Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.045
Filtrar
1.
Transpl Int ; 35: 10256, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35497890

RESUMO

Weight gain after liver transplantation (LTx) contributes to new-onset obesity. We explored patients' experiences with gaining weight after LTx. Individual interviews were guided by open-ended questions. We analyzed transcripts with the reflexive thematic analysis approach by Braun and Clarke. The 12 participants gained 11.5 kg weight (median) over a median of 23 months after LTx. The constitutive theme "The main thing is to be alive" was a recurrent insight, captured in three facets: "The arduous path back to living" was the emotional expression of the ups and downs during a life-threatening illness to finally being grateful for the new life. "A pleasurable new phase of life" was the legitimation, reflecting the appreciation of gaining weight and returning to a healthy appearance. "I am allowed to look like this now" was the consoling facet after a time of burden due to the increased weight and frustration of being unsuccessful in losing weight. Finally, the awareness of being a LTx survivor outplayed the burden of the excess weight. Early interventions are crucial because the comforting insight "I am allowed to look like this now" may hinder further engagement in weight loss activities. Our recommendations on education and self-management support may guide clinical practice.


Assuntos
Transplante de Fígado , Humanos , Obesidade/cirurgia , Pesquisa Qualitativa , Sobreviventes , Ganho de Peso
2.
JSLS ; 26(1)2022.
Artigo em Inglês | MEDLINE | ID: mdl-35444403

RESUMO

Background: Obesity is a chronic, multifactorial disease associated with multiple cardiometabolic conditions. The successful management of this condition includes a multidisciplinary approach with interventions focused on lifestyle modification, pharmaceutical therapies, and bariatric surgery. Endoscopic bariatric therapies (EBT) have been proposed as a way to bridge the gap between medical management and bariatric surgery. The Association for Bariatric Endoscopy in conjunction with the American Society for Gastrointestinal Endoscopy published the position statement approving and integrating EBT into practice. The aim of this article is to review the most common primary EBT's, their indications, outcomes, and complications. Database: A medical literature review was conducted using the defined keywords. Databases included PubMed, Google Scholar, Embase, and EBSCO. Articles in English were considered for review from June 1, 2000 to June 30, 2021. Conclusion: Endoscopic bariatric therapies should be offered in conjunction with lifestyle modification and with nutritional guidance, as part of a multidisciplinary approach in obesity management. They require a formal training process for endoscopists and bariatric surgeons to obtain the endoscopic skills needed before performing these procedures. Longer follow-up and larger trials are needed to validate current evidence, in order to enhance the process of standardization of these techniques.


Assuntos
Cirurgia Bariátrica , Cirurgia Bariátrica/métodos , Endoscopia Gastrointestinal , Humanos , Obesidade/cirurgia
3.
BMC Anesthesiol ; 22(1): 98, 2022 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-35382771

RESUMO

There has been an observed increase in theprevalence of obesity over the past few decades. The prevalence of anesthesiology related complications is also observed more frequently in obese patients as compared to patients that are not obese. Due to the increased complications that accompany obesity, obese patients are now more often requiring surgical interventions. Therefore, it is important that anesthesiologists be aware of this development and is equipped to manage these patients effectively and appropriately. As a result, this review highlights the effective management of obese patients undergoing surgery focusing on the preoperative, perioperative and postoperative care of these patients.


Assuntos
Anestésicos , Complicações Pós-Operatórias , Índice de Massa Corporal , Humanos , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/cirurgia , Complicações Pós-Operatórias/epidemiologia
4.
Obes Surg ; 32(6): 1831-1841, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35362916

