W. Salgado, Eduardo Bastos, Anna Dantas, Tiago Onzi, Lyz Silva, Á. Albano, Márcio Cortez, Luca Tristão, Clara dos Santos, Wanderley Bernardo
Aim: The aim of this study was to assess the safety and short-term effectiveness of metabolic surgery (MS) in nonobese diabetic patients. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used in this systematic review. The search for evidence was performed in the Medline (PubMed), Embase, Cochrane (CENTRAL), LILACS, and ClinicalTrials.gov databases from the inception to February 2023. The main eligibility criteria were nonobese adults (body mass index [BMI] <30 kg/m2) with type 2 diabetes mellitus (T2DM) undergoing MS. T2DM remission rate, glycemic parameters, and weight loss were measured before and after surgery. Complication rate was also described. Outcomes were aggregated and the quality of evidence was sorted. Heterogeneity was assumed when I2 >50%. The random-effects model was used to perform a proportional meta-analysis. Results: Twenty-one studies were included (n = 835). The overall rate of diabetes remission was 50.1% (95% confidence interval [CI] = 43.8%–56.1%; P = 0.993; I2 = 92%). The mean reduction of glycated hemoglobin and fasting glucose was 2.42% (95% CI = 1.91%–2.93%; P < 0.00001; I2 = 89%) and 70.60 mg/dL, respectively. A drop of 3.34 points (95% CI = 1.59–5.09; P < 0.0002; I2 = 95%) was observed in the HOMA-IR, and the mean postprandial glycemia was 123.27 mg/dL. No marked weight loss was observed (−3.80 kg/m2 in BMI; 95% CI = 2.70–4.91; P < 0.00001; I2 = 95%). There was no postoperative mortality, and the overall postoperative complication rate was about 12%. The certainty of evidence was low or very low. Conclusion: MS could be effective in the surgical approach of nonobese diabetic patients, but further long-term, more robust studies are needed to strengthen the evidence.
{"title":"Short-term effectiveness of metabolic surgery in nonobese diabetic patients: A systematic review and meta-analysis","authors":"W. Salgado, Eduardo Bastos, Anna Dantas, Tiago Onzi, Lyz Silva, Á. Albano, Márcio Cortez, Luca Tristão, Clara dos Santos, Wanderley Bernardo","doi":"10.4103/jbs.jbs_6_23","DOIUrl":"https://doi.org/10.4103/jbs.jbs_6_23","url":null,"abstract":"Aim: The aim of this study was to assess the safety and short-term effectiveness of metabolic surgery (MS) in nonobese diabetic patients. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used in this systematic review. The search for evidence was performed in the Medline (PubMed), Embase, Cochrane (CENTRAL), LILACS, and ClinicalTrials.gov databases from the inception to February 2023. The main eligibility criteria were nonobese adults (body mass index [BMI] <30 kg/m2) with type 2 diabetes mellitus (T2DM) undergoing MS. T2DM remission rate, glycemic parameters, and weight loss were measured before and after surgery. Complication rate was also described. Outcomes were aggregated and the quality of evidence was sorted. Heterogeneity was assumed when I2 >50%. The random-effects model was used to perform a proportional meta-analysis. Results: Twenty-one studies were included (n = 835). The overall rate of diabetes remission was 50.1% (95% confidence interval [CI] = 43.8%–56.1%; P = 0.993; I2 = 92%). The mean reduction of glycated hemoglobin and fasting glucose was 2.42% (95% CI = 1.91%–2.93%; P < 0.00001; I2 = 89%) and 70.60 mg/dL, respectively. A drop of 3.34 points (95% CI = 1.59–5.09; P < 0.0002; I2 = 95%) was observed in the HOMA-IR, and the mean postprandial glycemia was 123.27 mg/dL. No marked weight loss was observed (−3.80 kg/m2 in BMI; 95% CI = 2.70–4.91; P < 0.00001; I2 = 95%). There was no postoperative mortality, and the overall postoperative complication rate was about 12%. The certainty of evidence was low or very low. Conclusion: MS could be effective in the surgical approach of nonobese diabetic patients, but further long-term, more robust studies are needed to strengthen the evidence.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"171 1","pages":"60 - 67"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77469511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gloria Mittmann, Moritz Schuhbauer, B. Schrank, Verena Steiner-Hofbauer
Correlation between bariatric surgery (BS), weight loss, and alleviation of anxiety symptoms has been assessed frequently. Research indicates a rather positive effect on anxiety symptoms for the first 3 years after surgery. Beyond this time frame, alleviation of symptoms becomes less apparent. The aim of this study was to investigate the connection between anxiety and BS based on the following research question: does BS lead to an alleviation of their anxiety symptoms in adults with morbid obesity and anxiety symptomatology? The basic mechanism underlying this study was a comprehensive literature search in PubMed and PsycINFO, combining search terms for “anxiety” with “bariatric surgery” related terms. The data set resulting from this search was assessed for