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1.
Medicine (Baltimore) ; 99(19): e19823, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384427

RESUMEN

BACKGROUND/AIM: Obesity is associated with increased incidence of gastroesophageal reflux disease (GERD), and it has been suggested that GERD symptoms may be improved by weight reduction. However, various patterns of bariatric surgery may affect symptoms of GERD due to the changed anatomy of stomach and esophagus. The aim of this systematic review and meta-analysis is to analyze the effect of bariatric surgery on GERD. MATERIALS AND METHODS: A systematic literature search was performed using PubMed, EMBASE, and the Cochrane Library from January 2005 to January 2019, combining the words obesity, gastroesophageal reflux with different types of bariatric surgery and weight loss. The methodological quality of randomized controlled trials and non-randomized controlled trials published in English and have at least 1-year follow-up data were included and assessed by Cochrane Collaboration's tool for assessing risk bias and Newcastle-Ottawa scale. Only clinical trials were included, and case series or case reports were excluded. RESULTS: We anticipate that our review will provide the exact estimates of the burden and phenotype of GERD among patients that have undergone bariatric surgery. CONCLUSION: GERD may improve in obese patients who underwent laparoscopic sleeve gastrectomy (LSG); however, the most favorable effect is likely to be found after Roux-en-Y gastric bypass surgery. PROSPERO REGISTRATION NUMBER: CRD42018090074.


Asunto(s)
Cirugía Bariátrica , Reflujo Gastroesofágico/cirugía , Obesidad Mórbida/cirugía , Reflujo Gastroesofágico/etiología , Reflujo Gastroesofágico/fisiopatología , Humanos , Metaanálisis como Asunto , Obesidad Mórbida/complicaciones , Obesidad Mórbida/fisiopatología , Periodo Posoperatorio , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento , Pérdida de Peso/fisiología
2.
Clín. investig. arterioscler. (Ed. impr.) ; 32(2): 79-86, mar.-abr. 2020. ilus, tab
Artículo en Español | IBECS | ID: ibc-187151

RESUMEN

La prevalencia de la obesidad ha aumentado de manera exponencial en las últimas décadas, convirtiéndose en un problema de salud pública de primer orden. La dislipemia de la obesidad, caracterizada por niveles bajos de colesterol de las lipoproteínas de alta densidad (HDL), hipertrigliceridemia y partículas pequeñas y densas de lipoproteínas de baja densidad (LDL), es responsable en parte del elevado riesgo cardiovascular residual de esta situación clínica. Por otro lado, la cirugía bariátrica (CB) es el tratamiento más eficaz para la obesidad; con ella se obtiene una mayor pérdida ponderal que con el tratamiento médico convencional y favorece la mejoría o remisión de las comorbilidades asociadas. Las técnicas de CB más utilizadas en la actualidad son el bypass gástrico laparoscópico en Y de Roux (BGYRL) y la gastrectomía tubular laparoscópica (GTL). Estas han obtenido resultados similares tanto en cuanto a la pérdida de peso como a la remisión de ciertas comorbilidades como la diabetes mellitus tipo 2 o la hipertensión arterial. Un rasgo diferencial entre ambas técnicas podría ser el diferente impacto sobre el perfil lipoproteico. Así, estudios previos con seguimiento a corto y a medio plazo han objetivado una superioridad del BGYRL frente a la GTL en la reducción del colesterol total y del colesterol LDL. Existen resultados discordantes en cuanto a la evolución del colesterol HDL y los triglicéridos. Por todo ello, hemos considerado de interés revisar los efectos de la CB a corto y a medio plazo en el perfil lipoproteico, así como las tasas de remisión de las diferentes alteraciones lipídicas y los posibles factores relacionados


Obesity prevalence has presented an exponential increase in the last decades, becoming a first order public health issue. Dyslipidemia of obesity, characterized by low levels of high density lipoprotein (HDL) cholesterol, hypertriglyceridemia and small and dense low-density lipoprotein (LDL) particles, is partly responsible for the high residual cardiovascular risk of this clinical situation. On the other hand, bariatric surgery (BS) is the most effective treatment for obesity, obtaining a greater weight loss than achieved with conventional medical therapy and favoring the improvement or remission of associated comorbidities. The most commonly used BS techniques nowadays are laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). Both of these procedures have obtained similar results in terms of weight loss and comorbidity remission such as type 2 diabetes mellitus or hypertension. A differential feature between both techniques could be the different impact on the lipoprotein profile. In this respect, previous studies with short and mid-term follow-up have proved LRYGB to be superior to LSG in total and LDL cholesterol reduction. Results regarding triglycerides and HDL cholesterol are contradictory. Therefore, we consider of interest to review the effects of BS at short and mid-term follow-up on lipoprotein profile, as well as the remission rates of the different lipid abnormalities and the possible related factors