RESUMO

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is the most common type of bariatric surgery in Japan, and it is the only such procedure covered by national health insurance. The long-term cost of bariatric surgery in Japan has not yet been analyzed. We aimed to evaluate the long-term impact of LSG on the drug treatment costs of patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: We retrospectively analyzed data from 230 patients who had undergone LSG at our institution for their obesity and T2DM between 2007 and 2018. The clinicopathological data included age, sex, body mass index (BMI), as well as preoperative and postoperative medications for T2DM, hypertension, and dyslipidemia. We then calculated the drug treatment costs for T2DM, hypertension, and dyslipidemia before and after LSG; and we evaluated the remission rates of these obesity-related diseases. RESULTS: The median preoperative body weight and BMI of the 230 patients who underwent LSG were 115 kg and 40.6 kg/m2, respectively. Preoperative drug treatment costs per month per patient for T2DM, hypertension, and dyslipidemia were ¥3795 (¥0-40285), ¥3269 (¥0-14577), and ¥1428 (¥0-19464). Post-operation, the median drug treatment costs for all these diseases became nil. The remission rates of T2DM, hypertension, and dyslipidemia 5 years after LSG were 82.8%, 50%, and 43.8%, respectively. In Japan, the cost of an LSG operation corresponds to 4.75 years of median drug costs to treat T2DM and hypertension. CONCLUSION: In the long term, LSG in Japan is effective both physically and cost-wise for patients with obesity and T2DM.


Assuntos
Diabetes Mellitus Tipo 2 , Hipertensão , Laparoscopia , Obesidade Mórbida , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/etiologia , Diabetes Mellitus Tipo 2/cirurgia , Custos de Medicamentos , Gastrectomia/métodos , Humanos , Hipertensão/cirurgia , Japão , Laparoscopia/métodos , Obesidade/etiologia , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
5.
Obes Surg ; 32(6): 1872-1883, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35386040

RESUMO

PURPOSE: Bariatric surgery has been uncovered to relieve nonalcoholic fatty liver disease (NAFLD) in patients with obesity, while current studies have neutral or opposite results. This systematic review and meta-analysis aimed to evaluate the effects of bariatric surgery on NAFLD in patients with obesity. MATERIALS AND METHODS: PubMed, Embase, Cochrane Central, and Web of Science databases were performed to obtain publications containing comparison results of liver biopsy before and after bariatric surgery in obesity. Primary outcomes were biopsy-confirmed remission of NAFLD and NAFLD activity scores. Secondary outcomes were liver function. This study was registered with PROSPERO, CRD42021240346. RESULTS: Thirty-seven studies were included. After bariatric surgery, a biopsy-confirmed resolution of steatosis was improved in 56% of patients, ballooning degeneration in 49%, inflammation in 45%, and fibrosis in 25%. Bariatric surgery significantly decreased mean NAFLD activity scores. RYGB achieved the most obviously improvements in steatosis, and SG attained the most notably ameliorations in fibrosis. The percentage of patients with improved steatosis and hepatic fibrosis in Asian countries was higher than non-Asian countries. The reduction of ALT and AST was 11.95U/L and 6.44 U/L after surgery. CONCLUSION: Our study has revealed that bariatric surgery brought out significantly resolution of NAFLD in individuals with obesity. RYGB and SG have been proved to be of benefit to many hepatic parameters, and the improvement of liver steatosis and fibrosis, particularly in Asian countries. It is strongly suggested that bariatric surgery should be considered as a novel treatment for NAFLD.


Assuntos
Cirurgia Bariátrica , Hepatopatia Gordurosa não Alcoólica , Obesidade Mórbida , Cirurgia Bariátrica/métodos , Humanos , Fígado/patologia , Fígado/cirurgia , Cirrose Hepática/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade/cirurgia , Obesidade Mórbida/cirurgia
6.
Front Endocrinol (Lausanne) ; 13: 867838, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35432187

RESUMO

Introduction: The prevalence of obesity has increased exponentially in recent decades, being one of the diseases that most affects global health. It is a chronic disease associated with multiple comorbidities, which lead to a decrease in life expectancy and quality of life. It requires a multidisciplinary approach by a specialized medical team. Obesity can be treated with conservative or with surgical treatments that will depend on the characteristics of the patient. Objective/Methodology: The referenced surgery can be performed using different surgical techniques that are analyzed in the present work through an exhaustive narrative bibliographic review in the PubMed and Cochrane databases, as well as in UpToDate. Results: Currently, those most used are restrictive techniques, specifically vertical gastrectomy and mixed techniques, with gastric bypass being the "gold standard". Conclusions: In order to choose one technique or another, the characteristics of each patient and the experience of the surgical team must be taken into account.


Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Gastrectomia/métodos , Derivação Gástrica/métodos , Humanos , Laparoscopia/métodos , Obesidade/complicações , Obesidade/cirurgia , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Qualidade de Vida
7.
J Am Coll Cardiol ; 79(15): 1429-1437, 2022 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-35422238

RESUMO

BACKGROUND: The long-term effect of bariatric surgery on cardiovascular outcomes in the elderly population is not well studied. OBJECTIVES: The aim of this study was to evaluate the association between bariatric surgery and long-term cardiovascular outcomes in the Medicare population. METHODS: Medicare beneficiaries who underwent bariatric surgery from 2013 to 2019 were matched to a control group of patients with obesity with a 1:1 exact matching based on age, sex, body mass index, and propensity score matching on 87 clinical variables. The study outcomes included all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. An instrumental variable analysis was performed as a sensitivity analysis. RESULTS: The study cohort included 189,770 patients (94,885 matched patients in each group). By study design, the 2 groups had similar age (mean: 62.33 ± 10.62 years), sex (70% female), and degree of obesity (mean body mass index: 44.7 ± 7.3 kg/m2) and were well balanced on all clinical variables. After a median follow-up of 4.0 years (IQR: 2.4-5.7 years), bariatric surgery was associated with a lower risk of mortality (9.2 vs 14.7 per 1,000 person-years; HR: 0.63; 95% CI: 0.60-0.66), new-onset HF (HR: 0.46; 95% CI: 0.44-0.49), MI (HR: 0.63; 95% CI: 0.59-0.68), and stroke (HR: 0.71; 95%: CI: 0.65-0.79) (P < 0.001). The benefit of bariatric surgery was evident in patients who were 65 years and older. Using instrumental variable analysis, bariatric surgery was associated with a lower risk of mortality, HF, and MI. CONCLUSIONS: Among Medicare beneficiaries with obesity, bariatric surgery is associated with lower risk of mortality, new-onset HF, and MI.


Assuntos
Cirurgia Bariátrica , Insuficiência Cardíaca , Infarto do Miocárdio , Idoso , Índice de Massa Corporal , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/cirurgia , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/cirurgia , Estudos Retrospectivos , Estados Unidos/epidemiologia
9.
Obes Surg ; 32(6): 2010-2022, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35419698

RESUMO

PURPOSE: Bariatric surgery is emerging as an effective treatment for obesity and the metabolic syndrome. Recently, we demonstrated that Roux-en-Y gastric bypass (RYGB), but not vertical sleeve gastrectomy (VSG), resulted in improvements to white adipose physiology and enhanced brown adipose functioning. Since beneficial alterations to liver health are also expected after bariatric surgery, comparing the post-operative effects of RYGB and VSG on liver physiology is essential to their application in the treatment of non-alcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS: The effects of RYGB and VSG on liver physiology were compared using diet induced mouse model of obesity. High-fat diet (HFD) was administered for 12 weeks after surgery and alterations to liver physiology were assessed. RESULTS: Both RYGB and VSG showed decreased liver weight as well as reductions to hepatic cholesterol and triglyceride levels. There were demonstrable improvements to NAFLD activity score (NAS) and fibrosis stage scoring after both surgeries. In RYGB, these beneficial changes to liver function resulted from the downregulation of pro-fibrotic and upregulation anti-fibrotic genes, as well as increased fatty acid oxidation and bile acid flux. For VSG, though similar alterations were observed, they were less potent. However, VSG did significantly downregulate pro-fibrotic genes and showed increased glycogen content paralleled by decreased glycogenolysis which may have contributed to the resolution of NAFLD. CONCLUSION: RYGB and VSG improve liver physiology and function, but RYGB is more efficacious. Resolutions of NAFLD in RYGB and VSG are achieved through different processes, independent of weight loss.