relevant studies, which were the basis for the following narrative literature review. A set of 30 studies, 24 prospective cohort studies, and 6 literature reviews met inclusion criteria.The studies included 2228 participants (81% female). At baseline, mean age was 41.4 years and mean body mass index (BMI) was 47 kg/m2. The mean BMI at the end of the studies was 34 kg/m2. Different BS techniques were used for weight loss. A trend for change in anxiety at different time points postsurgery seems to exist. No clear statement can be made about a correlation between weight loss and alleviation of anxiety symptoms. Some studies found a significant correlation between the two parameters for up to 4 years; however, just as many studies found no correlation. The type of weight loss surgery utilized does most likely not determine the effect on anxiety symptoms. BS should not be thought of as a therapy method for anxiety.
{"title":"Effect of bariatric surgery on anxiety symptoms in morbidly obese patients: A systematic narrative literature review","authors":"Gloria Mittmann, Moritz Schuhbauer, B. Schrank, Verena Steiner-Hofbauer","doi":"10.4103/jbs.jbs_5_23","DOIUrl":"https://doi.org/10.4103/jbs.jbs_5_23","url":null,"abstract":"Correlation between bariatric surgery (BS), weight loss, and alleviation of anxiety symptoms has been assessed frequently. Research indicates a rather positive effect on anxiety symptoms for the first 3 years after surgery. Beyond this time frame, alleviation of symptoms becomes less apparent. The aim of this study was to investigate the connection between anxiety and BS based on the following research question: does BS lead to an alleviation of their anxiety symptoms in adults with morbid obesity and anxiety symptomatology? The basic mechanism underlying this study was a comprehensive literature search in PubMed and PsycINFO, combining search terms for “anxiety” with “bariatric surgery” related terms. The data set resulting from this search was assessed for relevant studies, which were the basis for the following narrative literature review. A set of 30 studies, 24 prospective cohort studies, and 6 literature reviews met inclusion criteria.The studies included 2228 participants (81% female). At baseline, mean age was 41.4 years and mean body mass index (BMI) was 47 kg/m2. The mean BMI at the end of the studies was 34 kg/m2. Different BS techniques were used for weight loss. A trend for change in anxiety at different time points postsurgery seems to exist. No clear statement can be made about a correlation between weight loss and alleviation of anxiety symptoms. Some studies found a significant correlation between the two parameters for up to 4 years; however, just as many studies found no correlation. The type of weight loss surgery utilized does most likely not determine the effect on anxiety symptoms. BS should not be thought of as a therapy method for anxiety.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"21 1","pages":"53 - 59"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85072538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The objective of the study is to evaluate the effect of very low-calorie diet (VLCD) on postbariatric surgery (BS) patients with weight regain (WR). Methods: This is a prospective, randomized, controlled, interventional clinical trial. The sample selection for the study was performed on the basis of prepared inclusion and exclusion criteria. Structured phone calls were made to all the subjects in which baseline information such as body weight and height were asked through which body mass index (BMI) was calculated to check the eligibility. A sample size of 40 subjects including both males and females with >10% gain of nadir weight after 2 years of BS with a current BMI of ≥30 kg/m[2] was selected. Two standardized VLCD plans for 4 weeks each were prescribed to them. A close supervision of selected subjects was done regularly through structured weekly calls, outpatient department follow-ups, and support group meets. The statistical analysis was done to find the average weight loss (WL) and change in body fat percentage over 8 weeks. Results: The mean average age of the sample was 45 ± 9.45 years among which 12 were male and 28 were female. The sample size was under the inclusion criteria with >10% WR after 2 years of BS. In this sample, the average total body WL after BS was found to be 47.3 kg. Postoperative average WR in the selected sample was 10.3%. After the follow-up period of 8 weeks of VLCD, an average WL of 3.66 kg (3.76%) along with a body fat percent loss of 2.58% was observed. It was also noted that the WL in the initial weeks was comparatively higher than that in the later weeks. An average WL in the first 4 weeks was 2.36 kg (2.42%) and average WL in the next 4 weeks was 1.32 kg (1.35%). Conclusion: VLCD is effective but long-term effects need to be seen. There have been no such Indian studies before this, and hence, more such studies need to be done.
