Bariatric surgery versus medical therapy in Korean obese patients: prospective multicenter nonrandomized controlled trial (KOBESS trial)

Purpose@#The aim of this study was to show that bariatric surgery (BS) is more effective than medical therapy (MT) in Asian obese patients. @*Methods@#In this prospective, multicenter, nonrandomized, controlled trial, obese patients with body mass index of ≥35 kg/m2 or 30.0–34.9 kg/m2 with obesity-related comorbidities were assigned to undergo BS, such as laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass, or MT. Patients who underwent BS were evaluated 4, 12, 24, and 48 weeks after surgery, whereas patients who received MT were monitored at a hospital every 6 weeks for 1 year. At each visit, weight, waist and hip circumference, and blood pressure were measured, and patients underwent physical examination and laboratory testing. Health-related quality of life (HQOL) was investigated using Euro QOL-5 Dimension, Impact of Weight on Quality of Life questionnaire-Lite and Obesity-related Problems scale. @*Results@#The study included 264 patients from 13 institutions; of these, 64 underwent BS and 200 received MT. Of the patients who underwent BS, 6.3% experienced early complications. Relative weight changes from baseline to 48 weeks were significantly greater in the BS than in the MT group (26.9% vs. 2.1%, P < 0.001), as were the rates of remission of diabetes (47.8% vs. 16.7%, P = 0.014), hypertension (60.0% vs. 26.1%, P < 0.001), and dyslipidemia (63.2% vs. 22.0%, P < 0.001). HQOL was better in the BS than in the MT group at 48 weeks. @*Conclusion@#BS was safe and effective in Korean obese patients, with greater weight reduction, remission of comorbidities, and quality of life improvement than MT.

Continuous Positive Airway Pressure Therapy Can Prevent Pulmonary Atelectasis after Laparoscopic Roux-en-Y Gastric Bypass Surgery in Obese Patients

PURPOSE: To compare the prophylactic effects of postoperative continuous positive airway pressure (CPAP) therapy plus conventional postoperatively pulmonary physiotherapy (CPP) and postoperative CPP alone on the development of pulmonary atelectasis after laparoscopic Roux-en-Y gastric bypass (LGBP) in obese patients. MATERIALS AND METHODS: Patients with BMIs>27.5 kg/m2 aged between 20 and 65 years were enrolled in the present study. All subjects received LGBP and were divided into 2 groups. Patients in the CPAP group received both CPAP and CPP therapy postoperatively, and patients in the conventional group received CPP alone. The primary outcome was the incidence of postoperative pulmonary atelectasis as determined by chest X-ray after LGBP, and the secondary outcome was duration of postoperative hospital stay (HS). RESULTS: Seventy-three patients were enrolled in this study. Fifty-seven patients received CPAP plus CPP, and 16 patients received CPP. The CPAP group had an atelectasis incidence of 40.4% (23/57) and the conventional group an incidence of 62.5% (10/16). Multivariate analysis showed the incidence of atelectasis after LGBP was significantly lower in the CPAP group (OR 0.198, 95% CI 0.045–0.874; P=0.033) and that HS was significantly correlated with the developments of atelectasis, pneumonia, and complications (partial correlation coefficients 0.271, 0.444 and 0.382; P-values 0.025, <0.05 and <0.05, respectively). CONCLUSION: Patients that received continuous positive airway pressure therapy plus conventional pulmonary physiotherapy postoperatively were at significantly less risk of developing pulmonary atelectasis after LGBP than patients that received conventional pulmonary physiotherapy postoperatively.

Long-term effect of bariatric surgery versus conventional therapy in obese Korean patients: a multicenter retrospective cohort study

PURPOSE: Long-term results following bariatric surgery compared to conventional treatments has never been reported in morbidly obese Korean patients. This study aimed to evaluate the long-term efficacy of bariatric surgery in morbidly obese Korean patients compared to conventional medical treatments. METHODS: In this multicenter retrospective cohort study, we reviewed 137 obese subjects between January 2008 and February 2011 with a body mass index (BMI) > 30 kg/m2 who had more than 5 years of follow-up clinical data after bariatric surgery (surgery group, n = 49) or conventional treatment (conventional treatment group, n = 88). Anthropometric data and the status of comorbidities were compared between the 2 groups. RESULTS: The median follow-up period was 72.1 months (range 19.3–109.7 months). At the last follow-up, the surgery group showed a greater amount of total weight loss than the conventional treatment group (24.9% vs. 2.8%, P < 0.001). The prevalence of diabetes and hypertension significantly decreased in the surgery group, while the conventional treatment group showed a marked increase in these comorbidities. In the surgery group, Roux-en-Y gastric bypass and sleeve gastrectomy achieved comparable long-term weight loss (26.5% vs. 22.4%, respectively; P = 0.087). CONCLUSION: In the long-term, bariatric surgery achieved and maintained significantly greater weight reduction, as well as a decrease in obesity-related comorbidities, than did conventional medical therapy in morbidly obese Korean patients.