Assuntos
Derivação Gástrica , Hepatopatia Gordurosa não Alcoólica , Obesidade Mórbida , Animais , Dieta Hiperlipídica , Gastrectomia/métodos , Derivação Gástrica/métodos , Humanos , Camundongos , Hepatopatia Gordurosa não Alcoólica/etiologia , Hepatopatia Gordurosa não Alcoólica/cirurgia , Obesidade/cirurgia , Obesidade Mórbida/cirurgia
10.
Trials ; 23(1): 264, 2022 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-35392958

RESUMO

BACKGROUND: Laparoscopic one anastomosis gastric bypass (LOAGB) is a simple variation of gastric bypass and has gained worldwide popularity with clinical outcomes similar to laparoscopic Roux-en-Y gastric bypass (LRYGB) for weight loss and management of comorbidities. However, biliary reflux to the esophagus negates the benefits of LOAGB. In addition, weight gain after LOAGB and after LRYGB is a major problem in bariatric surgery. The aim of this article is to describe the design and protocol of a randomized controlled trial comparing the outcomes of two methods of LOAGB: experimental method with wrapping versus standard method nonwrapping fundus of the excluded part of the stomach to prevent weight regain and biliary reflux after LOAGB. METHODS: The study was designed as a single-center prospective, interventional, randomized controlled trial. Masking: None (open label). Allocation: randomized. Enrollment: 100 obese patients. The relevant ethics committee approved the trial protocol. The endpoints (body mass index, bile reflux in the esophagus, other reflux symptoms) will be assessed presurgery and postsurgery (12, 24, and 36 months postoperatively). DISCUSSION: With its 3-year follow-up time, this RCT will provide important data on the impact of wrapping the fundus of the excluded part of the stomach to prevent weight regain and biliary reflux after LOAGB. TRIAL REGISTRATION: ClinicalTrials.gov NCT04834635 . Registered on 8 April 2021.


Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Gastrectomia/métodos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Obesidade/diagnóstico , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estômago/cirurgia , Resultado do Tratamento , Ganho de Peso
11.
BMJ Open ; 12(4): e053242, 2022 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-35396282

RESUMO

OBJECTIVES: To compare long-term effects and complications of medical treatment (MT) of obesity including very low energy diet with bariatric surgery. DESIGN AND SETTING: This prospective study conducted in a clinical setting recruited individuals with body mass index (BMI) ≥35 kg/m2 referred for obesity treatment. Demographic and anthropometric data, laboratory samples, and questionnaire replies were collected at baseline and 2 years. PARTICIPANTS AND INTERVENTIONS: 971 individuals were recruited 2015-2017. 382 received MT, 388 Roux-en-Y gastric bypass (RYGB) and 201 sleeve gastrectomy (SG). MAIN OUTCOME MEASURES: Primary outcomes included changes in anthropometric measures, metabolic variables and safety. These were analysed using a linear regression model. A logistic regression model was used to analyse composite variables for treatment success (secondary outcomes). A random forest (RF) model was used to examine the importance of 15 clinical domains as predictors for successful treatment. RESULTS: Two-year data were available for 667 individuals (68.7%). Regarding primary outcomes, the decrease in excess BMI was 27.5%, 82.5% and 70.3% and proportion achieving a weight of >10% was 45.3%, 99.6% and 95.6% for MT, RYGB and SG, respectively (p<0.001). The groups were comparable regarding levels of vitamins, minerals and haemoglobin or safety measures. Likelihood for success (secondary outcome) was higher in the surgical groups (RYGB: OR 5.3 (95% CI 3.9 to 7.2) vs SG: OR 4.3 ((95% CI 3.0 to 6.2)) in reference to MT. Baseline anthropometry had the strongest predictive value for treatment success, according to the RF model. CONCLUSIONS: In clinical practice, bariatric surgery by RYGB or SG is most effective, but meaningful weight loss is achievable by MT with strict caloric restriction and stepwise introduction of a normal diet. All treatments showed positive effects on well-being, cardiovascular risk factors, and levels of vitamins and minerals at 2-year follow-up and groups were similar regarding safety measures. TRIAL REGISTRATION NUMBER: NCT03152617.


