[Analysis of the effects of different nutritional support methods on postoperative recovery in patients with gastric cancer].

Objective: To assess the effects of different nutritional support methods on postoperative recovery in patients with gastric cancer. Methods: 98 patients who received radical gastrectomy were divided into three groups: parenteral nutrition group (PN group) (n=36), early enteral nutrition group (EEN group) (n=33) and early oral feeding group (EON group) (n=29). Tolerance of enteral nutrition, postoperative recovery and economic indicators were compared. Results: The number of laparoscopic-assisted surgeries was 18, 17 and 25 in PN group, EEN group and EON group, respectively. There was no significant difference in sex, age and body mass index(BMI) among the three groups. Gastrointestinal function recovered slowly in 3 cases, including 2 cases in EEN group and 1 case in EON group. 1 case in EON group had abdominal hemorrhage. Median postoperative hospital stay in PN, EEN and EON group was 11.0, 11.0 and 8.0 days respectively, and significant reduction can be found in EON group(P<0.001). The complication rates were 30.5% (11 cases), 12.1% (4 cases), and 13.8% (4 cases), respectively, with no statistically significant difference(P=0.102). The median nutritional support costs for PN group, EEN group, and EON group were 4 543.3, 974.2, and 265.0 yuan, respectively. The median albumin consumption was 90.0, 40.0, and 0 g, respectively. The EON groups were significantly lower (P<0.001). The results of the laparoscopic assisted subgroup and the ones of whole group were consistent. Conclusion: Compared with parenteral nutrition and early enteral nutrition, early oral feeding can reduce the amount of albumin consumption, decrease the cost of nutrition support and shorten the average hospital stay after surgey without increasing the incidence of complications.

Enhanced recovery after surgery in gastric resections. / Rehabilitación multimodal en la cirugía de resección gástrica.

INTRODUCTION: Enhanced recovery after surgery is a modality of perioperative management with the purpose of improving results and providing a faster recovery of patients. This kind of protocol has been applied frequently in colorectal surgery, presenting less available experience and evidence in gastric surgery. METHODS: According to the RICA guidelines published in 2015, a review of the bibliography and the consensus established in a multidisciplinary meeting in Zaragoza on the 9th of October 2015, we present a protocol that contains the basic procedures of fast-track for resective gastric surgery. RESULTS: The measures to be applied are divided in a preoperative, perioperative and postoperative stage. This document provides recommendations concerning the appropriate information, limited fasting and administration of carbohydrate drinks 2hours before surgery, specialized anesthetic strategies, minimal invasive surgery, no routine use of drainages and tubes, mobilization and early oral tolerance during the immediate postoperative period, as well as criteria for discharge. CONCLUSIONS: The application of a protocol of enhanced recovery after surgery in resective gastric surgery can improve and accelerate the functional recovery of our patients, requiring an appropriate multidisciplinary coordination, the evaluation of obtained results with the application of these measures and the investigation of controversial topics about which we currently have limited evidence.

Effectiveness of postoperative elemental diet (Elental®) in elderly patients after gastrectomy.

BACKGROUND: We aimed to investigate the efficacy of postoperative early intervention with an elemental diet to reduce weight loss and enhance recovery after gastrectomy. Nutritional status and gastrointestinal immune function tend to worsen, and postoperative weight loss is inevitable in these patients; therefore, improvement in their postoperative condition is important, especially in gastric cancer patients aged ≥80 years. METHODS: Clinical outcomes and postoperative nutritional status were compared between 21 and 22 consecutive elderly patients aged ≥80 years who underwent distal gastrectomy before and after the introduction of postoperative oral elemental diet (Elental®, 300 kcal/day), respectively, between October 2011 and June 2016. RESULTS: A significant reduction in postoperative complications was noted in the nutrition support group (N-group) as compared with the control group (C-group). In particular, the prevalence of systemic complications was significantly lower in the N-group (33.3 vs. 4.5 %, p = 0.015), whereas no significant difference was observed in the prevalence of locoregional complications. The percentage of weight loss and reduction in BMI from 1 month to 1 year after surgery was significantly lower in the N-group (p = 0.012 each). The nutrition status (albumin, total protein, hemoglobin, and C-reactive protein levels) at 1 month after surgery showed improvements (p = 0.005, p = 0.048), and hospital stay was decreased in the N-group as compared to the C-group (16.0 vs. 12.5 days, p = 0.041). CONCLUSIONS: Early intervention with an elemental diet after distal gastrectomy is valuable for reducing perioperative weight loss and improving nutritional management and may be associated with enhanced postoperative recovery in elderly patients.