Metabolic Surgery in Korea: What to Consider before Surgery

Obesity is increasing globally and represents a significant global health problem because it predisposes towards various diseases, such as type 2 diabetes mellitus, cardiovascular disease, degenerative joint disease, and certain types of cancer. Numerous studies have shown that bariatric surgery reduces body mass and ameliorates obesity-related complications, such as hypertension and hyperglycemia, suggesting that surgery is the most effective therapeutic option for severely obese and obese diabetic patients. Recent international guidelines recommend surgical treatment for diabetic patients with class III obesity (body mass index [BMI] >40 kg/m²), regardless of their level of glycemic control or the complexity of their glucose-lowering regimens, and for patients with class II obesity (BMI 35.0 to 39.9 kg/m²) and hyperglycemia that is poorly controlled despite appropriate lifestyle and pharmacological therapy. The most popular procedures are Roux-en-Y gastric bypass and sleeve gastrectomy, but new procedures with better outcomes have been reported. For optimal surgical outcome, comprehensive management including assessments of a medical condition, nutrition, mental health, and social support is needed before and after surgery. However, there is still a lack of understanding regarding metabolic surgery in Korea. Therefore, this article reviews indications for metabolic surgery in patients with a specific focus on the situation in Korea.

Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy vs. Gastric Banding: The First Multicenter Retrospective Comparative Cohort Study in Obese Korean Patients

PURPOSE: Bariatric surgery is relatively new in Korea, and studies comparing different bariatric procedures in Koreans are lacking. This study aimed to compare the clinical outcomes of laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) for treating morbidly obese Korean adults. MATERIALS AND METHODS: In this multicenter retrospective cohort study, we reviewed the medical records of 261 obese patients who underwent different bariatric procedures. Clinical outcomes were measured in terms of weight loss and resolution of comorbidities, such as diabetes, hypertension, and dyslipidemia. Safety profiles for the procedures were also evaluated. RESULTS: In terms of weight loss, the three procedures showed similar results at 18 months (weight loss in 52.1% for SG, 61.0% for LAGB, and 69.2% for RYGB). Remission of diabetes, hypertension, and dyslipidemia was more frequent in patients who underwent RYGB (65.9%, 63.6%, and 100% of patients, respectively). Safety profiles were similar among groups. Early complications occurred in 26 patients (9.9%) and late complications in 32 (12.3%). In the LAGB group, five bands (6.9%) were removed. Among all patients, one death (1/261=0.38%) occurred in the RYGB group due to aspiration pneumonia. CONCLUSION: The three bariatric procedures were comparable in regards to weight-loss outcomes; nevertheless, RYGB showed a higher rate of comorbidity resolution. Bariatric surgery is effective and relatively safe; however, due to complications, some bands had to be removed in the LAGB group and a relatively high rate of reoperations was observed in the RYGB group.

Validation of the Korean version Moorehead-Ardelt quality of life questionnaire II

PURPOSE: To investigate the weight loss effects with higher sensitivity, disease specific quality of life (QoL) instruments were important. The Moorehead-Ardelt quality of life questionnaire II (MA-II) is widely used, because it was simple and validated the several languages. The aims of present study was performed the translation of MA-II Korean version and the validation compared with EuroQol-5 dimension (EQ-5D), obesity-related problems scale (OP-scale), and impact of weight quality of life-lite (IWQoL-Lite). METHODS: The study design was a multicenter, cross-sectional survey and this study was included the postoperative patients. The validation procedure is translation-back translation procedure, pilot study, and field study. The instruments of measuring QoL included the MA-II, EQ-5D, OP-scale, and IWQoL-lite. The reliability was checked through internal consistency using Cronbach alpha coefficients. The construct validity was assessed the Spearman rank correlation between 6 domains of MA-II and EQ-5D, OP-scale, and 5 domains of IWQoL-Lite. RESULTS: The Cronbach alpha of MA-II was 0.763, so the internal consistency was confirmed. The total score of MA-II was significantly correlated with all other instruments; EQ-5D, OP-scale, and IWQoL-Lite. IWQoL-lite (rho = 0.623, P < 0.001) was showed the strongest correlation compared with MA-II, followed by OP-scale (rho = 0.588, P < 0.001) and EQ-5D (rho = 0.378, P < 0.01). CONCLUSION: The Korean version MA-II was valid instrument of measuring the obesity-specific QoL. Through the present study, the MA-II was confirmed to have good reliability and validity and it was also answered simple for investigating. Thus, MA-II could be estimated sensitive and exact QoL in obesity patients.