Assuntos
Cirurgia Bariátrica , Obesidade , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Restrição Calórica , Derivação Gástrica/efeitos adversos , Humanos , Obesidade/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Vitaminas
12.
Eur Rev Med Pharmacol Sci ; 26(5): 1484-1491, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35302192

RESUMO

OBJECTIVE: The melanocortin system is an important neural system underlying the control of body weight and food intake. This system has recently received great attention as a potential target for obesity treatment. Therefore, the objective of this study was to find out the leptin-melanocortin pathway before and after Laparoscopic Sleeve Gastrectomy (LSG) in obese patients. PATIENTS AND METHODS: The study was carried out with a total of 144 individuals in 3 groups [control, obese group before LSG and obese group after LSG (who underwent LSG one year ago)]. The amount of leptin (LEP), leptin receptor (LEPR), tropomyosin receptor kinase receptor B (TrkB), brain-derived neurotrophic factor (BDNF), pro-opiomelanocortin (POMC) and melanocortin-4 receptors (MC4R) molecules were measured by using Enzyme-Linked Immunosorbent Assays. RESULTS: A statistically significant difference was found between the groups in terms of body mass index (BMI) values (p = 0.001). There was also statistically significant difference present between obese before LSG group and obese after LSG group regarding the levels of LEP, TrkB, BDNF and proteins (p < 0.05). A decline was determined in the LEP and BDNF levels one year follow-up after LSG. CONCLUSIONS: The evidence suggests that the leptin melanocortin pathway strictly regulates food intake and BMI before and after LSG surgery. This pathway should be kept under control for effectively reducing food intake and body weight in the treatment of obesity.


Assuntos
Laparoscopia , Obesidade Mórbida , Índice de Massa Corporal , Fator Neurotrófico Derivado do Encéfalo , Gastrectomia , Humanos , Leptina , Melanocortinas , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Resultado do Tratamento
14.
Curr Neurol Neurosci Rep ; 22(4): 257-264, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35332515

RESUMO

PURPOSE OF REVIEW: Idiopathic intracranial hypertension (IIH) is a disorder primarily affecting obese women of childbearing age and, if left untreated, can lead to irreversible vision loss. No consensus exists on the best management strategy for IIH. Weight loss is advocated and few useful medical options exist. There is an unmet need to discover new treatment options for this increasingly prevalent condition. This article reviews the recent advances and research on the treatment of IIH. RECENT FINDINGS: Venous sinus stenting (VSS) is now performed in many experienced centers, and there is growing interest in bariatric surgery as a treatment modality. Newly approved anti-obesity drugs are showing effectiveness in weight loss, and novel targeted disease-modifying IIH therapies are being explored. Further evaluation of these novel therapeutic strategies as well as studies exploring the use of anti-obesity drugs in IIH is needed. While VSS is gaining popularity due to its efficacy and low complication rate, there is insufficient evidence to support any surgical procedure over another. Bariatric surgery is appealing for patients with non-sight-threatening IIH and needs to be further explored.


Assuntos
Fármacos Antiobesidade , Pseudotumor Cerebral , Feminino , Humanos , Obesidade/complicações , Obesidade/cirurgia , Pseudotumor Cerebral/terapia , Stents , Perda de Peso
15.
Scand J Surg ; 111(1): 14574969211072395, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35253540