{"title":"Investigating the impact of very low-calorie diet in patients' postbariatric surgery with weight regain: A randomized, prospective, interventional, and pilot study","authors":"Ritika Samaddar, Saumya Pawha, K. Sharma","doi":"10.4103/jbs.jbs_8_23","DOIUrl":"https://doi.org/10.4103/jbs.jbs_8_23","url":null,"abstract":"Objective: The objective of the study is to evaluate the effect of very low-calorie diet (VLCD) on postbariatric surgery (BS) patients with weight regain (WR). Methods: This is a prospective, randomized, controlled, interventional clinical trial. The sample selection for the study was performed on the basis of prepared inclusion and exclusion criteria. Structured phone calls were made to all the subjects in which baseline information such as body weight and height were asked through which body mass index (BMI) was calculated to check the eligibility. A sample size of 40 subjects including both males and females with >10% gain of nadir weight after 2 years of BS with a current BMI of ≥30 kg/m[2] was selected. Two standardized VLCD plans for 4 weeks each were prescribed to them. A close supervision of selected subjects was done regularly through structured weekly calls, outpatient department follow-ups, and support group meets. The statistical analysis was done to find the average weight loss (WL) and change in body fat percentage over 8 weeks. Results: The mean average age of the sample was 45 ± 9.45 years among which 12 were male and 28 were female. The sample size was under the inclusion criteria with >10% WR after 2 years of BS. In this sample, the average total body WL after BS was found to be 47.3 kg. Postoperative average WR in the selected sample was 10.3%. After the follow-up period of 8 weeks of VLCD, an average WL of 3.66 kg (3.76%) along with a body fat percent loss of 2.58% was observed. It was also noted that the WL in the initial weeks was comparatively higher than that in the later weeks. An average WL in the first 4 weeks was 2.36 kg (2.42%) and average WL in the next 4 weeks was 1.32 kg (1.35%). Conclusion: VLCD is effective but long-term effects need to be seen. There have been no such Indian studies before this, and hence, more such studies need to be done.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"6 1","pages":"85 - 92"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84825237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danielle Clyde, M. Boland, Leo Brown, G. McCabe, W. Cambridge, Kerry Aitken, Gillian Drummond, B. Joyce, Andrew Beaux, B. Tulloh, O. Moussa, Wah Yang, B. Madhok, Peter Lamb, K. Mahawar, Andrew N. Robertson
Introduction: Bariatric surgery is an accepted treatment worldwide for patients with obesity due to its proven metabolic effects. However, there are variations worldwide in clinical criteria that must be met to qualify for surgery. This study aims to explore globally established practice and opinions on preoperative workup for bariatric surgery. Materials and Methods: A review of literature and international guidelines was performed by a multidisciplinary team and used to develop an online questionnaire survey. This was distributed to bariatric professionals electronically. Results: Two hundred and forty-four bariatric health-care professionals from 224 medical centers across 57 countries completed the survey. The majority of respondents were surgeons (67.2%), and the remainder were other multidisciplinary professionals. Over half of medical centers were public hospitals (50.8%), with most performing over 200 procedures per year (30.3%). Only 68.4% (n = 167) of respondent hospitals used recognized referral guidelines; however, 81.9% felt that there should be written referral criteria (P < 0.001). In 71.3% (n = 172) of respondent units' patients underwent a Medical Weight Management Programme (MWMP) as part of their preparation for surgery. Significant differences were identified worldwide in the criteria used to determine progression to surgery (P < 0.001), time spent in MWMP prior to surgery (P < 0.001), and the roles of members forming the bariatric multidisciplinary team (P = 0.006). Conclusion: This study has identified significant variation in global bariatric surgery practices and highlights the responsibility that societies such as the International Federation for the Surgery of Obesity and Metabolic Disease (IFSO) and the Upper Gastrointestinal Surgery Society have in promoting universal clinical guidelines.