[Delayed coloesophagoplasty in difficult clinical situations].

AIM: To improve immediate and long-term results of delayed coloesophagoplasty in cancer patients. MATERIAL AND METHODS: We presented three case reports of coloesophagoplasty in difficult clinical situations including technical impossibility of primary plasty, extraordinary anesthetic situation, transplant necrosis after primary plasty. RESULTS: Gastrointestinal tract integrity was restored in all cases and patients returned to nutrition per os, that provided good quality of life and compensated nutritional deficiencies. Only one patient had bleeding in postoperative period that required relaparotomy. There were no postoperative complications in two other patients. CONCLUSION: Delayed coloesophagoplasty should be performed in all patients who underwent esophagogastrectomy if progression of primary disease is absent. Graft placement and colic segment are chosen individually. However left half of colon with retrosternal location of transplant is preferable for plasty.

[Possibilities of laparoscopic gastric resection for gastrointestinal stromal tumors].

Possibilities of laparoscopic technologies application while surgical excision of gas- trointestinal stromal tumors (GIST) were analyzed. In 2000 - 2015 yrs in the clinic 28 patients were operated on for gastric GIST. In 10 of them laparoscopic gastric resec- tion with tumor (in 3 - the tumor excision in borders of nonaffected tissues, in 4 - gas- tric fundus resection or stapler resection of a great curvature together with tumor, in 3 - transgastric excision of the tumor, using staplers) surgery was done. The disease recurrence in 2-5 yrs follow-up was absent. Laparoscopic operations has advantage over open interventions while preserving oncological radicalism.

"Fast track" rehabilitation after gastric cancer resection: experience with 80 consecutive cases.

BACKGROUND: To evaluate the safety, efficacy and outcomes of fast-track rehabilitation applied to gastric cancer proximal, distal and total gastrectomy. METHODS: Eighty consecutive patients undergoing gastric cancer resection performed by a single surgeon, received perioperative multimodal rehabilitation. Demographic and operative data, gastrointestinal function, postoperative hospital stays, surgical and general complications and mortality were assessed prospectively. RESULTS: Of the 80 patients (mean age 56.3 years), 10 (12.5%) received proximal subtotal gastrectomy (Billroth I), 38 (47.5%) received distal (Billroth II), and 32 (40%) received total gastrectomy (Roux-en-Y). Mean operative time was 104.9 minutes and intraoperative blood loss was 281.9 ml. Time to first flatus was 2.8 ± 0.5 postoperative days. Patients were discharged at a mean of 5.3 ± 2.2 postoperative days; 30-day readmission rate was 3.8%. In-hospital mortality was 0%; general and surgical complications were both 5%. CONCLUSIONS: Fast-track multimodal rehabilitation is feasible and safe in patients undergoing gastric cancer resection and may reduce time to first flatus and postoperative hospital stays.

Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study.

BACKGROUND: Laparoscopy-assisted distal gastrectomy (LADG) is generally considered superior to open distal gastrectomy (ODG) with regard to postoperative quality-of-life. Differences in postoperative pain may exist due to recent pain control techniques including epidural anesthesia. There is little evidence for this difference. In this article we report the results of our randomized single-blind study in LADG versus ODG. The aim of the present study was to evaluate differences in postoperative physical activity between LADG and ODG. METHODS: Forty patients with early gastric cancer (stage IA and IB) were registered in this randomized study. For strict evaluation, patients were not told about the type of operation until postoperative day 7. Postoperative physical activity was evaluated objectively by Active Tracer, which records the cumulative acceleration over a 24 h period to investigate differences in postoperative recovery. Questionnaire and visual analog scale score related to postoperative pain were also investigated. RESULTS: Significant differences were observed with a more favorable outcome noted in the LADG group with respect to intraoperative blood loss (P < 0.001), total amount of pain rescue (P < 0.001), wound size (P < 0.001), postoperative hospital stay (P < 0.001), and inflammatory parameters (C-reactive protein, SaO2, and duration of febrile period) (P < 0.001). Cumulative physical recovery to 70 % of the preoperative level was significantly shorter (by 3 days, P < 0.001) in the LADG group. CONCLUSIONS: Comparison of LADG and ODG for patients with early gastric cancer showed favorable outcome and earlier recovery of physical activity in the LADG group.