RESUMO

BACKGROUND AND OBJECTIVE: Obesity is prevalent and has a negative impact on women's health, including sexual dysfunction. Recent review articles suggest improvement in Female Sexual Function Index (FSFI) and proportion of female sexual dysfunction (FSD) among women with obesity after bariatric surgery. METHODS: We pooled data from 16 observational studies involving 953 women. The study outcomes were mean FSFI scores and proportion of FSD before and after bariatric surgery. We also sub-analyzed whether age and duration of follow-up affected these outcomes. RESULTS: The mean age of the subjects was 39.4 ± 4.2 years. Body mass index (BMI) showed significant reduction postoperatively (p < 0.0001). Bariatric surgery led to significant improvement in total FSFI score (p = 0.0005), and all sexual domains except pain. Bariatric surgery reduced the odds of having FSD by 76% compared with those who did not undergo operation (OR 0.24, 95% CI = 0.17, 0.33, p < 0.0001). Our sub-analysis demonstrated a significant reduction in the proportion of FSD for patients <40 years of age. The improvement of total FSFI scores and reduction in proportion of FSD remained significant within the first 12 months after surgery. Univariate meta-regression showed that BMI was not a significant covariate for improvement of FSFI scores (ß = 0.395, p = 0.1, 95% CI = 0.884, 0.095). CONCLUSIONS: Bariatric surgery is shown to improve sexual function scores and prevalence of FSD. This is especially significant among women <40 years of age. This benefit remained significant within the first year after surgery. This appears to be an additional benefit for these patients.


Assuntos
Cirurgia Bariátrica , Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Adulto , Feminino , Humanos , Obesidade/complicações , Obesidade/cirurgia , Comportamento Sexual , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/epidemiologia , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/cirurgia , Inquéritos e Questionários
16.
Surg Obes Relat Dis ; 18(5): 569-576, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35241377

RESUMO

BACKGROUND: NIH-established indications for bariatric surgery were set close to 3 decades ago. OBJECTIVES: The purpose of this study was to evaluate outcomes in patients undergoing bariatric surgery with class I obesity, a class that does not fall into current indications. SETTING: University Hospital. METHODS: De-identified records from a clinic system's Electronic Health Record database were accessed to identify adult patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 566) and sleeve gastrectomy (SG) (n = 730). Patients were compared in terms of resolution of co-morbidities and weight loss outcomes at 3 years following surgery. A mixed effects model was used, adjusting for the type of surgery, the number of quarters after the surgery when the averaged measurements were taken, and the interaction between these two variables. RESULTS: Patients lost up to 20% of their initial body mass index (BMI). Being of younger age, female, and having an obesity-related co-morbidity were associated with greater weight loss. At around 2 years after the surgery, the likelihood of being in remission from type 2 diabetes reached 45%. Remission probabilities for hypertension are 60% for RYGB and 50% for SG, 3 years after the surgery. On the other hand, the probabilities of remission from hyperlipidemia are close to 50% and 25% for RYGB and SG at 2 years. There was no difference between the BMI trajectories and remission from type 2 diabetes (T2D) when comparing the 2 groups. CONCLUSIONS: Bariatric surgery is effective in weight loss and resolution of comorbidities in patients with class I obesity. This data further supports the need to revisit the current indication criteria.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Derivação Gástrica , Obesidade Mórbida , Adulto , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Gastrectomia , Humanos , Obesidade/cirurgia , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Perda de Peso
17.
Surg Obes Relat Dis ; 18(5): 610-619, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35256278

RESUMO

BACKGROUND: Metabolic surgery is associated with improved cardiovascular risk profile. Randomized and observational studies exploring the impact of bariatric surgery on follow-up coronary revascularization (CR) as a primary endpoint are limited. OBJECTIVES: To identify the impact of metabolic surgery on the risk of follow-up CR, including percutaneous coronary revascularization (PCI) and coronary artery bypass grafting (CABG) SETTING: Stony Brook Department of Surgery, Stony Brook University Hospital, New York, United States. METHODS: A retrospective analysis was performed for patients with obesity between 2006 and September 2015. Patients were divided into those with history of metabolic surgery and those without. Patient were also stratified by bariatric surgery type. All study groups were followed till 2018 and for at least 3 years to monitor the development of the primary endpoint-any CR including PCI or CABG. RESULTS: The study population with obesity was 515,307 patients; 95,901 with history of surgery versus 419,406 matched patients without. A total of 12,873 (13.4%) with surgery and 51,478 (12.27%) without were lost to follow-up by 2018. The group with history of surgery had a reduced risk of future CR (hazard ratio [HR], .46; 95% confidence interval [CI]: .42-.50; P < .0001), PCI (HR, .45; 95% CI: .41-.49; P < .0001) and CABG (HR, .49; 95% CI:.42-.56; P < .0001). In subgroup analysis, laparoscopic adjustable gastric banding compared with Roux-en-Y gastric bypass (RYGB) was associated with higher follow-up CR (HR, 1.34; 95% CI: 1.11-1.63; P < .01) and PCI (HR, 1.34; 95% CI: 1.07-1.68; P < .05). CONCLUSION: Bariatric surgery is associated with reduced risk of future CR, PCI, and CABG. Upon subgroup analysis, RYGB was associated with reduced risk of PCI and CR.