Asunto(s)
Humanos , Obesidad Mórbida/sangre , Obesidad Mórbida/cirugía , Hiperlipidemias/sangre , Lípidos/sangre , Cirugía Bariátrica/métodos
4.
Int J Surg ; 76: 101-110, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32151750

RESUMEN

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy are the most common procedures performed in bariatric surgery and both have been demonstrated to have significant effectiveness in treating morbid obesity. However, comparative analysis of their effectiveness has not been well studied. This comparative analysis was conducted to determine whether Laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy have the same mid- and long-term outcomes in weight loss, resolution of obesity comorbidities and adverse events (AEs) of treatment. METHODS: We searched the Cochrane Library, PubMed, Embase and Web of Science databases from the establishment of the database to January 1, 2020 for both randomized control trials and non-randomised interventional studies that studied Laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy with respect to weight loss outcomes, resolution of obesity comorbidities and AEs of treatment. Standardised mean differences, risk ratios and odds ratio with 95% confidence intervals were calculated to compare the outcomes of the groups. Two reviewers assessed the quality of the trials and extracted the data independently. All statistical analyses were performed using the standard statistical procedures in Review Manager 5.2. RESULTS: We included 20 studies (N = 2917 participants) in this meta-analysis. Our results showed no significant difference in excess weight loss between Laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, with pooled Standardised mean differences of -0.16 (95% confidence interval: -0.52 to 0.19; P = 0.36) based on randomized control trials and 0.07 (95% confidence interval: -0.10 to 0.24; P = 0.41) based on non-randomised interventional studies. Further, the pooled results showed no significant differences in midterm and long-term weight loss outcomes between the comparative groups. Similarly, no significant difference was found in type 2 diabetes mellitus resolution. The pooled results indicated that patients receiving laparoscopic sleeve gastrectomy experienced fewer postoperative complication and reoperation rates, with pooled risk ratios of 1.66 (95% confidence interval: 1.33 to 2.07; P < 0.00001) and 1.73 (95% confidence interval: 1.14 to 2.62; P = 0.01), respectively. Laparoscopic Roux-en-Y gastric bypass was superior to laparoscopic sleeve gastrectomy in managing dyslipidemia, hypertension and gastroesophageal reflux disease. CONCLUSIONS: The present meta-analysis indicated that both Laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy had the same effectiveness in resulting in excess weight loss and type 2 diabetes mellitus resolution. However, patients who received laparoscopic sleeve gastrectomy experienced fewer postoperative complication and reoperation rates than those who received Laparoscopic Roux-en-Y gastric bypass. Laparoscopic Roux-en-Y gastric bypass was superior in the management of dyslipidemia, hypertension and gastroesophageal reflux disease.


Asunto(s)
Gastrectomía , Derivación Gástrica , Obesidad Mórbida , Pérdida de Peso , Comorbilidad , Diabetes Mellitus Tipo 2/complicaciones , Gastrectomía/métodos , Derivación Gástrica/métodos , Reflujo Gastroesofágico/cirugía , Humanos , Hipertensión/complicaciones , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Oportunidad Relativa , Complicaciones Posoperatorias/etiología , Reoperación , Segunda Cirugía
5.
Medicine (Baltimore) ; 99(12): e19427, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195937

RESUMEN

BACKGROUND: Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life. METHODS: This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured. DISCUSSION: This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery. TRIAL REGISTRATION NUMBER: ISRCTN registry (ISRCTN27697878).