{"title":"Patient pathways to bariatric surgery: What preoperative medical weight management programs exist globally – Results of an international survey","authors":"Danielle Clyde, M. Boland, Leo Brown, G. McCabe, W. Cambridge, Kerry Aitken, Gillian Drummond, B. Joyce, Andrew Beaux, B. Tulloh, O. Moussa, Wah Yang, B. Madhok, Peter Lamb, K. Mahawar, Andrew N. Robertson","doi":"10.4103/jbs.jbs_3_23","DOIUrl":"https://doi.org/10.4103/jbs.jbs_3_23","url":null,"abstract":"Introduction: Bariatric surgery is an accepted treatment worldwide for patients with obesity due to its proven metabolic effects. However, there are variations worldwide in clinical criteria that must be met to qualify for surgery. This study aims to explore globally established practice and opinions on preoperative workup for bariatric surgery. Materials and Methods: A review of literature and international guidelines was performed by a multidisciplinary team and used to develop an online questionnaire survey. This was distributed to bariatric professionals electronically. Results: Two hundred and forty-four bariatric health-care professionals from 224 medical centers across 57 countries completed the survey. The majority of respondents were surgeons (67.2%), and the remainder were other multidisciplinary professionals. Over half of medical centers were public hospitals (50.8%), with most performing over 200 procedures per year (30.3%). Only 68.4% (n = 167) of respondent hospitals used recognized referral guidelines; however, 81.9% felt that there should be written referral criteria (P < 0.001). In 71.3% (n = 172) of respondent units' patients underwent a Medical Weight Management Programme (MWMP) as part of their preparation for surgery. Significant differences were identified worldwide in the criteria used to determine progression to surgery (P < 0.001), time spent in MWMP prior to surgery (P < 0.001), and the roles of members forming the bariatric multidisciplinary team (P = 0.006). Conclusion: This study has identified significant variation in global bariatric surgery practices and highlights the responsibility that societies such as the International Federation for the Surgery of Obesity and Metabolic Disease (IFSO) and the Upper Gastrointestinal Surgery Society have in promoting universal clinical guidelines.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"129 1","pages":"68 - 78"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83976518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Time to discontinue body mass index (BMI) as a qualifying criterion for metabolic (diabetes) surgery","authors":"Ramen Goel","doi":"10.4103/jbs.jbs_11_23","DOIUrl":"https://doi.org/10.4103/jbs.jbs_11_23","url":null,"abstract":"","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"63 1","pages":"51 - 52"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80739899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Baig, P. Priya, A. Katakwar, A. Bhasker, Atul Peters, Carlyne Remedios, Deeba Siddiqui, Kankona Dey, Madhu Goel, M. Khaitan, Mariam Lakdawala, R. Palaniappan, Ramen Goel, R. Wadhawan, Ritika Samaddar
Introduction: Variations in cultural practices, diet, socioeconomic factors, genetics, and procedure selection have a potential impact on nutritional outcomes after bariatric surgery. There are no updated guidelines from India on clinical practice on the nutritional management of patients undergoing bariatric surgery. This is the first attempt to have a consensus on the subject. Methods: An expert committee was constituted which voted for three rounds on 20 statements/questions based on a Delphi method. Results: There was consensus regarding preoperative screening of hemoglobin, packed cell volume, albumin, iron, ferritin, Vitamin D, Vitamin B12, preoperative weight loss, postoperative prophylactic protein supplementations, therapeutic supplementation of iron, B12, and Vitamin D, postoperative testing, and frequency of follow-up visits. Experts did not agree on the routine preoperative testing of serum folate and thiamine. There was no consensus on lifelong supplementation with bariatric formulation, difference of supplementation dosages for Roux-en-Y gastric bypass and one anastomosis gastric bypass, or postponement of surgery pending correction of nutritional deficiencies. Conclusion: We need a better-quality regional data to formulate guidelines that can provide evidence-based guidance for the clinical practice.
