Adding Short to Left Gastric Artery Embolization for the Treatment of Obesity: Safety and Effectiveness.

PURPOSE: This study assessed the safety and effectiveness of a technical modification that involves adding short gastric artery (SGA) embolization to left gastric artery (LGA) embolization. MATERIAL AND METHODS: This retrospective single-center study analyzed twenty obese patients (median age of 53.5 (30-73)) who were not eligible for bariatric surgery and underwent bariatric embolization with 300-500-µm microspheres in addition to a lifestyle counseling program between March 2021 and July 2022. Eight patients had LGA + SGA embolization, and twelve had LGA embolization alone. The primary outcome measure was total body weight loss (TBWL) at 6 months in the SGA + LGA and the LGA-only cohorts. Safety was assessed, defined as the 30-day adverse events rate according to the SIR classification. RESULTS: The mean 6-month post-embolization TBWL in the SGA + LGA cohort was 7.3 kg (95%CI 2.1-12.4; p = .01) and 4.1 kg (95%CI 0.4-8.6; p = 0.034) in the LGA-only cohort (mean difference - 3.1 kg ± 2.8; 95%CI (- 9.1-2.8); p = .28). The mean 6-month post-embolization TBWL in the entire cohort was 5.3 kg (p < .01). The rate of complications was similar between the two groups. CONCLUSION: Combined SGA and LGA embolization is safe and effective to treat obesity. Larger studies are needed to determine whether SGA + LGA embolization results in more significant weight loss than LGA embolization alone.

Bariatric dentistry: implications for coordinated dental education and public health policy.

Bariatric dentistry is the branch of dental medicine focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing US and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy, it is necessary that proper accommodations are made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. The aim of the present case report was to bring awareness and start professional discussions on the importance of dental practitioners in the community and dental academic programs working together to assure access for primary oral health for bariatric patients.

From Newtonian Concepts To A Quantum Understanding: The Evolution Of Endocrinology And Metabolism.

Conventional endocrinology is based upon linear or Newtonian feedback mechanisms. Thisframework helpsin learning and sharing science in a lucid and simple manner, just as Newton's Laws clarified our understanding of physics. Modern endocrinology and metabolism are more confusing, as exemplified by the multifarious etiopathogenic factors that continue to be unearthed for various diseases, such as obesity and diabetes. These diseasestend to follow a modelsimilar to that of quantum physics. We propose a Quantum theory of baro-mechanics to help understand the complexity that surrounds metabolic disease, especially obesity. Hopefully, thisinsight will help mitigate the frustration that one encounters while managing these conditions.

Surgical Ulcer Debridement in a Patient With Spina Bifida Complicated by Osteomyelitis, Obesity, and Diabetes.

The combination of obesity, diabetes mellitus (DM), and reduced mobility due to spina bifida can contribute to an increased risk of osteomyelitis. Spina bifida, a congenital defect of the spinal cord, causes vertebral column deformities and neurological impairment. Obesity can lead to increased pressure and stress on the bones and joints, as well as poor circulation and immune dysfunction, including neutrophil migration disorders. Similarly, DM can also contribute to poor circulation and inadequate immune function. These changes can increase the risk of neuropathic ulcerations and osteomyelitis. We report a case of a 59-year-old man who presented for surgical consultation at the inpatient care unit. He had a nonhealing sacral ulcer on the left buttock that persisted for a year. He had a history of spina bifida, type 2 DM, and anemia, and his body mass index was 57.6 kg/m2. Physical examination revealed an unstageable left buttock pressure ulcer. The patient was afebrile, and his laboratory findings and imaging results indicated osteomyelitis. Despite intravenous antibiotic treatment, healing of the sacral ulcer remained poor, and the patient experienced chronic pain. Subsequent surgical intervention in the operating room involved debridement of the skin and soft tissue using high-powered water via the VERSAJET™ Hydrosurgery System (Smith & Nephew, London, UK). Ulcerated and necrotic skin and subcutaneous tissue extending deeper than the muscles and bones were observed. Loop colostomy was performed after determining that the wound would not heal owing to its proximity to the rectum and the inevitable contamination with stool. Postoperatively, sacral bone biopsy confirmed osteomyelitis. Alternative treatment options remained limited, as several other treatment methods failed prior to surgical debridement and colostomy placement. Although repeated debridement improved tissue viability, loop colostomy was performed to divert stool and prevent contamination of the ulcer.

The etiopathogenesis and management of obesity: The quintessential quincunx.

