Surgery for Obesity and Related Diseases最新文献

{"title":"Predictors and weight impact of postbariatric hypoglycemia after Roux-en-Y gastric bypass surgery: a prospective observational cohort study","authors":"Anouk Lüscher ,&nbsp;Nathalie Vionnet M.D., Ph.D. ,&nbsp;Jérôme Pasquier M.D., Ph.D. ,&nbsp;Dionysios Chartoumpekis M.D., Ph.D. ,&nbsp;Styliani Mantziari M.D., M.Sc. ,&nbsp;Anne Wojtsusizyn M.D. ,&nbsp;Lucie Favre M.D.","doi":"10.1016/j.soard.2024.06.006","DOIUrl":"10.1016/j.soard.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Postbariatric hypoglycemia (PBH) is a challenging condition affecting quality of life of patients after bariatric surgery. However, its incidence and predictive factors remain debated.</div></div><div><h3>Objectives</h3><div>To determine the incidence of PBH, identify predictors of PBH and assess its association with weight trajectory after bariatric surgery.</div></div><div><h3>Setting</h3><div>University Hospital.</div></div><div><h3>Methods</h3><div>Prospective observational cohort study including 222 nondiabetic patients who underwent Roux-en-Y gastric bypass between 2014 and 2021, had an oral glucose tolerance test (OGTT) and/or A1C (glycated hemoglobin) measurement prior to surgery and were followed for at least 12 months. Diagnosis of PBH was made when symptoms of hypoglycemia were accompanied by a postprandial plasma glucose level &lt; 3.9 mmol/l or a glycemia &lt; 3.9 mmol/l during continuous glucose monitoring, with resolution of symptomatology after carbohydrate consumption. Univariable and multivariable logistic regression analyses were performed to identify factors associated with PBH.</div></div><div><h3>Results</h3><div>Out of 222 patients, 71 (32%) were diagnosed with PBH. The highest incidence rate was observed at 2 years postbariatric surgery with a cumulative incidence of 26.5%. Predictive factors for higher risk of PBH were younger age at surgery (OR = .97; 95% CI: .94–.99; <em>P</em> = .049) and early dumping syndrome (OR = 3.05; 95% CI: 1.62–6.04; <em>P</em> = .0008). In multivariable logistic regression, higher glycemia at 2 hours during preoperative OGTT was associated with lower risk of PBH (OR = .8; 95% CI: .63–.98; <em>P</em> = .04). PBH was not associated with weight trajectory after surgery in our cohort.</div></div><div><h3>Conclusions</h3><div>Younger age at time of surgery and lower blood glucose at 120 minute during preoperative OGTT are risk factors for PBH. Early dumping syndrome is significantly associated with PBH and could be used as a red flag to help identify patients at risk of PBH.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Pages 1187-1195"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Observations of Ramadan fasting in the initial year after bariatric surgery","authors":"Ala Wafa M.D. ,&nbsp;Jessica G. Cunningham M.D., Ph.D. ,&nbsp;Ali Shagan M.D. ,&nbsp;Suleiman Naji M.D. ,&nbsp;Rawad Friwan M.D. ,&nbsp;Salim Abunnaja M.D., F.A.C.S., F.A.S.M.B.S.","doi":"10.1016/j.soard.2024.07.010","DOIUrl":"10.1016/j.soard.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Ramadan is considered to be the holiest month of the Islamic religion. Hundreds of millions of Muslims practice the commitments of Ramadan, which include the abstinence from eating and drinking during daylight hours. Although there are exemptions to fasting for medical reasons, there is very limited guidance in terms of the safety of fasting in the postoperative period after bariatric surgery.</div></div><div><h3>Objectives</h3><div>To assess outcomes and impact of fasting on patients who underwent bariatric surgery within the year leading up to Ramadan 2023.</div></div><div><h3>Setting</h3><div>Community hospital health system.</div></div><div><h3>Methods</h3><div>Retrospective review of medical records and direct patient contact for 376 study participants.