High preoperative depression, phobic anxiety, and binge eating scores and low medium-term weight loss in sleeve gastrectomy obese patients: a preliminary cohort study.

OBJECTIVE: Although depression, anxiety, and binge eating are prevalent in candidates for bariatric surgery, their impact on weight loss is unknown following sleeve gastrectomy. This study assesses the associations between weight loss and preoperative depression, anxiety, and binge eating scores in patients undergoing sleeve gastrectomy for morbid obesity. METHOD: This cohort study included 34 patients who underwent sleeve gastrectomy for morbid obesity between May 2006 and February 2010 in a French tertiary referral center. We assessed preoperative depression (using the Beck depression inventory and the SCL-90-R depression subscale), anxiety (using the Hamilton anxiety rating scale and the SCL-90-R anxiety subscales), and binge eating (using the bulimic investigatory test, Edinburgh). The primary outcome was the percentage of excess weight loss at 12 months (PEWL). RESULTS: The preoperative mean body mass index (BMI) was 55.3 kg/m2 ± 10.2 kg/m2 and 41.7 kg/m2 ± 8.7 kg/m2 at the 12-month follow-up visit. The mean PEWL was 46.8% ± 15.8%. After adjusting for the preoperative BMI, the PEWL was negatively associated with preoperative scores for depression (ß= -0.357; P < 0.05), phobic anxiety (ß = -0.340; P < 0.05), interpersonal sensitivity (ß = -0.328; P < 0.05), and binge eating (ß = -0.315; P = 0.05). Other forms of anxiety were not correlated with the PEWL. CONCLUSIONS: Higher preoperative depression, phobic anxiety, interpersonal sensitivity, and binge eating scores are associated with low postoperative weight loss in patients undergoing sleeve gastrectomy. Future studies should assess the preoperative prevalence of syndromal or subsyndromal atypical depression and its relationship to postoperative weight loss in bariatric surgery candidates.

Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial.

BACKGROUND: Fast-track surgery has been shown to enhance postoperative recovery in several surgical fields. This study aimed to evaluate the safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy. METHODS: The present study was designed as a single-center, randomized, unblinded, parallel-group trial. Patients were eligible if they had gastric cancer for which laparoscopic distal gastrectomy was indicated. The fast-track surgery protocol included intensive preoperative education, a short duration of fasting, a preoperative carbohydrate load, early postoperative ambulation, early feeding, and sufficient pain control using local anesthetics perfused via a local anesthesia pump device, with limited use of opioids. The primary endpoint was the duration of possible and actual postoperative hospital stay. RESULTS: We randomized 47 patients into a fast-track group (n=22) and a conventional pathway group (n=22), with three patients withdrawn. The possible and actual postoperative hospital stays were shorter in the fast-track group than in the conventional group (4.68±0.65 vs. 7.05±0.65; P<0.001 and 5.36±1.46 vs. 7.95±1.98; P<0.001). The time to first flatus and pain intensity were not different between groups; however, a greater frequency of additional pain control was needed in the conventional group (3.64±3.66 vs. 1.64±1.33; P=0.023). The fast-track group was superior to the conventional group in several factors of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, including: fatigue, appetite loss, financial problems, and anxiety. The complication and readmission rates were similar between groups. CONCLUSIONS: Fast-track surgery could enhance postoperative recovery, improve immediate postoperative quality of life, and be safely applied in laparoscopic distal gastrectomy.

Changes in fasting bile acid profiles after Roux-en-Y gastric bypass and sleeve gastrectomy.

BACKGROUND: Bile acid is an essential factor that plays a role in metabolic regulation, but how bile acid is regulated after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) remains unclear. This meta-analysis aimed to investigate changes in the levels of fasting bile acids following RYGB and SG. METHODS: A systematic literature search of the PubMed, EMBASE, Cochrane Library and Web of Science databases through July 2020 was performed in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The concentrations of bile acids were evaluated. RESULTS: Thirteen studies with 289 patients were included. Our results showed that patients who underwent RYGB had increased levels of fasting total bile acids, primary bile acids, secondary bile acids, conjugated bile acids, and unconjugated bile acids, but no significant differences in all these bile acid levels were observed in patients who underwent SG. Furthermore, 12a-hydroxylated bile acid levels and the 12a-hydroxylated/non-12a-hydroxylated bile acid ratio also increased following RYGB. CONCLUSION: In this study, we found that fasting bile acid levels, especially 12a-hydroxylated bile acids levels, were increased after RYGB. However, no differences in fasting bile acid levels were observed following SG.