This communication uses the quincunx, i.e, a quadruple surrounding a central point, to create a model that describes the etiopathogenesis, as well as informs the management strategy of obesity. With the energy fulcrum (mismatch between energy intake and expenditure) at its centre, the model lists two external influencers-the physical environment and psychosocial environment, and two internal influencers- the hypothalamo-bariatric axis and the endocrine system, to explain the etiopathogenesis of obesity. Genetics factors are included with the hypothalamo-bariatric axis. The same model can be used to explain the five pillars of management: lifestyle and nutritional modification at the centre, along with environmental optimization, behavioural therapy, baro-thalamic modulation, and endocrine optimization.

Eight-Centimeter Gallbladder Stone Post-Roux-en-Y Gastric Bypass: A Case Report.

Cholelithiasis occurs when a stone forms in the gallbladder; when symptoms develop, the condition is termed symptomatic cholelithiasis. The correlation between bariatric surgery and post-operative symptomatic cholelithiasis has long been established. Presented is a case of a 56-year-old female status post-Roux-en-Y gastric bypass who developed symptomatic cholelithiasis and subsequently underwent cholecystectomy with the removal of an 8-centimeter (cm) gallbladder stone. This case report explores the benefits and limitations of watchful waiting versus prophylactic concomitant cholecystectomy among bariatric surgery patients, noting the difference between the bariatric sleeve and bypass anatomy for managing biliary complications.

Gastric Band Insertion to Revise Sleeve Gastrectomy: A Case Report.

Bariatric surgery for the treatment of obesity, first introduced in the 1950s and 1960s, is now relatively commonplace. Often patients will first have an adjustable gastric band inserted, as this does not require altering or removing parts of the gastrointestinal tract. This procedure is associated with short hospital stays and quick recoveries and may be adjusted without further surgery. Typically only after banding fails mechanically or fails to bring about a satisfactory reduction in body mass index (BMI) do patients undergo further bariatric procedures which involve altering or removing parts of the gastrointestinal tract. Recent research has suggested that gastric banding is associated with greater weight reduction results as a secondary or follow-up procedure following a failed initial bariatric surgery. Here we report the case of a 43-year-old female with a history of cryptogenic organizing pneumonitis, gastroesophageal reflux disease (GERD), asthma, obesity, and prior sleeve gastrectomy who underwent a laparoscopic gastric band insertion to revise the prior sleeve gastrectomy, in reverse of the typical sequence of bariatric surgeries.

Intragastric satiety-inducing device reduces food intake and suppresses body weight gain in a rodent model.

BACKGROUND: An intragastric satiety-inducing device (ISD) (Full Sense Device; Baker, Foote, Kemmeter, Walburn, LLC, Grand Rapids, MI) is a novel weight-loss device, which may induce satiety by applying continuous pressure on the gastric cardia. This study investigated the effect of the ISD on food intake and body weight gain in a rodent model. METHODS: Thirty-two male Sprague-Dawley rats (weight, 250-300 g) were randomly divided into four groups of eight individuals. Single-disk (SD) and double-disk (DD) group animals underwent peroral placement of a single- or double-disk ISD, respectively, under fluoroscopic guidance. The ISD comprised a 4 mm × 1.5 cm nitinol stent placed in the lower esophagus and one (single-disk) or two (double-disk) 2.5-cm-diameter star-shaped nitinol disks placed in the gastric fundus. Esophageal stent (ES) and sham-operated (SO) group animals underwent peroral placement of the ES part of the ISD and a sham operation, respectively. RESULTS: Food intake was significantly different among the four groups over the 4-week study period (P < 0.001); food intake was significantly lower in the SD and DD groups than in the SO group (P = 0.016 and P = 0.002, respectively) but was not significantly different between the SD and DD groups (P > 0.999) and between the ES and SO groups (P = 0.677). Body weight was significantly different among the four groups by the end of the study period (P < 0.001); body weight was significantly lower in the DD group than in the SD, ES, and SO groups (P = 0.010, P < 0.001, and P < 0.001, respectively) and in the SD group than in the SO group (P = 0.001), but it was not significantly different between the ES and SO groups (P = 0.344). CONCLUSION: ISD reduced food intake and suppressed body weight gain in a rodent model.

Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery.