</div></div><div><h3>Results</h3><div>Of the 376 participants who underwent bariatric surgery in the year before Ramadan, only 8 patients (2.1%) reported they did not intend to fast during Ramadan. Patients who ended up having to break fasting were closer to their surgery date, at 4.3 months from surgery, than patients who were able to fast for the entire month of Ramadan, who were 5.1 months out from surgery. There was no difference between the number of patients needing to break fasting on the basis of what type of bariatric surgery they had performed. The number of patients needing to go to the emergency department and receive intravenous fluids was small, at 11 patients (2.9%), and these patients were also closer to surgery than those not needing to go to the emergency department or receive intravenous fluids. Side effects experienced during Ramadan, including abdominal pain, nausea/vomiting, and hypoglycemia, were more common in patients that were closer to their surgery, notably within 4 months of their surgery date. Patients who lost weight during Ramadan were closer to their surgery date at 4.9 months from surgery compared with those who maintained or gained weight, who were 7.0 months out from surgery.</div></div><div><h3>Conclusions</h3><div>There are a limited number of studies examining the safety and patient outcomes in those who fast for religious purposes after bariatric surgery. In this study, 376 participants who were within 1 year of undergoing surgery were followed throughout the month of Ramadan. Patients closer to surgery were more likely to break fasting, present to the emergency department, and experience side effects. However, the overall rate of complications was low, suggesting that fasting in the setting of a religious tradition in the carefully chosen patient with counseling and supervision may be a safe option.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Pages 1253-1259"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer incidence following bariatric surgery in renal transplant recipients: a retrospective multi-center analysis","authors":"Laxmi Dongur M.D. ,&nbsp;Yara Samman B.S. ,&nbsp;George Golovko Ph.D. ,&nbsp;Kostiantyn Botnar Ph.D. ,&nbsp;Michael L. Kueht M.D., F.A.C.S. ,&nbsp;Jennifer Moffett M.D., F.A.C.S. ,&nbsp;Sarah Samreen M.D., F.A.C.S.","doi":"10.1016/j.soard.2024.06.010","DOIUrl":"10.1016/j.soard.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Obesity, a known independent risk factor for developing malignancy. Additionally, renal transplant recipients (RTR) confer a 2- to 4-fold increased risk of overall malignancies with an excess absolute risk of .7% per year. While transplant recipients are at risk for obesity and malignancy, the effect of bariatric surgery (BS) in the posttransplantation setting is not well known.</div></div><div><h3>Objectives</h3><div>Our study primarily evaluated the impact of BS on cancer incidence in RTR with severe obesity in the posttransplantation setting. Weight loss outcomes were analyzed secondarily.</div></div><div><h3>Setting</h3><div>University Hospital.</div></div><div><h3>Methods</h3><div>A retrospective study using TriNetX database was developed to analyze cancer outcomes in RTR with posttransplantation BS versus RTR without BS from 2000 to 2023. After the exclusion process and propensity matching, both cohorts consisted of 153 patients.</div></div><div><h3>Results</h3><div>RTR-BS had a significantly lower incidence of overall cancer and transplant-related cancers (<em>P</em> &lt; .05). No significant difference was identified in cutaneous, gastrointestinal, and reproductive cancers. Percent Excess Weight Loss (%EWL) was significantly lower in RTR-only cohort (11.4%) versus RTR-BS cohort (57.8%) at 5 years. Sleeve gastrectomy (SG) patients (73.19%) had significantly higher %EWL than Roux en-Y gastric bypass (RYGB) patients (49.33%) at 3 years. No difference in cancer incidence was noted between SG and RYGB patients.</div></div><div><h3>Conclusion</h3><div>Postrenal transplantation BS had a diminishing effect on overall and transplant-related cancer incidence in RTR with severe obesity. Significant weight loss was also demonstrated with post-renal transplantation BS.