Pub Date : 2022-12-01DOI: 10.17476/jmbs.2022.11.2.39
Eun Young Kim
It has been proven that surgery is more effective than non-surgical treatment in obese patients. However, this approach has several disadvantages, especially long-term weight loss. Weight loss failures can be broadly classified into two categories; insufficient weight loss (poor responder) and weight regain. However, a unified definition has not been established yet for each category, and there is no clear standard for the post-surgery time point to be used to assess weight loss failure. In addition, analyzing factors that contribute to weight loss failure will lead to strategies for reducing it. Therefore, many researchers have been interested in this subject and have published conflicting results. This review presents a definition for and describes the mechanisms and predictors of weight loss failure after bariatric surgery.
{"title":"Definition, Mechanisms and Predictors of Weight Loss Failure After Bariatric Surgery.","authors":"Eun Young Kim","doi":"10.17476/jmbs.2022.11.2.39","DOIUrl":"https://doi.org/10.17476/jmbs.2022.11.2.39","url":null,"abstract":"<p><p>It has been proven that surgery is more effective than non-surgical treatment in obese patients. However, this approach has several disadvantages, especially long-term weight loss. Weight loss failures can be broadly classified into two categories; insufficient weight loss (poor responder) and weight regain. However, a unified definition has not been established yet for each category, and there is no clear standard for the post-surgery time point to be used to assess weight loss failure. In addition, analyzing factors that contribute to weight loss failure will lead to strategies for reducing it. Therefore, many researchers have been interested in this subject and have published conflicting results. This review presents a definition for and describes the mechanisms and predictors of weight loss failure after bariatric surgery.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/04/jmbs-11-39.PMC10011675.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9188434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.17476/jmbs.2022.11.2.30
Sang-Yong Son, Jeong Ho Song, Ho-Jung Shin, Hoon Hur, Sang-Uk Han
Obesity by itself is a factor in the development of gallstone disease, and periods of weight loss after bariatric surgery further increase the risk of gallstone formation. In patients with obesity, hypersecretion of cholesterol may increase the risk of gallstone formation, which is approximately five-fold higher than that in the general population. The incidence of gallstone formation after bariatric surgery is 10-38% and often associated with a proportional increase in the risk of developing biliary complications. Routine postoperative administration of ursodeoxycholic acid (UDCA) is recommended to prevent gallstone formation. Several randomized trials have indicated that UDCA can effectively prevent gallstones and reduce the risk of cholecystectomy after bariatric procedures. The effective daily dose of UDCA in each study ranged from 500 to 1,200 mg, and it may be considered at least during the period of rapid weight loss (first 3-6 months postoperatively) to decrease the incidence of symptomatic gallstones.
{"title":"Prevention of Gallstones After Bariatric Surgery using Ursodeoxycholic Acid: A Narrative Review of Literatures.","authors":"Sang-Yong Son, Jeong Ho Song, Ho-Jung Shin, Hoon Hur, Sang-Uk Han","doi":"10.17476/jmbs.2022.11.2.30","DOIUrl":"https://doi.org/10.17476/jmbs.2022.11.2.30","url":null,"abstract":"<p><p>Obesity by itself is a factor in the development of gallstone disease, and periods of weight loss after bariatric surgery further increase the risk of gallstone formation. In patients with obesity, hypersecretion of cholesterol may increase the risk of gallstone formation, which is approximately five-fold higher than that in the general population. The incidence of gallstone formation after bariatric surgery is 10-38% and often associated with a proportional increase in the risk of developing biliary complications. Routine postoperative administration of ursodeoxycholic acid (UDCA) is recommended to prevent gallstone formation. Several randomized trials have indicated that UDCA can effectively prevent gallstones and reduce the risk of cholecystectomy after bariatric procedures. The effective daily dose of UDCA in each study ranged from 500 to 1,200 mg, and it may be considered at least during the period of rapid weight loss (first 3-6 months postoperatively) to decrease the incidence of symptomatic gallstones.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cc/61/jmbs-11-30.PMC10011673.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9188430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-01DOI: 10.17476/jmbs.2022.11.2.63
Ki Hyun Kim, Yoonhong Kim, Kwang Il Seo, Kyung Won Seo
Purpose: The number of Korean patients undergoing metabolic surgery for obesity is on the increase. Patients undergoing obesity and metabolic surgery have a body mass index (BMI) ≥30 kg/m2. In this study, we investigated the prevalence of nonalcoholic fatty liver disease in Korean patients who had undergone bariatric surgery.