OBJECTIVE: This study aimed to explore the experiences of women who had developed excessively restrictive eating behaviours following bariatric surgery. METHOD: Five female participants, who were at least nine months post-bariatric surgery and exhibiting restrictive eating behaviours, were recruited from Bariatric Surgery Psychology Services and asked to complete qualitative face-to-face semi-structured interviews. The data was analysed using interpretative phenomenological analysis (IPA). RESULTS: Three super-ordinate themes emerged: (1) experiences of weight stigma and weight history on self, (2) the impact of loose skin, (3) thoughts about food and disordered eating patterns. These captured the impact of past weight-related experiences-including weight stigma, intense fears of weight gain, negative cognitions about the self, the impact of excess skin, changes in the way the women thought about food and restrictive eating behaviours. DISCUSSION: This study is one of the first to specifically explore restrictive eating disorders after bariatric surgery using a qualitative approach. The findings of this study may offer helpful aspects for professionals to hold in mind when identifying individuals with problematic restrictive eating behaviours following bariatric surgery. Body contouring surgery, internalised weight bias and weight stigma are explored in relation to the post-bariatric surgery treatment pathway. The current diagnostic criterion for anorexia nervosa are discussed to highlight difficulties in diagnosing this presentation in the post-bariatric surgery population, where people can have BMIs over 25 kg/m2 but are severely restricting energy intake.

Condutas na ritidoplastia e apontamentos histológicos na pele da face do paciente pós-bariátrica / Rhytidoplasty practices and histological notes for the facial skin of post-bariatric patients

Introdução: O número de pacientes classificados com sobrepeso ou obesos e, com isso, dos pacientes pós-bariátricas vem aumentando, gerando uma demanda por ritidoplastias neste perfil de público. O objetivo é expor a rotina e táticas cirúrgicas em um hospital de ensino, o perfil destes pacientes, além de um comparativo superficial histológico da pele, tecido celular subcutâneo e SMAS, entre os pacientes pós e não pós-bariátrica. Métodos: Foi realizado revisão de dados do centro cirúrgico e de prontuário entre os anos de 2012 e 2016 em um hospital público na cidade de Goiânia-GO, com levantamento de 32 casos. Resultados: A tática de ritidoplastia utilizada nos pacientes pós-bariátrica não apresenta grandes diferenças entre a utilizada nos pacientes não pós-bariátrica. A análise histopatológica das amostras colhidas evidenciou diferenças marcantes entre os pacientes pós e não pós-bariátrica. Conclusão: Percebeu-se que a técnica operatória na ritidoplastia do paciente pós-bariátrica sustentou detalhes específicos, com resultado cirúrgico pós-operatório satisfatório, uma pele de pior qualidade histológica, com complicações perioperatórias dentro do esperado e com necessidade de maiores estudos para avaliar durabilidade do procedimento.

Introduction: The number of patients classified as overweight or obese has resulted in an increased number of post-bariatric patients, generating a demand for rhytidoplasty in this public profile. The objective is to expose the routine and surgical tactics in a teaching hospital, patient profiles, subcutaneous cellular tissue, and the superficial musculoaponeurotic system are compared between post-bariatric and non-post-bariatric patients, as well as histological superficial comparison of the skin. Methods: A review of the data of 32 cases treated in 2012­2016 was conducted in a public hospital in Goiânia-GO. Results: The tactics of rhytidoplasty used in post-bariatric patients do not differ significantly from those used in nonpost- bariatric patients. A histopathological analysis of the collected samples showed marked differences between post-bariatric and non-post-bariatric patients. Conclusion: The surgical technique of rhytidoplasty of post-bariatric patients sustained specific details with satisfactory postoperative surgical results, skin with worse histological quality, perioperative complications within the expected range, and the need for further studies to assess the procedure's durability

New Era: Endoscopic treatment options in obesity-a paradigm shift.

The prevalence of obesity continues to rise, and along with it comes a multitude of health-related consequences. The healthcare community has consistently struggled with providing treatment options to obese patients, in part due to the reluctance of patients in pursuing the more effective (yet invasive) surgical approaches such as sleeve gastrectomy and Rou-en-Y gastric bypass. On the other hand, the less invasive approach such as lifestyle/behavioral interventions and pharmacotherapy (Orlistat, Phenteramine, Phentermine/Topiramate, Locaserin, Naltrexon/Buproprion, and Liraglutide) have very limited efficacy, especially in the morbidly obese patients. Despite our best efforts, the epidemic of obesity continues to rise and pose enormous costs on our healthcare system and society. Bariatric endoscopy is an evolving field generated to combat this epidemic through minimally invasive techniques. These procedures can be performed in an ambulatory setting, are potentially reversible, repeatable, and pose less complications than their invasive surgical counterparts. These modalities are designed to alter gut metabolism by means of space occupation, malabsorption, or restriction. In this review we will discuss different bariatric endoscopic options (such as intragastric balloons, endoscopic sleeve gastroplasty, endoscopic aspiration therapies and gastrointestinal bypass sleeves), their advantages and disadvantages, and suggest a new paradigm where providers may start incorporating this modality in their treatment approach for obese patients.