Asunto(s)
Cirugía Bariátrica/rehabilitación , Terapia por Ejercicio/métodos , Obesidad Mórbida/terapia , Adolescente , Adulto , Ejercicio Físico , Femenino , Humanos , Inflamación/fisiopatología , Resistencia a la Insulina/fisiología , Persona de Mediana Edad , Obesidad Mórbida/cirugía , Pruebas de Función Ovárica , Aptitud Física/fisiología , Calidad de Vida , Método Simple Ciego , Rigidez Vascular/fisiología , Adulto Joven
7.
Surg Clin North Am ; 100(2): 417-430, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32169187

RESUMEN

In this article, we review the role of robotics in bariatric surgery. After a brief overview of the evolution of minimally invasive bariatric surgery, we discuss possible advantages of robotic systems and subsequently go into more details about each procedure, including adjustable gastric bands, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. We also discuss outcomes of robotics in reoperative bariatric surgery. Considerations about training are presented as well.


Asunto(s)
Cirugía Bariátrica/métodos , Obesidad Mórbida/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Humanos , Reoperación
8.
Rev Col Bras Cir ; 46(6): e20192351, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32022112

RESUMEN

OBJECTIVE: to analyse clinical and epidemiological characteristics, postoperative complications, and weight loss in patients undergoing conventional vertical gastrectomy in a hospital under Brazil's Public Health System (SUS). METHODS: cross-sectional longitudinal retrospective study based on data collection from medical records for variable analysis in patients undergoing open vertical gastrectomy in SUS, from July 2013 to January 2017. RESULTS: we analysed 296 patients operated on during the study period, of which 54% were male. The average age was of 39.9 years ±11.4; the average body mass index (BMI) was of 43.5kg/m² in the preoperative period and of 30.3kg/m² in the postoperative period; and the excess weight loss was of 73.6% (83.24% had an excess weight loss greater than 50%). Preoperative BMI was higher in the group with weight loss below 50%. We observed a 5.4% rate of early complications requiring hospitalization and a 1% mortality rate. CONCLUSION: open vertical gastrectomy is a safe and effective weight loss technique, which can be more performed in SUS. Among the variables evaluated in our work, the previous BMI was the only one related to the postoperative success.


Asunto(s)
Gastrectomía/métodos , Obesidad Mórbida/cirugía , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Brasil , Estudios Transversales , Humanos , Laparoscopía/métodos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
9.
Ann R Coll Surg Engl ; 102(1): 54-61, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31891669

RESUMEN

INTRODUCTION: Studies have attempted to identify prognostic indicators for successful outcomes following bariatric surgery for obesity. The aim of this study was to determine whether the degree of obesity affects outcomes in patients who are morbidly obese (basal metabolic index, BMI, 40-49.9 kg/m2), super-obese (BMI 50-59.9 kg/m2) and super-super-obese (BMI greater than 60 kg/m2) undergoing restrictive or malabsorptive bypass procedures. MATERIAL AND METHODS: Retrospective analysis of a prospectively maintained database was undertaken to include all consecutive laparoscopic adjustable gastric bands (LAGB), laparoscopic sleeve gastrectomies (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures since 2010. Patients with at least two years of follow-up were included. At each visit, the patient's weight, BMI, excess weight loss and comorbidity status were recorded. RESULTS: A total of 353 patients (75% women) were included in the analysis; 65 (18.4%) underwent LAGB; 70 (19.8%) LSG and 218 (61.8%) LRYGB. At presentation, the median BMI for the morbidly obese sub-group was 47.2 kg/m2 for LAGB, 46.4 kg/m2 for LSG and 46.6 kg/m2 for LRYGB (P = 0.625); for the super-obese sub-group it was 53.2 kg/m2 for LAGB, 52.9 kg/m2 for LSG and 52.4 kg/m2 for LRYGB (P = 0.481); and for the super-super-obese sub-group 66.9 kg/m2 for (LAGB, 66.7 kg/m2 for LSG and 61.5 kg/m2 for LRYGB (P = 0.169). Percentage of excess weight loss at the end of two years was significantly higher in the morbidly obese and super-morbidly obese sub-groups undergoing LRYGB (median 68.5% and 69.5%, respectively; P < 0.001) than in the sub-groups undergoing LAGB and LSG. This was also reflected in the reduction of BMI achieved with bypass in the two sub-groups (P < 0.001). Complete diabetes remission was significantly higher in the morbidly obese and super-morbidly obese sub-groups undergoing LRYGB treatment (P < 0.05). Sleep apnoea, asthma and exercise tolerance had significantly improved in the super-morbidly obese undergoing LRYGB (P < 0.05). There was no significant difference between the three treatment groups in remission of hypertension; dyslipidaemia; gastro-oesophageal reflux disease and depression in all three BMI sub-groups. CONCLUSION: The mid-term results for weight loss and resolution of obesity-related comorbidities is best achieved in super-obese patients undergoing LRYGB, without any significant increase in complications with this procedure as compared with LAGB and LSG.