Effects of preoperative oral single-dose and double-dose carbohydrates on insulin resistance in patients undergoing gastrectomy:a prospective randomized controlled trial.

BACKGROUND & AIMS: Preoperative oral carbohydrates are strongly recommended for routine use before various elective procedures. The regimen mainly includes preoperative oral single-dose carbohydrate (2-3 h before surgery) and preoperative oral double-dose carbohydrates (10 h before surgery and 2-3 h before surgery). The choice between the two options is still controversial. METHODS: A total of 139 patients with gastric cancer who underwent radical gastrectomy were recruited from a hospital in Sichuan Province, China. The patients were randomly assigned to a single-dose group (n = 70) or a double-dose group (n = 69). Insulin resistance indicators, subjective comfort indicators, inflammatory mediators, immunological indicators, postoperative recovery indexes, and complications were compared between the two groups. RESULTS: There were no differences in insulin resistance indicators (fasting plasma glucose, fasting insulin, and homeostasis model assessment indexes), inflammatory mediators (C-reactive protein, interleukin-6, and tumor necrosis factor-α), immunological indicators (CD3+, CD4+, CD8+, and CD4+/CD8+) between the single-dose group and double-dose group (all P > 0.05) at preoperative day 1, preoperative 3 h, and postoperative day 1. There were no differences in subjective comfort indicators (thirst, hunger, anxiety, nausea, fatigue, and weakness) between the two groups (all P > 0.05) at preoperative day 1, preoperative 3 h, preoperative 1 h, and postoperative day 1. The postoperative recovery indexes and complications (exhaust time, liquid intake time, postoperative hospital stay, complication incidence, unplanned readmission rate, and unplanned reoperation rate 30 days after operation) did not significantly differ between the two groups (all P > 0.05). The number of preoperative nighttime urinations in the double-dose group was higher than that in the single-dose group (88.3% VS 48.5%, P < 0.001), and the number of hours of preoperative sleep in the double-dose group was lower than that in the single-dose group (4.56 ± 0.68 VS 5.71 ± 0.57, P < 0.001). CONCLUSION: Oral carbohydrates administered the night before surgery did not enhance the effects of oral carbohydrates administered 2-3 h before surgery on insulin resistance, subjective comfort, inflammation, and immunity and might affect the patients' night rest. In making a decision between oral carbohydrate regimes, evening carbohydrates could be omitted. TRIAL REGISTRATION: ChiCTR, ChiCTR1900020608. Registered January 10, 2019, http://www.chictr.org.cn: ChiCTR1900020608.

Personalized trimodal prehabilitation for gastrectomy.

BACKGROUND: Surgery is the only potentially curative treatment for gastric cancer, however, it bears a high postoperative morbidity and mortality rate. A recent randomized control trial proposed prehabilitation to reduce the postoperative morbidity in patients undergoing major abdominal surgery. Currently, there is a lack of evidence of using prehabilitation for patients undergoing gastrectomy for gastric cancer. The aim of our study is to demonstrate that home-based prehabilitation can reduce postoperative morbidity after gastrectomy for gastric cancer. METHODS: PREFOG is a multi-center, open-label randomized control trial comparing 90-days postoperative morbidity rate after gastrectomy for gastric cancer between patients with or without prehabilitation. One-hundred twenty-eight patients will be randomized into an intervention or control group. The intervention arm will receive trimodal home-based prehabilitation including nutritional, psychological and exercise interventions. Secondary outcomes of the study will include physical and nutritional status, anxiety and depression level, quality of life, postoperative mortality rates and full completion of the oncological treatment as determined by the multidisciplinary tumor board. DISCUSSION: PREFOG study will show if home-based trimodal prehabilitation is effective to reduce postoperative morbidity after gastrectomy for gastric cancer. Moreover, this study will allow us to determine whether prehabilitation can improve physical fitness and activity levels, nutritional status and quality of life as well as reducing anxiety and depression levels after gastrectomy for gastric cancer. TRIAL REGISTRATION: ClinicalTrials.gov NCT04223401 (First posted: 10 January 2020).