Assuntos
Cirurgia Bariátrica , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Doença da Artéria Coronariana/cirurgia , Humanos , Obesidade/complicações , Obesidade/cirurgia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
ESC Heart Fail ; 9(3): 1844-1852, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35274493

RESUMO

AIM: We aim to assess the risk of heart failure in patients with obesity with and without gastric bypass surgery compared with population controls. METHODS AND RESULTS: This cohort study included all patients aged 20-65 years with a first ever registered principal diagnosis of obesity in the Swedish Patient Register in 2001-2013. These patients were matched by age, sex, and region with two population controls from the general Swedish population without obesity diagnosis. The obesity cohort was divided into two groups: 27 882 patients who had undergone gastric bypass surgery within 2 years of obesity diagnosis and 39 564 patients who had not undergone such surgery. These groups were compared with 55 149 and 78 004 matched population controls, respectively. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, education, and sex. During follow-up (maximum 10 years, median 4.4 years, and interquartile range 2.5-7.2 years), 1884 participants were hospitalized for heart failure. Compared with population controls, gastric bypass patients had no excess risk of heart failure during the initial 0-≤4 years of follow-up (HR = 1.35 [95% CI = 0.96-1.91]) but a marked increased risk during the final >4-10 years of follow-up (HR = 3.28 [95% CI = 2.25-4.77]). Non-operated patients with obesity had a marked excess risk of heart failure throughout the study period compared with population controls. CONCLUSIONS: Gastric bypass for obesity seems to reduce the risk of heart failure to levels similar to the general population during the initial 4 years after surgery, but not thereafter.


Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Insuficiência Cardíaca , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Estudos de Coortes , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Humanos , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/cirurgia
20.
Obes Surg ; 32(5): 1586-1600, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35277793

RESUMO

Obesity may be treated by bariatric procedures and is related to enterohormone release modulation. Nevertheless, a majority of commonly used surgical procedures have a significant impact on vagus nerve function by breaking the connections with its gastric branches. In the case of an intragastric balloon (BAL), this interaction is unclear. However, BAL-induced weight reduction is not long-lasting. Interestingly, this method has not been used in combination with vagotomy (VAG). Thus, we evaluated, for the first time, the short- and long-term effects of combined BAL and VAG using the animal-based translational model and compared these effects with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Wistar rats were fed a high-calorie diet for 8 weeks to induce obesity before SG, RYGB, BAL + / - VAG. Animals' weight and eating behaviors were monitored weekly. After 90 days, serum samples were collected to evaluate postprandial and fasting GLP-1, GIP, PYY, ghrelin, glucagon, insulin, leptin, and pancreatic polypeptide concentrations by fluorescent assay. VAG, SG, RYGB, and BAL + VAG significantly reduced body weight 30 and 90 days after surgery. BAL alone induced temporal weight reduction observed after 30 days, reversed after 90 days. Calories intake was reduced at the first half of the observation period in all groups. Fluid intake was reduced in all groups except SG and BAL. Enterohormone profile for BAL + VAG was comparable to SG and RYGB but not BAL. VAG and BAL + VAG but not BAL alone maintain weight reduction, alimentary intake changes, and enterohormone release after long-term observation. VAG may improve the effectiveness of bariatric procedures for obesity treatment in clinical practice.


Assuntos
Cirurgia Bariátrica , Balão Gástrico , Derivação Gástrica , Obesidade Mórbida , Animais , Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Derivação Gástrica/métodos , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Ratos , Ratos Wistar , Vagotomia , Perda de Peso/fisiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...