Improvement of Body Composition and Quality of Life Following Intragastric Balloon.

BACKGROUND: The aim is to evaluate the effects of IGB in overweight or class I obese patients, by analyzing body composition and quality of life (QOL). METHODS: Prospective study including patients with BMI 27-34.9 kg/m2.body composition analysis (BCA) was performed before IGB implantation and its removal, after 6 months of treatment. QOL was assessed by the Short Form 36 (SF-36) Health Survey at baseline and after treatment. RESULTS: Forty patients were included in this study, but four were excluded. The total weight decreased by 12.29 kg after 6 months of use of IGB, which corresponds to loss of 13.69% of the total weight. There was a significant reduction in body fat mass and fat area. QOL improved in all eight sections analyzed (p < 0.001 to 0.041): functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health. CONCLUSIONS: IGB induces not only weight loss but changes in body composition through the reduction of body fat mass and fat area. Furthermore, it improves QOL.

Defining and Using Preoperative Predictors of Diabetic Remission Following Bariatric Surgery.

BACKGROUND: Diabetes remission is defined as the return of glycemic control in the absence of medication or insulin use after bariatric surgery. We sought to identify and assess the clinical utility of a predictive model for remission of type 2 diabetes mellitus in a population seeking bariatric surgery. METHOD: A retrospective cohort design was applied to presurgical data on patients referred for Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG). The model developed from logistic regression was compared with a published model through receiver operating characteristic analyses. RESULTS: At 12 months postoperatively, 59.7% of the cohort was remitted, with no differences between RYGB and VSG. Logistic regression analyses yielded a model in which 4 preoperative variables reliably predicted remission. A Hosmer-Lemeshow goodness-of-fit test result of 0.204 indicated good fit of the developed prediction model to our outcome data. The predictive accuracy of this prediction model was compared with a published model, and an associated variation with diabetes years was substituted for age in our patient population. Our model was the most accurate. CONCLUSIONS: Using these predictors, healthcare providers may be able to better counsel patients who are living with diabetes and considering bariatric surgery on the likelihood of achieving remission from the intervention. This refined prediction model requires further testing in a larger sample to evaluate its external validity.

Filling the Void: A Review of Intragastric Balloons for Obesity.

Endoscopic bariatric therapies are predicted to become much more widely used in North America for obese patients who are not candidates for bariatric surgery. Of all the endoscopic bariatric therapies, intragastric balloons (IGBs) have the greatest amount of clinical experience and published data supporting their use. Three IGBs are FDA approved and are now commercially available in the USA (Orbera, ReShape Duo, and Obalon) with others likely soon to follow. They are generally indicated for patients whose BMI ranges from 30 to 40 mg/kg2 and who have failed to lose weight with diet and exercise. IGBs have been shown to be safe, effective, and relatively straightforward to place and remove. Accommodative symptoms commonly occur within the initial weeks post-placement; however, major complications are rare. Gastric ulceration can occur in up to 10% of patients, while balloon deflation with migration and bowel obstruction occurs in <1% of patients. The effectiveness of the Orbera and ReShape Duo IGBs ranges from 25 to 50% EWL (excess weight loss) after 6 months of therapy. The use of IGBs is likely to grow dramatically in the USA, and gastroenterologists and endoscopists should be familiar with their indications/contraindications, efficacy, placement/removal, and complications.

Recent Clinical Results of Endoscopic Bariatric Therapies as an Obesity Intervention.

Despite advances in lifestyle interventions, anti-obesity medications, and metabolic surgery, the issue of health burden due to obesity continues to evolve. Interest in endoscopic bariatric techniques has increased over the years, as they have been shown to be efficacious, reversible, relatively safe, and cost effective. Further, these techniques offer a therapeutic window for some patients who may otherwise be unable to undergo bariatric surgery. This article aims to review the literature on the safety and efficacy of currently offered endoscopic bariatric techniques, as well as those that are in the pipeline of end-development and regulatory approval.