Tolerability of early oral nutrition and factors predicting early oral nutrition failure after gastrectomy.

BACKGROUND & AIMS: Many studies have suggested the feasibility and safety of early oral nutrition after gastrectomy; however, the tolerability of early oral nutrition has rarely been investigated. This study aimed to investigate the tolerability of early oral nutrition and factors affecting early oral nutrition failure after gastrectomy. METHODS: We retrospectively reviewed 565 patients with gastric cancer who had undergone gastrectomy and who had received oral nutrition on postoperative day 1. Failure of early oral nutrition was defined as cessation of at least one meal for any reason. Preoperative clinical information and operative factors were analyzed concerning an association with early oral nutrition failure. RESULTS: The tolerability of early oral nutrition after gastrectomy was 74.7%. Of 565 patients, 72 (12.7%) failed early oral nutrition due to adverse gastrointestinal symptoms, 52 (9.2%) failed due to gastric stasis or ileus, and 19 (3.4%) patients failed due to other postoperative complications. In the univariate analysis, age (≥70 years), male sex, preoperative tumor obstruction, remnant stomach cancer, open surgery, operating time (≥4 h), and an advanced preoperative stage were associated with failed early oral nutrition. Multivariable analysis of these factors revealed that male sex, preoperative tumor obstruction, operating time, and advanced preoperative stage were independent predictive factors for early oral nutrition failure after gastrectomy. CONCLUSIONS: The tolerability of early oral nutrition after gastrectomy was comparable to that of other gastrointestinal surgeries. A tailored approach for postoperative oral nutrition is required based on identified risk factors for early oral nutrition failure.

Lipoprotein(a) Change After Sleeve Gastrectomy Is Affected by the Presence of Metabolic Syndrome.

BACKGROUND: Patients with metabolic syndrome (MetS) are at high risk of developing cardiovascular disease (CVD) and lipoprotein(a) (Lp(a)) is an independent risk factor for CVD. This study aimed to determine the effect of vertical sleeve gastrectomy (VSG)-induced weight loss on Lp(a) levels in obese individuals. METHODS: Patients submitted to VSG from January 2011 to July 2015 were included. Anthropometric and metabolic parameters were recorded before and 12 months after surgery. Univariate analysis identified associations between Lp(a) and anthropometry and metabolic parameters, and the logistic regression predictors of Lp(a) decrease after VSG. RESULTS: MetS was present in 47% of the 330 patients involved. Patients with MetS had higher body mass index (BMI) and triglyceride levels and were more insulin-resistant. No differences were found between groups respecting Lp(a) levels prior to surgery (15.2 mg/dL vs. 15.0 mg/dL, p = 0.795). After surgery, patients without MetS had a decrease in Lp(a) levels (14.7 mg/dL vs. 12.3 mg/dL, p = 0.006), while MetS patients showed no differences (13.9 mg/dL vs. 14.6 mg/dL, p = 0.302). The regression model evidenced that older age and Δ HDL-c were predictors of Lp(a) decrease, whereas the greater the number of MetS components and lower estimated BF% loss, the lesser odds of decreasing Lp(a) after surgery. CONCLUSIONS: Despite a global improvement of conventional CVD risk factors, only individuals without MetS showed a decrease of Lp(a) levels after VSG. Further studies should explore not only the pathophysiological mechanisms underlying the absence of decrease of Lp(a) levels in MetS patients, but also its impact on the metabolic beneficial changes usually observed after VSG.

Changes in Left Ventricular Mechanics After Sleeve Gastrectomy.

OBJECTIVE: The aim of this study was to examine echocardiographic parameters of left ventricle (LV) mechanics in obese patients before and after sleeve gastrectomy (SG). DESIGN AND METHODS: Twenty-five obese individuals submitted to laparoscopic SG were enrolled in this study. Echocardiography was performed before and after the procedure, and left ventricle mechanics were evaluated by speckle tracking imaging. RESULTS: Before surgery, altered global longitudinal strain (GLS) values were present in 56% of the patients. In a mean follow-up of 3.6 ± 0.5 months after surgery, there was an increase in GLS values (from 17.4 ± 3.2 to 19.3 ± 2.7%, P = 0.01). There was an inverse correlation between the absolute values of GLS in the preoperative period and the variation in the GLS at follow-up (r = 0.577, P = 0.002). Measurements of global circumferential strain (GCS), global radial strain (GRS), and LV twist were normal preoperatively and did not change after surgery. CONCLUSIONS: Altered global longitudinal strain values were common in young obese patients. Sleeve gastrectomy increased global longitudinal strain even in the early postoperative phase without promoting changes in global radial strain, global circumferential strain, and left ventricle twist measurements.