{"title":"Perioperative nutritional practices in patients undergoing bariatric surgery in India: A delphi consensus","authors":"S. Baig, P. Priya, A. Katakwar, A. Bhasker, Atul Peters, Carlyne Remedios, Deeba Siddiqui, Kankona Dey, Madhu Goel, M. Khaitan, Mariam Lakdawala, R. Palaniappan, Ramen Goel, R. Wadhawan, Ritika Samaddar","doi":"10.4103/jbs.jbs_14_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_14_22","url":null,"abstract":"Introduction: Variations in cultural practices, diet, socioeconomic factors, genetics, and procedure selection have a potential impact on nutritional outcomes after bariatric surgery. There are no updated guidelines from India on clinical practice on the nutritional management of patients undergoing bariatric surgery. This is the first attempt to have a consensus on the subject. Methods: An expert committee was constituted which voted for three rounds on 20 statements/questions based on a Delphi method. Results: There was consensus regarding preoperative screening of hemoglobin, packed cell volume, albumin, iron, ferritin, Vitamin D, Vitamin B12, preoperative weight loss, postoperative prophylactic protein supplementations, therapeutic supplementation of iron, B12, and Vitamin D, postoperative testing, and frequency of follow-up visits. Experts did not agree on the routine preoperative testing of serum folate and thiamine. There was no consensus on lifelong supplementation with bariatric formulation, difference of supplementation dosages for Roux-en-Y gastric bypass and one anastomosis gastric bypass, or postponement of surgery pending correction of nutritional deficiencies. Conclusion: We need a better-quality regional data to formulate guidelines that can provide evidence-based guidance for the clinical practice.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"18 1","pages":"26 - 30"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81942824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eduardo Bastos, Fábio Viegas, A. Valezi, J. Marchesini, Juliano Canavarros, Antônio Silvinato, Wanderley Bernardo
Aim: The aim is to assess the long- and very long-term rate of unfavorable outcomes associated with the laparoscopic adjustable gastric band (LAGB) in morbid obesity. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was used in this systematic review. The search for evidence was performed in the MEDLINE (PubMed), EMBASE, LILACS, Clinical Trials, and Google Scholar databases from the inception to October 2021. The main eligibility criteria were obese adult undergoing LAGB, unfavorable outcomes, and a minimum follow-up of 4 years. Outcomes were aggregated using the Comprehensive Meta-Analysis software for noncomparative studies, and the quality of evidence was sorted. Heterogeneity was assumed when I2 >50%. Because of expected differences among retrieved studies and several uncontrolled variables, the random-effects model was used to perform a proportional meta-analysis. Results: Data on 23,916 unfavorable outcomes were extracted from 28 studies (N = 107,370 patients). The use of the LAGB may be related to a rate of around 30% for reoperation (95% confidence interval [CI] = 20.4%–41.4%), 18% for band removal (95% CI = 13.3%–24.5%), 12% for nonresponse (95% CI = 5.2%–23.8%), 8% for port/tube complications (95% CI = 5.1%–13.6%), 7% for slippage/prolapse (95% CI = 5.3%–9.7%), 6% for pouch enlargement (95% CI = 3.4%–9.9%), and 3% for erosion/migration (95% CI = 2.0%–4.3%) in the long- and very long-term follow-up. However, the quality of evidence was considered very low. Conclusion: Despite the very low quality of evidence, LAGB was associated with not negligible rates of unfavorable outcomes in long- and very long-term follow-up.