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Pages 1198-1205"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia considerations for pediatric metabolic and bariatric surgery","authors":"Katherine Manupipatpong M.D. ,&nbsp;Colton D. Wayne M.D. ,&nbsp;Joseph D. Tobias M.D. ,&nbsp;Olubukola O. Nafiu M.D., F.R.C.A., M.S. ,&nbsp;Marc P. Michalsky M.D., M.B.A. ,&nbsp;Ahsan Syed M.D.","doi":"10.1016/j.soard.2024.07.004","DOIUrl":"10.1016/j.soard.2024.07.004","url":null,"abstract":"<div><div>Childhood obesity is a rapidly growing global health issue, linked to significant lifelong morbidity and mortality. Its impact on various organ systems increases perioperative complications. Obesity treatment in children and adolescents involves lifestyle, dietary, and behavioral modifications, as well as pharmacologic interventions that targets hormonal, metabolic, and neurochemical abnormalities. Metabolic and bariatric surgery, proven safe and effective for adults with severe obesity (class 2 or higher), is now being recommended for adolescents. Key anesthetic considerations for these surgeries include preoperative optimization, advanced airway management, targeted ventilation strategies, and opioid-sparing analgesic regimens. Comprehensive presurgical evaluations must address co-morbid conditions such as hypertension, obstructive sleep apnea, asthma, and impaired glycemic control. Preoperative management should also consider the effects of antiobesity medications on gastric emptying and hemodynamic stability. Ventilation strategies should prevent atelectasis while avoiding barotrauma, and drug dosages must be adjusted for altered pharmacokinetics due to increased adipose tissue. Employing enhanced recovery after surgery protocols may reduce perioperative complications, shorten postsurgical stays, and improve outcomes.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Pages 1322-1328"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retention and transition to adult health care in adolescent bariatric surgery","authors":"Laura C. Hart M.D., M.P.H. ,&nbsp;Ihuoma Eneli M.D., M.S.","doi":"10.1016/j.soard.2024.06.005","DOIUrl":"10.1016/j.soard.2024.06.005","url":null,"abstract":"<div><div>The American Society of Metabolic and Bariatric Surgery (ASMBS) and the American Academy of Pediatrics (AAP) recommend bariatric surgery as a treatment option for severe obesity. Bariatric surgery results in weight loss and improves obesity-related comorbidities. After surgery, adolescents and young adults require close observation and interdisciplinary care to help optimize weight loss, minimize nutrient deficiencies, address mental or physical health complications, and ensure a smooth transition to adult care. Yet, the extant literature on adherence and transition of care in bariatric programs is limited. Using 3 case studies from 2 bariatric programs, one on retention and 2 on transition of care, this paper highlights learning opportunities for care delivery after bariatric surgery. A quality improvement framework and an embedded electronic medical health registry can improve retention rates within a bariatric program. In addition, implementing a workflow ensures standardization of care; however, a key challenge is inadequate staffing. The programs established a transition of care policy and protocol by incorporating several of the Six Core Elements, a recognized guide for ensuring a safe and appropriate transfer from pediatric to adult care. Several research gaps remain, and further work is needed to determine and standardize best practices for adolescent bariatric surgery.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Pages 1314-1321"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare events model of the MBSAQIP database: risk of early bowel obstruction following metabolic surgery","authors":"Teresa H. Schauer B.S. ,&nbsp;Michael Kachmar D.O. ,&nbsp;Florina Corpodean M.D. ,&nbsp;Kathyrn P. Belmont B.S. ,&nbsp;Denise Danos Ph.D. ,&nbsp;Michael W. Cook M.D. ,&nbsp;Philip R. Schauer M.D. ,&nbsp;Vance L. Albaugh M.D., Ph.D.","doi":"10.1016/j.soard.2024.07.005","DOIUrl":"10.1016/j.soard.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Early small bowel obstruction (eSBO) (within 30-days) is a rare but important complication that is associated with high rates of morbidity, including readmission, reintervention, and reoperation.</div></div><div><h3>Objectives</h3><div>To identify patient-specific and operation-specific characteristics that predispose patients to eSBO and to identify at-risk individuals preoperatively.