR o GM. Veinte (57%) pacientes fueron ejercicio físico (+) y 15 (43%) ejercicio físico (−). Los promedios de edad e IMC preoperatorio en ejercicio físico (+) y ejercicio físico (−) fueron de 33,5 ± 8,9 y 43,3 ± 12,4 años (p < 0,05), y 40,4 ± 7,1 y 35,8 ± 5 kg/m² (p < 0,05), respectivamente. No hubo diferencias en composición corporal entre ambos grupos. Un año después de la cirugía, la pérdida de masa magra en pacientes ejercicio físico (+) y ejercicio físico (−) representó un 17,9 ± 4,1% y 30,1 ± 4,5% del total de la pérdida de peso, respectivamente (p < 0,05). Conclusiones: Estos resultados sugieren que la estimulación muscular mediante ejercicio físico regular logra disminuir la pérdida de masa magra observada después de la cirugía bariátrica, mejorando así la composición corporal de los pacientes.

Objective: We sought to characterize the effect of a physical exercise program on fat free mass loss in morbidly-obese patients one year after bariatric surgery. Patients and methods: Retrospective cohort study of a group of patients who underwent Roux-en-Y gastric bypass (RYGB) or Sleeve Gastrectomy (SG) and had body composition analysis before and at 3, 6 and 12 months after surgery. Identified patients were further classified as physical exercise (+) or physical exercise (−) based on whether they followed or not a physical exercise program during the first year after surgery. Results: We identified 35 morbidly obese patients who underwent RYGB or SG. 20 (57%) patients were physical exercise (+) and 15 (43%) patients were physical exercise (−). Mean age and preoperative BMI in physical exercise (+) and physical exercise (−) patients was 33.5 ± 8.9 and 43.3 ± 12.4 years (P < .05), and 40.4 ± 7.1 and 35.8 ± 5 kg/m² (P < .05), respectively. There were no differences in body composition between both groups. One year after surgery, fat free mass loss in physical exercise (+) and physical exercise (−) patients represented 17.9 ± 4.1% and 30.1 ± 4.5% of total weight loss, respectively (P < .05). Conclusions: The results of this study suggest that muscle stimulation through physical exercise can decrease the lean body mass loss induced by surgery, thus improving body composition outcomes after surgery.

Bariatric surgery in 1119 patients with preoperative body mass index<35 (kg/m(2)): results at 1 year.

BACKGROUND: The use of body mass index (BMI) as the only criterion to indicate bariatric surgery is currently under discussion. There is growing evidence that supports bariatric surgery in carefully selected patients with lower BMI. OBJECTIVES: To report our experience in bariatric surgery in>1000 patients with BMI<35 kg/m(2) and their results at 1 year. SETTING: University hospital (censored). METHODS: A retrospective analysis was performed in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG) with preoperative BMI<35 kg/m(2) from January 2008 to December 2011. Demographic and anthropometric data, preoperative co-morbidities, and perioperative variables were retrieved. Weight loss and co-morbidities progression were analyzed 1 year after surgery and compared among procedures. A P value<.05 was considered significant. RESULTS: We identified 1119 patients: mean age 38.8±11.4, 951 (85%) women, preoperative weight 87.5±9.3 kg and BMI 33.1 (31.9-34.1) kg/m(2). Preoperatively, 11.7% had type 2 diabetes mellitus, 25.9% arterial hypertension, 55.6% insulin resistance, and 53.2% dyslipidemia. In total, 283 patients (25.2%) underwent LRYGB and 836 (74.8%) SG. One year after surgery (follow-up: 66.67%) patients reached 24.5 (22.8-26.4) BMI and the percentage of excess of weight loss (%EWL) was 107.9±36.6%. Diabetes, hypertension, insulin resistance, and dyslipidemia remission/improvement rates were 54/39%, 58/29%, 72/17%, and 54/30%, respectively. CONCLUSIONS: Bariatric surgery in selected class I obesity patients can safely be performed. We have observed good results in terms of weight loss and co-morbidity improvement/remission. Long-term follow-up is required.

Effect of Early Use of Covered Self-Expandable Endoscopic Stent on the Treatment of Postoperative Stapler Line Leaks.

BACKGROUND: Postoperative leaks are a dreaded complication after bariatric surgery (BS). Its treatment is based on nutritional support and sepsis control by antibiotics, collections drainage and/or prosthesis, and/or surgery. OBJECTIVES: The aim of this study is to report our experience with coated self-expandable endoscopic stents (SEES) for leaks treatment. SETTING: This study was performed in a University Hospital, (censored). METHODS: We performed a retrospective analysis of our BS database from January 2007 to December 2013. All patients with leak after BS treated with SEES were included. RESULTS: We identified 29 patients; 17 (59%) were women, with median age of 37 (19-65) years, and preoperative body mass index of 40 (28.7-56-6) kg/m(2). Nineteen (65.5%) patients had a sleeve gastrectomy and 10 (34.5%) a Roux-en-Y gastric bypass. All patients had a leak in the stapler line. Median time from surgery to leak diagnosis was 7 (1-51) days, and SEES were installed 8 (0-104) days after diagnosis. Twenty-one (72%) patients also had abdominal exploration. Median length of SEES use was 60 (1-299) days. Patients who had SEES as primary treatment (with or without simultaneous reoperation) had a shorter leak closure time (50 [6-112] vs 109 [60-352] days; p = 0.008). Twenty-eight (96.5%) patients successfully achieved leak closure with SEES. There were 16 migrations in 10 (34%) patients, 1 (3%) stent fracture, 1 opening of the blind end of alimentary limb (3%), and 5 patients (17%) required a second stent due to leak persistence. CONCLUSIONS: SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.

Laparoscopic hand-sewn revisional gastrojejunal plication for weight loss failure after Roux-en-Y gastric bypass.

BACKGROUND: Revisional surgery has become a widely accepted alternative for weight loss failure/regain after bariatric surgery. However, it is associated to higher morbi-mortality and lesser weight loss than primary bariatric procedure. Our aims are to present a novel technique for weight loss treatment after failed laparoscopic Roux-en-Y gastric bypass (LRYGB) and to report its short-term results. METHODS: This is a retrospective analysis of patients submitted to a revisional hand-sewn double-layer gastrojejunal plication (GJP) for treatment of weight loss failure/regain after LRYGB. Analysis of demographics, body mass index (BMI), and percentage of excess weight loss (%EWL) at the 6th month complications, and financial costs involved was included. RESULTS: Four patients were submitted to revisional GJP. Three patients were female and the mean age at revision was 30 ± 9 years (21-44). The median time interval between LRYGB and GJP was 51 months (24-120). The median BMI at the moment of GJP and the 3rd and 6th month was 35.6 kg/m2 (32.0-37.8), 32.2 kg/m2 (29.7-34.1), and 30.7 kg/m2 (28.1-32.1), respectively. The median %EWL at the 3rd and 6th month was 35.4% (13.6-38.9) and 46.2 % (45.1-55.5), respectively, reaching a cumulative (combined surgeries) %EWL of 62.9% (16.5-67.9) and 71.7% (65.1-77.6), respectively. There were no complications or mortality. Financial costs were significantly lower compared to revisional gastrojejunal stapled reduction (US $1400 cheaper). CONCLUSION: Revisional GJP is a feasible, safe, and cost-effective novel procedure for treatment of weight loss failure/regain after LRYGB. Mid- and long-term results are necessary in order to establish its real effectiveness.