Materials and methods: Between January 2019 and December 2021, 147 patients who underwent bariatric surgery were studied. Of these, 133 patients underwent transient elastography, and the prevalence was analyzed after being classified using the World Health Organization (WHO) obesity classification system. The participants were divided into three groups as Class 1, BMI 30 to <35 kg/m2; Class 2, BMI 35 to <40 kg/m2; and Class 3, BMI ≥40 kg/m2).
Results: The average ages of three classes of patients according to the WHO obesity classification system were 42.4, 38.8, and 36.0 years with intergroup differences. Controlled attenuation parameter (CAP) and liver stiffness also showed differences in each group (307.6±59.3, 325.8±53.0, and 346.5±52.2, respectively, P=0.007; CAP, 5.5±2.1, 7.1±3.8, and 11.7±9.1, P<0.001; liver stiffness). The prevalence of type 2 diabetes mellitus also differed among the groups (61.3%, 42.2%, and 36.8%, respectively, P=0.036). The proportion of patients with liver fibrosis also showed differences in each group (16.1%, 42.2%, and 59.6%, respectively; P<0.001).
Conclusion: Our study shows that most Korean patients undergoing bariatric surgery were also diagnosed with hepatic steatosis. Furthermore, the rate of liver fibrosis was higher among patients with more severe obesity.
{"title":"Prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) in Korean Patients Undergoing Bariatric Surgery.","authors":"Ki Hyun Kim, Yoonhong Kim, Kwang Il Seo, Kyung Won Seo","doi":"10.17476/jmbs.2022.11.2.63","DOIUrl":"https://doi.org/10.17476/jmbs.2022.11.2.63","url":null,"abstract":"<p><strong>Purpose: </strong>The number of Korean patients undergoing metabolic surgery for obesity is on the increase. Patients undergoing obesity and metabolic surgery have a body mass index (BMI) ≥30 kg/m<sup>2</sup>. In this study, we investigated the prevalence of nonalcoholic fatty liver disease in Korean patients who had undergone bariatric surgery.</p><p><strong>Materials and methods: </strong>Between January 2019 and December 2021, 147 patients who underwent bariatric surgery were studied. Of these, 133 patients underwent transient elastography, and the prevalence was analyzed after being classified using the World Health Organization (WHO) obesity classification system. The participants were divided into three groups as Class 1, BMI 30 to <35 kg/m<sup>2</sup>; Class 2, BMI 35 to <40 kg/m<sup>2</sup>; and Class 3, BMI ≥40 kg/m<sup>2</sup>).</p><p><strong>Results: </strong>The average ages of three classes of patients according to the WHO obesity classification system were 42.4, 38.8, and 36.0 years with intergroup differences. Controlled attenuation parameter (CAP) and liver stiffness also showed differences in each group (307.6±59.3, 325.8±53.0, and 346.5±52.2, respectively, P=0.007; CAP, 5.5±2.1, 7.1±3.8, and 11.7±9.1, P<0.001; liver stiffness). The prevalence of type 2 diabetes mellitus also differed among the groups (61.3%, 42.2%, and 36.8%, respectively, P=0.036). The proportion of patients with liver fibrosis also showed differences in each group (16.1%, 42.2%, and 59.6%, respectively; P<0.001).</p><p><strong>Conclusion: </strong>Our study shows that most Korean patients undergoing bariatric surgery were also diagnosed with hepatic steatosis. Furthermore, the rate of liver fibrosis was higher among patients with more severe obesity.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/f9/jmbs-11-63.PMC10011674.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9484734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The obesity pandemic has led to metabolic-associated fatty liver disease as being a major cause of chronic liver disease and liver transplantation worldwide. Metabolic and bariatric surgery (MBS), through a significant and sustained weight loss, has been shown to have a positive impact on both liver steatohepatitis and fibrosis. This review article aims to present and critically appraise the current literature on the impact of MBS on liver disease and highlight its increasing acceptance within the liver transplant community.