目的:目的是评估与病态肥胖的腹腔镜可调节胃束带(LAGB)相关的长期和非常长期不良结局率。方法:本系统评价采用系统评价首选报告项目和荟萃分析声明。从开始到2021年10月，在MEDLINE (PubMed)、EMBASE、LILACS、临床试验和Google Scholar数据库中进行了证据搜索。主要入选标准为接受LAGB的肥胖成人，不良结局，至少随访4年。使用非比较性研究的综合meta分析软件对结果进行汇总，并对证据质量进行排序。当I2 >50%时，假设异质性。由于在检索的研究和几个不受控制的变量之间存在预期的差异，我们使用随机效应模型进行比例荟萃分析。结果:从28项研究(N = 107,370例患者)中提取了23,916个不良结局的数据。在长期和极长期随访中，LAGB的使用可能与再手术率约30%(95%置信区间[CI] = 20.4%-41.4%)，带拔出率为18% (95% CI = 13.3%-24.5%)，无反应率为12% (95% CI = 5.2%-23.8%)，口/管并发症率为8% (95% CI = 5.1%-13.6%)，滑脱/脱垂率为7% (95% CI = 5.3%-9.7%)，眼袋增大率为6% (95% CI = 3.4%-9.9%)，糜烂/移位率为3% (95% CI = 2.0%-4.3%)有关。然而，证据的质量被认为非常低。结论:尽管证据质量很低，但在长期和极长期随访中，LAGB与不可忽略的不良结局发生率相关。
{"title":"Long- and very long-term unfavorable outcomes of the laparoscopic adjustable gastric band in the surgical approach of morbid obesity: A systematic review and meta-analysis","authors":"Eduardo Bastos, Fábio Viegas, A. Valezi, J. Marchesini, Juliano Canavarros, Antônio Silvinato, Wanderley Bernardo","doi":"10.4103/jbs.jbs_10_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_10_22","url":null,"abstract":"Aim: The aim is to assess the long- and very long-term rate of unfavorable outcomes associated with the laparoscopic adjustable gastric band (LAGB) in morbid obesity. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was used in this systematic review. The search for evidence was performed in the MEDLINE (PubMed), EMBASE, LILACS, Clinical Trials, and Google Scholar databases from the inception to October 2021. The main eligibility criteria were obese adult undergoing LAGB, unfavorable outcomes, and a minimum follow-up of 4 years. Outcomes were aggregated using the Comprehensive Meta-Analysis software for noncomparative studies, and the quality of evidence was sorted. Heterogeneity was assumed when I2 >50%. Because of expected differences among retrieved studies and several uncontrolled variables, the random-effects model was used to perform a proportional meta-analysis. Results: Data on 23,916 unfavorable outcomes were extracted from 28 studies (N = 107,370 patients). The use of the LAGB may be related to a rate of around 30% for reoperation (95% confidence interval [CI] = 20.4%–41.4%), 18% for band removal (95% CI = 13.3%–24.5%), 12% for nonresponse (95% CI = 5.2%–23.8%), 8% for port/tube complications (95% CI = 5.1%–13.6%), 7% for slippage/prolapse (95% CI = 5.3%–9.7%), 6% for pouch enlargement (95% CI = 3.4%–9.9%), and 3% for erosion/migration (95% CI = 2.0%–4.3%) in the long- and very long-term follow-up. However, the quality of evidence was considered very low. Conclusion: Despite the very low quality of evidence, LAGB was associated with not negligible rates of unfavorable outcomes in long- and very long-term follow-up.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"81 10 1","pages":"3 - 12"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89580793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Early identification of patients at risk of poor weight loss following bariatric surgery may provide an opportunity for timely addition of intervention to optimize weight loss. This study investigates the relationship between early postsurgery weight loss trajectory and final weight loss outcomes. Methods: Data from patients who underwent primary sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one-anastomosis gastric bypass (OAGB) between October 2014 and March 2020 at a single institution were analyzed retrospectively. Total weight loss percentage (%TWL) was calculated at 1, 3, 6, 9, 12, 18, 24, 30, and 36 months postsurgery. Regression analysis demonstrated associations between early weight loss and %TWL between 12 and 36 months. Multivariate analysis identified predictors of maximal weight loss (MWL) and insufficient weight loss (IWL). Results: Six hundred and sixteen patients met the inclusion criteria. Follow-up weights were available at 12 months for n = 571, 18 months for n = 382, 24 months for n = 344, 30 months for n = 198, and 36 months for n = 187. The median (interquartile range) MWL for SG, RYGB, and OAGB was 29.9% (24.3–35.7), 32.5% (27.5–38.2), and 38.0% (32.6–42.4), respectively. On multivariate linear regression, MWL was best predicted by 3–6-month %TWL after both SG (P < 0.001) and OAGB (P < 0.001) and by 6–9-month %TWL following RYGB (P < 0.001). Conclusion: Early weight loss predicts MWL and %TWL up to 36 months following laparoscopic SG, RYGB, and OAGB. Identification of poor weight loss responders early may represent an opportunity to intervene to optimize postsurgical outcomes.