</div></div><div><h3>Setting</h3><div>2015-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).</div></div><div><h3>Methods</h3><div>Utilizing the 2015-2021 MBSAQIP PUF, 1,016,484 records were analyzed. Pediatric, revisional, open-conversion, and cases with incomplete data in sex, body mass index, operative-time, 30-day-follow-up variables were excluded. Case details were compared using Fisher’s exact &amp; Wilcoxon -Mann -Whitney tests to identify at-risk patients. The likelihood of eSBO was modeled with rare event logistic regression.</div></div><div><h3>Results</h3><div>Incidence of eSBO was .40%. Of the 4103 occurrences of eSBO, RYGB (Roux-en-Y gastric bypass), SG (sleeve gastrectomy), and DS (duodenal switch) accounted for 79.4%, 19.3%, and 1.3%, respectively. Many patient-specific characteristics were significantly associated with eSBO. History of prior foregut surgery, a non-metabolic surgery trained operator, and longer operative times were all associated with increased eSBO (<em>P</em> &lt; .0001). While simultaneously controlling for these factors, eSBO remained higher in DS (OR 9.55, <em>P</em> &lt; .0001) and RYGB (OR 5.18, <em>P</em> &lt; .0001) compared to SG. Increased length of operation (OR 1.03, <em>P</em> &lt; .0001) and non -MS-trained operators (OR 1.33, <em>P</em> &lt; .0001) remained highly significant. Male-sex (OR .70, <em>P</em> &lt; .0001) and diabetes (OR .78, <em>P</em> &lt; .0001) were both protective.</div></div><div><h3>Conclusions</h3><div>In the largest analysis to date, eSBO remains a rare event. RYGB accounts for the largest proportion of eSBO, however, DS has a higher risk adjusted rate of eSBO.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Pages 1216-1224"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SOARD Category 1 CME Credit Featured Articles, Volume 20, December 2024","authors":"","doi":"10.1016/j.soard.2024.10.027","DOIUrl":"10.1016/j.soard.2024.10.027","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Pages 1402-1404"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Cancer incidence following bariatric surgery in renal transplant recipients: a retrospective multicenter analysis","authors":"Walter J. Pories M.D., F.A.C.S., Colonel M.C. U.S.A. (RET.)","doi":"10.1016/j.soard.2024.07.016","DOIUrl":"10.1016/j.soard.2024.07.016","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Page 1206"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Rare events model of the MBSAQIP database: risk of early bowel obstruction following metabolic surgery","authors":"Adisa Poljo M.D.,&nbsp;Ralph Peterli M.D.","doi":"10.1016/j.soard.2024.08.015","DOIUrl":"10.1016/j.soard.2024.08.015","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Pages 1224-1225"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron homeostasis in obesity and metabolic and bariatric surgery: a narrative review","authors":"Peter N. Benotti M.D. ,&nbsp;Jila Kaberi-Otarod M.D. ,&nbsp;G. Craig Wood M.S. ,&nbsp;Glenn S. Gerhard M.D. ,&nbsp;Christopher D. Still D.O. ,&nbsp;Bruce R. Bistrian M.D., Ph.D.","doi":"10.1016/j.soard.2024.08.018","DOIUrl":"10.1016/j.soard.2024.08.018","url":null,"abstract":"<div><div>Iron deficiency has been recognized as a potentially modifiable nutritional complication of metabolic and bariatric surgery (MBS) since prior to the turn of the century. Despite this, it remains the most common and clinically significant nutritional complication of this surgery with the potential to negate quality of life and the health benefits of surgical weight loss. This narrative review summarizes the current literature regarding iron deficiency as it relates to patients with severe obesity and those who undergo MBS. Advances in the clinical knowledge of iron homeostasis in severe obesity as a chronic disease, current diagnostic criteria for the diagnosis of iron deficiency in this patient population, the significance of preoperative iron deficiency, postoperative iron deficiency, and the status of supplementation and treatment will be reviewed with emphasis on gaps in knowledge and needed areas of further study.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 12","pages":"Pages 1370-1380"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}