Asunto(s)
Cirugía Bariátrica/métodos , Peso Corporal/fisiología , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Adulto , Cirugía Bariátrica/estadística & datos numéricos , Femenino , Humanos , Laparoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Pérdida de Peso/fisiología
11.
Rev Med Suisse ; 16(679): 233-234, 2020 Jan 29.
Artículo en Alemán | MEDLINE | ID: mdl-31995320
14.
Health Psychol ; 39(3): 245-254, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31944798

RESUMEN

OBJECTIVE: Bariatric surgery is an effective treatment for obesity, which has been increasing worldwide. However, bariatric surgery causes dramatic physical changes that can cause significant stress. Prior research has found that psychological variables such as personality traits and levels of psychopathology can influence success after bariatric surgery (in terms of body mass index [BMI] reduction and weight loss). However, most prior studies have been limited by small sample sizes, inconsistent follow up, and categorical assessment of psychopathology. METHOD: The present study examines the predictive utility of the Personality Assessment Inventory (PAI) scales for three bariatric surgery outcomes (BMI reduction, weight loss, and percent excess weight loss [%EWL]) across 10 follow-up points 5 years after surgery. It also examines the largest sample of bariatric surgery-completing patients (N = 2,267) on the PAI to date. Latent growth modeling was used to examine change in the outcome variables. RESULTS: Results indicate that personality and psychopathology variables predicted less BMI reduction, weight loss, and %EWL 5 years after surgery and also affected the trajectories of change in the outcome variables across time. The PAI scales predicted more variance in the 5-year BMI outcomes than did age and gender. The most robust effects were for scales assessing phobias, traumatic stress, identity problems, and negative relationships. CONCLUSION: The PAI may be useful to clinical health psychologists who conduct recommended psychological evaluations with potential bariatric surgery candidates. (PsycINFO Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Cirugía Bariátrica/métodos , Índice de Masa Corporal , Obesidad Mórbida/cirugía , Trastornos de la Personalidad/psicología , Psicopatología/métodos , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad Mórbida/psicología , Resultado del Tratamiento
15.
Transplant Proc ; 52(1): 276-283, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31889539

RESUMEN

BACKGROUND: Obesity is a major public health burden that affects the transplant community because of its key role in fatty liver disease and transplantation outcomes. OBJECTIVES: To evaluate the role of sleeve gastrectomy in treating recurrent and de novo nonalcoholic fatty liver disease (NAFLD) in liver transplant recipients. SETTING: A university hospital. METHODS: We describe 2 obese liver transplant recipients with recurrent and de novo NAFLD who underwent minimally invasive metabolic and bariatric surgery. RESULTS: The surgery was performed successfully, with much of the operative time consumed by enterolysis. There were no intraoperative or postoperative complications. At last follow-up appointment (16 months postoperatively), there was a mean reduction in weight (31.98 kg), body mass index (10.2 kg/m2), glycosylated hemoglobin (1.05%), alanine aminotransferase (38 IU/L), steatosis score (0.34), and fibrosis score (0.05). The mean decrease in 6-month postoperative hepatic fat quantification was 6%. CONCLUSIONS: These cases show that metabolic and bariatric surgery in obese, posttransplant recipients with recurrent and de novo nonalcoholic steatohepatitis lead to improved steatosis and reduced obesity and obesity-associated comorbidities.