{"title":"Early weight loss trajectory predicts outcome following bariatric surgery","authors":"Rosalind Walmsley, L. Chong, P. Sumithran, M. Hii","doi":"10.4103/jbs.jbs_15_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_15_22","url":null,"abstract":"Background: Early identification of patients at risk of poor weight loss following bariatric surgery may provide an opportunity for timely addition of intervention to optimize weight loss. This study investigates the relationship between early postsurgery weight loss trajectory and final weight loss outcomes. Methods: Data from patients who underwent primary sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one-anastomosis gastric bypass (OAGB) between October 2014 and March 2020 at a single institution were analyzed retrospectively. Total weight loss percentage (%TWL) was calculated at 1, 3, 6, 9, 12, 18, 24, 30, and 36 months postsurgery. Regression analysis demonstrated associations between early weight loss and %TWL between 12 and 36 months. Multivariate analysis identified predictors of maximal weight loss (MWL) and insufficient weight loss (IWL). Results: Six hundred and sixteen patients met the inclusion criteria. Follow-up weights were available at 12 months for n = 571, 18 months for n = 382, 24 months for n = 344, 30 months for n = 198, and 36 months for n = 187. The median (interquartile range) MWL for SG, RYGB, and OAGB was 29.9% (24.3–35.7), 32.5% (27.5–38.2), and 38.0% (32.6–42.4), respectively. On multivariate linear regression, MWL was best predicted by 3–6-month %TWL after both SG (P < 0.001) and OAGB (P < 0.001) and by 6–9-month %TWL following RYGB (P < 0.001). Conclusion: Early weight loss predicts MWL and %TWL up to 36 months following laparoscopic SG, RYGB, and OAGB. Identification of poor weight loss responders early may represent an opportunity to intervene to optimize postsurgical outcomes.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"69 1","pages":"20 - 25"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75927746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Foundations of understanding to challenge the stigma surrounding overweight, obesity, and bariatric surgery","authors":"Yitka Graham, K. Mahawar","doi":"10.4103/jbs.jbs_1_23","DOIUrl":"https://doi.org/10.4103/jbs.jbs_1_23","url":null,"abstract":"","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"7 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89867412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bariatric surgery has been consistently demonstrated in randomized controlled trials to be the most effective treatment currently available for patients with Type 2 diabetes mellitus (T2DM) and obesity. In spite of this, with the emergence of longer-term data, it is now becoming apparent that some of the metabolic benefits afforded by bariatric surgery fatigue with time, prompting clinicians to re-consider how patients should be managed in the postoperative period. As is seen with many other chronic diseases including peripheral vascular disease as well as some cancers, surgery is seen as a means of inducing disease control with medications being employed to maintain sustained remission. In recent years, there have been remarkable advances in pharmacotherapy for the treatment of T2DM as well as additional agents which can produce clinically significant weight loss. Having recognized the potential need for further treatment following bariatric surgery along with the availability of highly effective medical therapies presents the opportunity to explore a multimodal approach to care, combining medications with surgery to potentially improve long-term outcomes.
{"title":"Combining metabolic surgery with medications for type 2 diabetes: Is there a benefit?","authors":"A. Sudlow, D. Pournaras, C. Roux","doi":"10.4103/jbs.jbs_16_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_16_22","url":null,"abstract":"Bariatric surgery has been consistently demonstrated in randomized controlled trials to be the most effective treatment currently available for patients with Type 2 diabetes mellitus (T2DM) and obesity. In spite of this, with the emergence of longer-term data, it is now becoming apparent that some of the metabolic benefits afforded by bariatric surgery fatigue with time, prompting clinicians to re-consider how patients should be managed in the postoperative period. As is seen with many other chronic diseases including peripheral vascular disease as well as some cancers, surgery is seen as a means of inducing disease control with medications being employed to maintain sustained remission. In recent years, there have been remarkable advances in pharmacotherapy for the treatment of T2DM as well as additional agents which can produce clinically significant weight loss. Having recognized the potential need for further treatment following bariatric surgery along with the availability of highly effective medical therapies presents the opportunity to explore a multimodal approach to care, combining medications with surgery to potentially improve long-term outcomes.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"15 1","pages":"13 - 19"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88034436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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