Impact of enhanced recovery after surgery on postoperative rehabilitation, inflammation, and immunity in gastric carcinoma patients: a randomized clinical trial.

We determined the effects of enhanced recovery after surgery (ERAS) in patients undergoing radical surgery for gastric carcinoma. Sixty patients undergoing radical gastrectomy for gastric carcinoma in Lishui Hospital between March and October 2016 were randomized to receive either ERAS (30 patients) or conventional care (30 patients, controls). Clinical, economic, and laboratory indices were analyzed. ERAS patients showed faster recovery and shorter postoperative hospital stays than the controls (P<0.05). Some clinical indices (i.e., time to first flatus and defecation, time to removal of drainage tubes, time to resumption of oral feeding, time to postoperative mobilization, and postoperative complications) were significantly better in ERAS patients than in controls. Duration of postoperative infusion was lower in ERAS patients than in controls (P<0.05). In ERAS patients, serum albumin and prealbumin were higher on postoperative day 7, C-reactive protein was lower on postoperative days 3 and 7, and neutrophil count was lower on postoperative day 3 compared to the values in controls (P<0.05 for all). IgM levels were higher in ERAS patients on postoperative days 3 and 7 (P<0.05), while IgG levels were higher on postoperative day 3 (P<0.05). Total T lymphocytes were higher in ERAS patients on postoperative day 3, while helper T cells and CD4+/CD8+ ratio were higher on postoperative days 3 and 7 (P<0.05 for all). In gastric carcinoma patients, ERAS may reduce perioperative inflammation, improve immunity and postoperative nutrition, shorten hospitalization, and enhance rehabilitation.

Prospective Longitudinal Trends in Body Composition and Clinical Outcomes 3 Years Following Sleeve Gastrectomy.

BACKGROUND AND AIMS: Longitudinal assessment of body composition following bariatric surgery allows monitoring of health status. Our aim was to elucidate trends of anthropometric and clinical outcomes 3 years following sleeve gastrectomy (SG). METHODS: A prospective cohort study of 60 patients who underwent SG. Anthropometrics including body composition analysis measured by multi-frequency bioelectrical impedance analysis, blood tests, liver fat content measured by abdominal ultrasound and habitual physical activity were evaluated at baseline and at 6 (M6), 12 (M12), and 36 (M36) months post-surgery. RESULTS: Sixty patients (55% women, age 44.7 ± 8.7 years) who completed the entire follow-up were included. Fat mass (FM) was reduced significantly 1 year post-surgery (55.8 ± 11.3 to 26.7 ± 8.3 kg; P < 0.001) and then increased between 1 and 3 years post-operatively, but remained below baseline level (26.7 ± 8.3 to 33.1 ± 11.1 kg; P < 0.001). Fat free mass (FFM) decreased significantly during the first 6 months (64.7 ± 14.3 to 56.9 ± 11.8 kg; P < 0.001), slightly decreased between M6 and M12 and then reached a plateau through M36. Weight loss "failure" (< 50% excess weight loss) was noticed in 5.0% and 28.3% of patients at M12 and M36, respectively. Markers of lipid and glucose metabolism changed thereafter in parallel to the changes observed in FM, with the exception of HDL-C, which increased continuingly from M6 throughout the whole period analyzed (45.0 ± 10.2 to 59.5 ± 15.4 mg/dl; P < 0.001) and HbA1c which continued to decrease between M12 and M36 (5.5 ± 0.4 to 5.3 ± 0.4%; P < 0.001). There were marked within-person variations in trends of anthropometric and clinical parameters during the 3-year follow-up. CONCLUSIONS: Weight regain primarily attributed to FM with no further decrease in FFM occurs between 1 and 3 years post-SG. FM increase at mid-term may underlie the recurrence of metabolic risk factors and can govern clinical interventions.

Analysis of the Association between Eating Behaviors and Weight Loss after Laparoscopic Sleeve Gastrectomy.