Asunto(s)
Cirugía Bariátrica/métodos , Gastrectomía/métodos , Trasplante de Hígado , Enfermedad del Hígado Graso no Alcohólico/cirugía , Obesidad Mórbida/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Obesidad Mórbida/complicaciones , Complicaciones Posoperatorias/cirugía , Receptores de Trasplantes
16.
Eur J Endocrinol ; 182(3): 303-311, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31940278

RESUMEN

Objective: Roux-en-Y-gastric bypass (RYGB) surgery is an effective treatment for morbid obesity. A possible overlooked side effect is negative bone metabolic consequences. Design: A seven-year prospective study following ten women and seven men after RYGB (baseline mean age 43 ± 8 years, BMI 42 ± 6 kg/m2). Methods: Lumbar spine and total hip bone mineral density (BMD) using dual energy x-ray absorptiometry, distal radius and tibia bone geometry, volumetric BMD, microarchitecture and finite element estimated bone strength using high-resolution peripheral quantitative CT and biochemical markers of bone remodelling were assessed at baseline, 2 and 7 years. Results: Compared to baseline, body weight was 24 ± 10% lower after 2 years and 21 ± 11% after 7 years. During the 7 years of follow-up, radius and tibia vBMD had declined 13 ± 8% and 8 ± 7% from baseline to 2 years and further 10 ± 7% and 7 ± 8% from 2 to 7 years (all P < 0.001). At both radius and tibia, cortical thickness declined and cortical porosity increased. From baseline to 7 years, there were clear indications of deteriorations of the trabecular network with fewer, more widely spaced and more in-homogeneously distributed trabeculae in both radius and tibia. Overall, declines in estimated bone strength of 16 ± 9% in radius and 16 ± 7% in tibia were observed (both P < 0.001). Conclusion: Seven years after RYGB, evidence of continuous declines in BMD and ongoing deterioration of bone microarchitecture and reduced estimated bone strength compared to baseline and 2 years post-surgery results were found. These findings emphasize the need for regular assessment of bone health in patients with prior RYGB.


Asunto(s)
Anastomosis en-Y de Roux/efectos adversos , Densidad Ósea , Huesos/patología , Complicaciones Posoperatorias/patología , Absorciometría de Fotón , Adulto , Remodelación Ósea , Huesos/ultraestructura , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Cadera/patología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad Mórbida/cirugía , Estudios Prospectivos , Columna Vertebral/patología
17.
Ann R Coll Surg Engl ; 102(1): e7-e11, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31530171

RESUMEN

Ehlers-Danlos syndrome is a hereditary connective tissue disorder that has gastrointestinal manifestations in over 50% of its cases. We present the first case of bariatric surgery in a patient with Ehlers-Danlos syndrome and outline management challenges in the context of the relevant literature. A 56-year-old man with type IV Ehlers-Danlos syndrome and a body mass index of 41.8 kg/m2 was referred to the bariatric centre of the Churchill Hospital, Oxford, for consideration of surgery for morbid obesity. His comorbidity included type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea. He underwent a laparoscopic Roux-en-Y gastric bypass. His initial recovery was uneventful and he was discharged on the first postoperative day. Six weeks later, he presented with 43.9% excess weight loss and improved glycaemic control. Three months postoperatively, however, he complained of dysphagia, regurgitation and postprandial pain. A barium meal and gastroscopy suggested the presence of a gastric diverticulum. A surgical exploration was planned. Intraoperative gastroscopy demonstrated an asymmetrical gastric pouch dilatation and the pouch was therefore refashioned laparoscopically. Despite the initial symptomatic relief, two months later he experienced retrosternal pain with progressive dysphagia. Since then, multiple endoscopic dilatations of the gastro-oesophageal junction have been performed for recurrence of symptoms. Finally, a laparoscopic hiatus hernia repair and adhesiolysis was performed resulting in complete relief of patient's symptoms. Bariatric management of patients with Ehlers-Danlos syndrome can prove challenging. The bariatric team must implement a careful management plan including a detailed consent process, a tailored surgical intervention and a follow-up focused on potential gastrointestinal manifestations.


Asunto(s)
Síndrome de Ehlers-Danlos/complicaciones , Obesidad Mórbida/cirugía , Trastornos de Deglución/etiología , Diabetes Mellitus Tipo 2/complicaciones , Endoscopía del Sistema Digestivo/métodos , Derivación Gástrica/métodos , Hernia Hiatal/diagnóstico , Hernia Hiatal/etiología , Hernia Hiatal/cirugía , Herniorrafia/métodos , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reoperación
19.
J Laparoendosc Adv Surg Tech A ; 30(1): 20-30, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31855096