{"title":"Impact of metabolic and bariatric surgery on liver diseases: Current evidence","authors":"Lokesh Agarwal, Ritvik Chekuri, Vitish Singla, Arun Kumar, Shalimar, S. Aggarwal","doi":"10.4103/jbs.jbs_9_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_9_22","url":null,"abstract":"The obesity pandemic has led to metabolic-associated fatty liver disease as being a major cause of chronic liver disease and liver transplantation worldwide. Metabolic and bariatric surgery (MBS), through a significant and sustained weight loss, has been shown to have a positive impact on both liver steatohepatitis and fibrosis. This review article aims to present and critically appraise the current literature on the impact of MBS on liver disease and highlight its increasing acceptance within the liver transplant community.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77379947","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}
Nishant Gurnani, Mehul Gupta, S. Aggarwal, A. Nehra, V. Sreenivas
Introduction: South Asia has noted an increasing prevalence of obesity and employment of bariatric surgery (BS) procedures. Prior studies have shown improvement in memory, executive function and attention, after Roux-en-Y gastric bypass (RYGB) operation in the Western population. However, there is a scarcity of data on cognitive improvement following BS in a non-Western population. Objective: The objective of the study is to evaluate changes in cognitive functions of patients with severe obesity, after BS. Study Setting: Tertiary-care Academic Center, India. Methodology: A prospective study of patients undergoing BS was conducted. Specific neurocognitive tests (Mini-mental Status Examination, Standard progressive matrices, Controlled Oral Word Association Test, and Post Graduate Institute Memory Scale test) were used to assess cognitive status at baseline (preoperatively), and at 3, 6, and 12 months. Results: Fifty-three patients were enrolled in the study, out of which 50 had completed 1 year of follow-up at the time of analysis (n = 50). Thirty-six patients (72%) were females. The median age was 42 years, and the mean preoperative body mass index (BMI) was 45.5 ± 6.3 kg/m2. 40 patients underwent SG, while 10 underwent RYGB procedure. At baseline, the study cohort had impairment of abstract reasoning, attention, and verbal retention, as compared to normative data. At 1 year after surgery, the mean BMI was 29.1 ± 2.6 kg/m2. There was a significant (P < 0.05) improvement in most cognitive domains (global cognitive functioning, abstract reasoning, attention/concentration, and memory function). However, improvement in language function was not found to be significant across the follow-up duration of 12 months (P = 0.35). Conclusions: Individuals with severe obesity experience baseline impairment in cognitive functions. Similar to results from the Western population, BS (RYGB and SG) results in a significant improvement in multiple cognitive domains even in a non-Western population.
{"title":"Cognitive improvement following sleeve gastrectomy and roux-En-Y gastric bypass procedures","authors":"Nishant Gurnani, Mehul Gupta, S. Aggarwal, A. Nehra, V. Sreenivas","doi":"10.4103/jbs.jbs_6_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_6_22","url":null,"abstract":"Introduction: South Asia has noted an increasing prevalence of obesity and employment of bariatric surgery (BS) procedures. Prior studies have shown improvement in memory, executive function and attention, after Roux-en-Y gastric bypass (RYGB) operation in the Western population. However, there is a scarcity of data on cognitive improvement following BS in a non-Western population. Objective: The objective of the study is to evaluate changes in cognitive functions of patients with severe obesity, after BS. Study Setting: Tertiary-care Academic Center, India. Methodology: A prospective study of patients undergoing BS was conducted. Specific neurocognitive tests (Mini-mental Status Examination, Standard progressive matrices, Controlled Oral Word Association Test, and Post Graduate Institute Memory Scale test) were used to assess cognitive status at baseline (preoperatively), and at 3, 6, and 12 months. Results: Fifty-three patients were enrolled in the study, out of which 50 had completed 1 year of follow-up at the time of analysis (n = 50). Thirty-six patients (72%) were females. The median age was 42 years, and the mean preoperative body mass index (BMI) was 45.5 ± 6.3 kg/m2. 