SETTING: In a private medical center, 300 patients who underwent a laparoscopic sleeve gastrectomy (LSG) were classified into 4 groups according to their eating behaviors (EB) preoperatively. During a 3-year postoperative follow-up, dietary changes in relation to weight loss were studied. OBJECTIVES: To explore the influence of abnormal EB on the outcome of sleeve gastrectomy. BACKGROUND: Patients with morbid obesity often suffer from abnormal EB. After LSG, the outcome depends largely on improvement of the feeding behaviors acquired. METHODS: This prospective study includes 300 patients who underwent LSG from 2013 to 2014, divided into the following 4 groups: binge eaters, snack eaters, sweet eaters, and volume eaters. RESULTS: The average age was 41.65 years, the ratio of male to females was 1 to 2. The average baseline body mass index (BMI) was 42.02. After 3 years, no significant change was found in the number of binge eaters (p = 0.396), but there was an 8.9% increase in snack eaters (p < 0.001), a 12.9% increase in sweet eaters (p < 0.001), and 17.2% increase in healthy eating habits (p < 0.001). Sixty-five (24.8%) patients did not experience changes in their eating patterns. However, after surgery, 24.6% of the patients continued with the same EB and 125 (49.5%) patients changed from one EB to another unhealthy EB. Weight loss, measure as ΔBMI, was similar in each group after 3 years, with a mean BMI of 29.8. When eating habits were related to different features such as gender, sports practice, type of work, smoking, marital status, comorbidities, no influence on the operative results were found. CONCLUSION: LSG promotes the reduction of overeaters; however, it promotes a switch between other unhealthy EB. The significant increase in snack eaters and sweet eaters is outstanding, although it did not affect weight loss in the midterm follow-up. Worsening of eating habits after LSG is a common fact.

Comparison of Energy and Food Intake Between Gastric Bypass and Sleeve Gastrectomy: a Meta-analysis and Systematic Review.

AbstractObesity is a developed nutritional problem, and today, surgery is one of the approaches to cure it. A good understanding of the variations in food intake will be beneficial for sustaining long-term weight loss post-surgery and for improving nutrition care strategies. The purpose of this review was the comparison of the impact of two methods of gastric bypass (GBP) and sleeve gastrectomy (SG) on dietary intake. Databases of PubMed, Embase, Scopus, Google Scholar, and Web of science were used for the literature search up to June 2018. We concluded the studies that measured mean daily energy intake and the percent of macronutrients from total calorie intake of before and after GBP and SG. A total of 18 studies were finally included in the meta-analysis for the effect of bariatric surgery on food intake. Bariatric surgery significantly decreased energy intake by 1050.04 kcal/day (p < 0.001) compared with the baseline values of energy intake. The pooled effect of bariatric surgery on protein intake was 0.82 g/day (p = 0.004) compared with the baseline values. The pooled analysis found no significant impact of bariatric surgery on carbohydrate intake (WMD = 0.56 g/day; p = 0.40) compared with the baseline values. The pooled estimate of effect for bariatric surgery on fat intake was - 1.34 g/day (p = 0.006). This study demonstrates that bariatric surgery might be effective on energy and fat intake; however, there was no effect on carbohydrate intake.

Quality of Life 10 Years after Sleeve Gastrectomy: A Multicenter Study.

OBJECTIVE: Sleeve gastrectomy (SG) has recently become the most commonly applied bariatric procedure worldwide. Substantial regaining of weight or severe reflux might compromise quality of life (QOL) after SG in the long-term follow-up. Long-term data on patients' QOL is limited, even though the persistent improvement in QOL is one of the aims of bariatric surgery. The objective of this study was to present patients' QOL 10 years after SG. METHODS: Of 65 SG patients with a follow-up of ≥10 years after SG who were asked to fill out the Bariatric Quality of Life Index (BQL) and Short Form 36 (SF36) questionnaires, 48 (74%) completed them. This multicenter study was performed in a university hospital setting in Austria. RESULTS: The BQL score revealed nonsignificant differences between the patients with > 50% or < 50% excess weight loss (EWL). It did show significant differences between patients with and without any symptoms of reflux. Patients with < 50% EWL scored significantly lower in 3/8 categories of SF36. Patients suffering from reflux had significantly lower scores in all categories. CONCLUSIONS: EWL and symptomatic reflux impair patients' long-term QOL after SG.