The Effects of Bariatric Surgery on Renal, Neurological, and Ophthalmic Complications in Patients with Type 2 Diabetes: the Taiwan Diabesity Study.

BACKGROUND: Bariatric surgery has been shown to improve glycemic control in patients with type 2 diabetes. However, less is known whether it can also reduce diabetic renal, neurological, and ophthalmic complications. METHODS: This prospective multicenter cohort study compared renal, ophthalmic, and neurological complications between 49 patients with obesity/overweight receiving bariatric surgery and 338 patients receiving standard medical treatment after follow-up for 2 years. Patients received neurological examinations including toe tuning fork vibration test, ankle tendon reflex test, 10-g monofilament test, and ophthalmic examinations including visual acuity measurement and fundus examinations. Multiple regressions, propensity score weighting, and matching were employed to adjust for baseline differences. RESULTS: After 2 years of follow-up, patients with type 2 diabetes receiving bariatric surgery had greater reduction in BMI, HbA1c, and urine albumin-creatinine ratio, greater improvement in estimated glomerular filtration rate, and greater increase in tuning fork test score of right and left toes compared with the medical group. However, there is no improvement in 10 g-monofilament test, visual acuity, diabetic non-proliferative retinopathy, and proliferative retinopathy. Similar results were obtained using multiple regression adjustment, propensity-score weighting, or comparing age-, sex-, and BMI-matched subjects. CONCLUSIONS: After 2-year follow-up, patients with obesity/overweight and type 2 diabetes receiving bariatric surgery have increased glomerular filtration rate, reduced albuminuria, and improved tuning folk vibration sensation.

High Incidence of Secondary Hyperparathyroidism in Bariatric Patients: Comparing Different Procedures.

BACKGROUND: Bariatric surgery is an effective therapy for morbid obesity but may reduce calcium absorption and significantly decrease the bone mineral density. This study examined the prevalence of secondary hyperparathyroidism (SHPT) in obese subjects during follow-up after different bariatric surgeries. We investigated predictors of SHPT. METHODS: We enrolled 1470 obese subjects undergoing bariatric/metabolic surgery with at least 1-year follow-up, including 322 patients undergoing Roux-en-Y gastric bypass (RYGB), 695 undergoing single anastomosis (mini-) gastric bypass (SAGB), 93 undergoing laparoscopic adjustable gastric banding (LAGB), and 360 undergoing sleeve gastrectomy (SG). Five years of data were available for 215 patients. Patients were instructed to supplement their diet according to the guideline. Calcium, parathyroid hormone (PTH), and vitamin D levels were measured before surgery and at 1 and 5 years after surgery. SHPT was defined as PTH > 69 pg/mL. RESULTS: The overall prevalence of SHPT was high, 21.0% before surgery and was not different between patients with different bariatric procedures. Pre-operative PTH correlated with age, BMI, and vitamin D levels. Multi-variate analysis confirmed that vitamin D level was the only independent predictor of SHPT before surgery. The prevalence of SHPT increased to 35.4% at 1 year after surgery and 63.3% at 5 years after surgery. SAGB had the highest prevalence of SHPT (50.6%) followed by RYGB (33.2%), LAGB (25.8%), and SG (17.8%) at 1 year after surgery. At 5 years after surgery, SAGB still had the highest prevalence of SHPT (73.6%), followed by RYGB (56.6%), LAGB (38.5%), and SG (41.7%). Serum PTH at 1 year after surgery correlated with decreased BMI and weight loss. Multi-variate analysis confirmed that age, sex, calcium level, and bypass procedure were independent predictor of SHPT after surgery. CONCLUSIONS: The prevalence of SHPT is high in morbidly obese patients before bariatric surgery which is related to vitamin D deficiency. The prevalence of SHPT increased continually along with the time after bariatric surgery, especially in patients receiving SAGB, followed by RYGB. The supplementation of vitamin D and calcium have to be higher in bypass procedure, especially in malabsorptive procedure.

Diet behavior and low hemoglobin level after laparoscopic mini-gastric bypass surgery.

BACKGROUND/AIMS: Nutrition problems caused by laparoscopic mini-gastric bypass surgery (LMGB) include lack of iron, calcium and poor nutrition. Iron deficiency anemia is the common. The purpose of this study was to investigate why our patients' hemoglobin level was at a low value after surgery and the relationship between diet frequency, diet behavior, and low hemoglobin level. METHODOLOGY: From January 2009 to April 2010, 120 patients who received laparoscopic mini-gastric bypass surgery were included in this study. Among all patients, there were 34 men and 86 women. Hemoglobin level of male patients less than 13mg/dL and that of female patients less than 11.5mg/dL was defined as anemia. The clinical characteristics and diet behavior were analyzed. RESULTS: The mean age was 30.9±10.5 years and the mean body mass index was 41.4±7.2kg/m2. Before and after surgery, the proportion of anemia was 4.1% and 26.6%, respectively. The proportion of anemia in females increased more than in males. Hemoglobin level after surgery showed positive correlation (p<0.05) with the diet frequency of high protein, sugar drinks with balanced formula, alcoholic drinks and exercise, but negative correlation (p<0.01) with iron supplements. CONCLUSIONS: The study concluded that patients after laparoscopic mini-gastric bypass surgery should increase the ingestion of high-protein drinks or food, alcoholic drinks and exercise, to prevent a low hemoglobin level.

Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for the treatment of morbid obesity but is technically challenging and results in significant perioperative complications. While laparoscopic mini-gastric bypass (LMGB) has been reported to be a simple and effective treatment for morbid obesity, controversy exists. Long-term follow-up data from a large number of patients comparing LMGB to LRYGB are lacking. METHODS: Between October 2001 and September 2010, 1,657 patients who received gastric bypass surgery (1,163 for LMGB and 494 for LRYGB) for their morbid obesity were recruited from our comprehensive obesity surgery center. Patients who received revision surgeries were excluded. Minimum follow-up was 1 year (mean 5.6 years, from 1 to 10 years). The operative time, estimated blood loss, length of hospital stay, and operative complications were assessed. Late complication, changes in body weight loss, BMI, quality of life, and comorbidities were determined at follow-up. Changes in quality of life were assessed using the Gastrointestinal Quality of Life Index. RESULTS: There was no difference in preoperative clinical parameters between the two groups. Surgical time was significantly longer for LRYGB (159.2 vs. 115.3 min for LMGB, p < 0.001). The major complication rate was borderline higher for LRYGB (3.2 vs. 1.8%, p = 0.07). At 5 years after surgery, the mean BMI was lower in LMGB than LRYGB (27.7 vs. 29.2, p < 0.05) and LMGB also had a higher excess weight loss than LRYGB (72.9 vs. 60.1%, p < 0.05). Postoperative gastrointestinal quality of life increased significantly after operation in both groups without any significant difference at 5 years. Obesity-related clinical parameters improved in both groups without significant difference, but LMGB had a lower hemoglobin level than LRYGB. Late revision rate was similar between LRYGB and LMGB (3.6 vs. 2.8%, p = 0.385). CONCLUSIONS: This study demonstrates that LMGBP can be regarded as a simpler and safer alternative to LRYGB with similar efficacy at a 10-year experience.