RESUMEN

Introduction: Vitamin A deficiency (VAD) is an underreported micronutrient deficiency after bariatric surgery (BS). Objectives: The goal of this study was to characterize VAD prevalence in patients undergoing malabsorptive and restrictive procedures up to 2 years postoperatively. Methods: Primary sleeve gastrectomy (SG; n = 322) and gastric bypass (GB; n = 249) patients were reviewed. Levels for overall VAD (oVAD; retinol <39 mcg/dL) and moderate VAD (mVAD; retinol <30 mcg/dL) were reported preoperatively and 6, 12, and 24 months postoperatively. Differences in demographic, surgical, and postoperative data were tested between these groups. Settings: Single-center academic institution. Results: Serum retinol levels were documented for 56%, 74%, 61%, and 37% of patients for listed time points. Baseline retinol inversely correlated to preop body mass index (BMI) (R = -0.15, P = .007). Both oVAD and mVAD peaked 6 months postoperatively (33% vs. 15%, P < .005; 12% vs. 4%, P = .0004, respectively). oVAD remained elevated at 24 months (22% vs. 15%, P = .03). Compared to SG, oVAD was higher following GB at 6 months (39% vs. 28%, P = .001) and 12 months (26% vs. 17%, P = .04), and mVAD was greater with GB at 6 months (18% vs. 6%, P < .0005). African American patients had higher oVAD/mVAD preoperatively (26% vs. 13%, P = .02; 13% vs. 3%, P = .001, respectively) and at 6 months (19% vs. 10%, P = .04). Prior mild VAD (retinol 1.05-1.35 µM) was significantly associated with mVAD up to 12 months postoperatively. Conclusions: Although higher following LRYGB, VAD is prevalent following both malabsorptive and restrictive procedures. Preoperative serum retinol is inversely correlated to increasing BMI, and African American race and mild VAD are associated with moderate VAD.


Asunto(s)
Gastrectomía/efectos adversos , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Deficiencia de Vitamina A/epidemiología , Adulto , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Periodo Preoperatorio , Prevalencia , Índice de Severidad de la Enfermedad , Vitamina A/sangre , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/etiología
20.
J Laparoendosc Adv Surg Tech A ; 30(1): 12-19, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31855106

RESUMEN

Background and Aims: Laparoscopic sleeve gastrectomy (LSG) among older obese subjects (>60 years of age) has recently gained popularity because of the population aging. We performed a meta-analysis to clarify whether elderly patients undergoing this procedure have an increased complications risk. Methods: A literature search aiming at outcomes of LSG in elderly patients throughout Cochrane Library, Embase, Google Scholar, Medline, and Scopus databases was performed from inception until June 2019. Primary endpoints consisted of mortality and overall complications. Secondary endpoints comprised excess weight loss percentage (%EWL), remission, or postoperative improvement of several comorbidities (type-2 diabetes [T2DM], hypertension, dyslipidemia, and obstructive sleep apnea [OSA]). Heterogeneity between the studies was assessed by I2 test and random effects model for the comparative analysis. Mean difference (MD) and relative risk (RR) were used to report the results. Results: Eleven studies involving 2259 patients were scrutinized for this study. Overall complications rates did not significantly differ among younger and elderly patients undergoing LSG (RR: 1.71; 95% CI [confidence interval]: 0.76-3.83; P = .19). %EWL was superior among younger patients (MD: -7.63; 95% CI: -13.19 - 2.08; P = .007) while there were no significant differences in remission of T2DM, hypertension, and hyperlipidemia between the age groups (RR: 1.04; 95% CI: 0.83-1.31; P = .72; RR: 1.00; 95% CI: 0.84-1.18; P = .96; RR: 1.05; 95% CI: 0.79-1.38; P = .76). Younger patients exhibited a significantly higher OSA remission/improvement rate (RR: 0.81; 95% CI: 0.69-0.95; P = .001). Conclusion: LSG is a reliable bariatric method that is also safe in elderly patients with similar overall morbidity and similar obesity-related comorbidity resolution rates than younger ones, although weight loss outcomes were inferior.


Asunto(s)
Gastrectomía/efectos adversos , Obesidad Mórbida/cirugía , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Gastrectomía/métodos , Gastrectomía/mortalidad , Humanos , Hiperlipidemias/complicaciones , Hipertensión/complicaciones , Laparoscopía/métodos , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Apnea Obstructiva del Sueño/complicaciones , Pérdida de Peso
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