The effect of duodenojejunal bypass for type 2 diabetes mellitus patients below body mass index 25 kg/m2: one year follow-up / 대한외과학회지

PURPOSE: The goals of this study are to evaluate the effect of duodenojejunal bypass (DJB) for type 2 diabetes mellitus (T2DM) patients below body mass index (BMI) 25 kg/m2 in one year follow-up, and to compare the results of 1 week which we have reported in 2011. METHODS: In this prospective observational study, there were 31 type 2 diabetic patients who underwent DJB at Inha University Hospital from July 2009 to January 2011. We did laboratories such as 75-g oral glucose tolerance test (OGTT), insulin level and hemoglobin A1c (HbA1c), etc. and compared their changes of preoperative, a week, 3 months, and 12 months. RESULTS: Mean BMI was 23.1 +/- 1.3 kg/m2, mean duration of T2DM was 8.3 +/- 4.7 and mean age was 46.6 +/- 7.7 years. There were a significant decrease of 75-g OGTT levels and increase of insulin secretion after 3 months. 13.3% showed diabetic remission (HbA1c < 6.0, medication cessation) and 26.7% showed diabetic improvement. The rates of remission and improvement much declined comparing with that of postoperative 1 week although those were determined by fasting and postprandial 2 hour level of glucose. CONCLUSION: This is the first study of metabolic surgery in Korean diabetes patients in the healthy weight range. DJB exerted positive influences on insulin resistance as well as beta cell function. Early effects on T2DM after DJB could be estimated as one of good modalities, although the effectiveness seems to be unacceptable. Further studies are mandatory for evaluation of the effectiveness of metabolic surgery and finding prognostic factors.

Validation of the Korean translation of obesity-related problems scale assessing the quality of life in obese Korean / 대한외과학회지

PURPOSE: The objective of this study was to translate the obesity-related problems (OP) scale for Koreans and to validate it for use in Korean populations. METHODS: Translation and back-translation of the OP scale was performed and a pilot test was conducted. Following this, patients who had received treatment at the Obesity Center of Inha University Hospital were selected for participation in the field test. Cronbach's alpha (alpha) was used for assessment of the internal consistency of the OP scale. Spearman's correlation coefficients were used to assess the concurrent validity between the OP scale, the EuroQoL-5D (EQ-5D), and the Beck depression inventory (BDI) scale. One-way analysis of variance and t-test were used to assess the factors associated with the OP scale. RESULTS: A total of 67 individuals participated in the field study. The standardized Cronbach's alpha of the OP was 0.913. A significant negative correlation was observed between the OP scale and the EQ-5D and a positive correlation was observed between the OP scale and the BDI (the correlation coefficient with EQ-5D = -0.316, and the BDI = 0.305, P < 0.05). CONCLUSION: The results of this study prove that the Korean version of the OP has been translated and adapted correctly in order to meet the standard of its use.

Extensive Thrombosis in a Patient with Familial Mediterranean Fever, Despite Hyperimmunoglobulin D State in Serum: First Adult Case in Korea

Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent episodes of fever accompanied by peritonitis, pleuritis, arthritis, or erysipelas-like erythema. It is known to occur mainly among Mediterranean and Middle Eastern populations such as non-Ashkenazi Jews, Arabs, Turks, and Armenians. FMF is not familiar to clinicians beyond this area and diagnosing FMF can be challenging. We report a 22-yr old boy who presented with fever, arthalgia and abdominal pain. He had a history of recurrent episodes of fever associated with arthalgia which would subside spontaneously or by antipyretics. Autosomal recessive periodic fever syndromes were suspected. Immunoglobulin D (IgD) level in the serum was elevated and DNA analysis showed complex mutations (p.Glu148Gln, p.Pro369Ser, p.Arg408Gln) in the MEFV gene. 3D angio computed tomography showed total thrombosis of splenic vein with partial thrombosis of proximal superior mesenteric vein, main portal vein and intrahepatic both portal vein. This is a case of FMF associated with multiple venous thrombosis and elevated IgD level. When thrombosis is associated with elevated IgD, FMF should be suspected. This is the first adult case reported in Korea.

Erratum: Correction of Title

This erratum is being published to correct of title.