Recent Clinical Results of Endoscopic Bariatric Therapies as an Obesity Intervention

Despite advances in lifestyle interventions, anti-obesity medications, and metabolic surgery, the issue of health burden due to obesity continues to evolve. Interest in endoscopic bariatric techniques has increased over the years, as they have been shown to be efficacious, reversible, relatively safe, and cost effective. Further, these techniques offer a therapeutic window for some patients who may otherwise be unable to undergo bariatric surgery. This article aims to review the literature on the safety and efficacy of currently offered endoscopic bariatric techniques, as well as those that are in the pipeline of end-development and regulatory approval.

Cirugía bariátrica: generalidades / Bariatric surgery: general

La obesidad es considerada una epidemia en la actualidad. Es definida por la OMS como un índice de masa corporal (IMC) mayor o igual a 30. Se han realizado numerosos esfuerzos para determinar distintos tratamientos que permitan disminuir tanto la prevalencia de dicha enfermedad como las complicaciones asociadas a la misma.La cirugía bariátrica marca el inicio de una nueva era, en la que es posible reducir la morbi-mortalidad asociada a la obesidad. Específicamente se ha demostrado remisión en algunos casos de diabetes, tendencia a la mejoría en pacientes con NAFLD, NASH y reflujo gastroesofágico, así como franca mejoría a nivel cardiovascular. El propósito principal de este artículo es discutir el impacto de la cirugía bariátrica sobre dichas comorbilidades y sobre mortalidad, además las técnicas quirúrgicas, complicaciones y criterios de selección, con el fin de definir cuáles pacientes se benefician de este abordaje.

Obesity is defined as a body mass index greater or equal to 30, nowadays it is considered an epidemic. Numerous efforts have been carried on in order to define treatments that will effectively reduce the prevalence and complications of this condition. Bariatric surgery came to mark the beginning to a new era in this field; it demonstrated a reduction in morbi-mortality in patients with obesity. It has proven to induce remission in patients with diabetes, to improve NAFLD, NASH and GERD, and to be associated to a definite cardiovascular benefit. The main purpose of this article is to discuss the impact that bariatric surgery has over these comorbidities as well as on mortality. Surgical techniques, complications, and selection criteria are also addressed with the objective of defining which patients will benefit from this intervention.

Manga gástrica laparoscópica. Revisión detallada / Laparoscopic sleeve gastrectomy

Resumen La cirugía bariátrica es una rama de la medicina que se dedica al tratamiento de la obesidad y sus posibles comorbilidades a través de procedimientos quirúrgicos. Presentamos la historia y varios aspectos de la manga gástrica laparoscópica a través de 20 años. La reducción de peso se logra aquí por varios mecanismos: uno es la reducción del volumen estomacal y otro es la menor secreción de la hormona ghrelina; lo que promueve una saciedad más rápida y una reducción del apetito. Karamankos S.N. encontraron un mayor porcentaje en la apérdida del exceso de peso con manga gástrica que con bypass gástrico en un seguimiento a 1 año (69,7 ± 14,6% contra 60,5 ± 10,7%). En un metaanálisis publicado en 2011, Padwal R. y cols. concluyeron que existe una mayor disminución de índice de masa corporal en pacientes sometidos a manga gástrica que en bypass gástrico de −10,1 kg/m2 y -9 kg/m2 respectivamente.

Abstract Bariatric surgery is a medical specialty dedicated to the treatment of obesity and its comorbidities through surgical procedures. We present a detailed collection on the history and evolution of laparoscopic sleeve gastrectomy over the course of 20 years. The gastric sleeve induces weight loss by several mechanisms. It significantly reduces gastric chamber size and decreases the secretion of the hormone called ghrelin, thus promoting quicker satiety and decreasing appetite. Karamankos S.N. found a greater percentage of excess-weight loss with gastric sleeve than with bypass in a 1-year follow-up (69,7% ± 14,6% versus 60,5% ± 10,7%). A 2011 meta-analysis by Padwal R. et al. concluded that there is a greater decrease in body mass index in patients undergoing sleeve gastrectomy than with gastric bypass, -10,1 kg/m2 and -9 kg/m2, respectively.

Practical issues in the surgical care of the obese patient.

The incidence of obesity has steadily climbed to epidemic proportions in the United States. To provide optimal surgical care for the growing number of obese surgical patients, surgeons and other healthcare personnel must often modify routine procedures and standard treatment protocols. Psychological support of obese patients is an additional factor that frequently must be addressed during the perioperative period.