40 patients underwent SG, while 10 underwent RYGB procedure. At baseline, the study cohort had impairment of abstract reasoning, attention, and verbal retention, as compared to normative data. At 1 year after surgery, the mean BMI was 29.1 ± 2.6 kg/m2. There was a significant (P < 0.05) improvement in most cognitive domains (global cognitive functioning, abstract reasoning, attention/concentration, and memory function). However, improvement in language function was not found to be significant across the follow-up duration of 12 months (P = 0.35). Conclusions: Individuals with severe obesity experience baseline impairment in cognitive functions. Similar to results from the Western population, BS (RYGB and SG) results in a significant improvement in multiple cognitive domains even in a non-Western population.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88815401","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}
D. Poudel, R. Pandey, A. Bhalla, Ankur Sharma, B. Ray, J. Punj, V. Darlong, S. Aggarwal
Background: Patients undergoing bariatric surgeries are at higher perioperative risk due to multiple comorbidities. We studied the hemodynamic changes during pneumoperitoneum and reverse Trendelenburg position in bariatric surgery, using noninvasive cardiac output (CO) monitoring. Methods: In this prospective observational study, 60 patients of the American Society of Anesthesiologists Grade I–II, aged between 18 and 60 years, planned for elective laparoscopic bariatric surgery were included. During the intraoperative period, hemodynamic monitoring was done using an estimated continuous CO (esCCO) monitor. We noted oxygen saturation (SpO2), heart rate, blood pressure (BP), and CO values obtained before induction of general anesthesia and were compared with values obtained after induction, postintubation, after pneumoperitoneum, after reverse Trendelenburg, and every 10 min during the procedure and postextubation. Results: The mean baseline SpO2, pulse rate (PR), systolic BP (SBP), diastolic BP (DBP), and CO was 99.17 ± 1.7, 99.9 ± 1.35 bpm, 136.3 ± 14.5 mm Hg, 83.11 ± 10.5 mm Hg, and 7.59 ± 1.44 L/min, respectively. There was a significant fall in PR, SBP, DBP, and CO after induction of anesthesia and intubation (P = 0.001). After creating pneumoperitoneum and reverse Trendelenburg, the fall in hemodynamic parameters was also significant (P = 0.001). Conclusions: The esCCO noninvasive CO monitor can be used in patients undergoing bariatric surgeries and predict CO during surgery.
背景:由于多种合并症，接受减肥手术的患者围手术期风险较高。我们使用无创心输出量(CO)监测，研究了减肥手术中气腹和逆Trendelenburg体位的血流动力学变化。方法:在这项前瞻性观察研究中，纳入60例美国麻醉师学会I-II级患者，年龄在18岁至60岁之间，计划进行选择性腹腔镜减肥手术。术中使用预估连续CO (esCCO)监测仪进行血流动力学监测。我们记录了全麻诱导前的血氧饱和度(SpO2)、心率、血压(BP)和CO值，并与诱导后、插管后、气腹后、逆Trendelenburg后、术中和拔管后每10分钟的值进行比较。结果:平均基线SpO2、脉搏率(PR)、收缩压(SBP)、舒张压(DBP)和CO分别为99.17±1.7、99.9±1.35 bpm、136.3±14.5 mm Hg、83.11±10.5 mm Hg和7.59±1.44 L/min。诱导麻醉和插管后PR、SBP、DBP和CO显著下降(P = 0.001)。在制造气腹和逆转Trendelenburg后，血流动力学参数也显著下降(P = 0.001)。结论:esCCO无创CO监测可用于减肥手术患者，可预测术中CO的发生。
{"title":"Hemodynamic changes during pneumoperitoneum and reverse Trendelenburg position in bariatric surgery: An observational study using noninvasive cardiac output monitoring","authors":"D. Poudel, R. Pandey, A. Bhalla, Ankur Sharma, B. Ray, J. Punj, V. Darlong, S. Aggarwal","doi":"10.4103/jbs.jbs_12_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_12_22","url":null,"abstract":"Background: Patients undergoing bariatric surgeries are at higher perioperative risk due to multiple comorbidities. We studied the hemodynamic changes during pneumoperitoneum and reverse Trendelenburg position in bariatric surgery, using noninvasive cardiac output (CO) monitoring. Methods: In this prospective observational study, 60 patients of the American Society of Anesthesiologists Grade I–II, aged between 18 and 60 years, planned for elective laparoscopic bariatric surgery were included. During the intraoperative period, hemodynamic monitoring was done using an estimated continuous CO (esCCO) monitor. We noted oxygen saturation (SpO2), heart rate, blood pressure (BP), and CO values obtained before induction of general anesthesia and were compared with values obtained after induction, postintubation, after pneumoperitoneum, after reverse Trendelenburg, and every 10 min during the procedure and postextubation. Results: The mean baseline SpO2, pulse rate (PR), systolic BP (SBP), diastolic BP (DBP), and CO was 99.17 ± 1.7, 99.9 ± 1.35 bpm, 136.3 ± 14.5 mm Hg, 83.11 ± 10.5 mm Hg, and 7.59 ± 1.44 L/min, respectively. There was a significant fall in PR, SBP, DBP, and CO after induction of anesthesia and intubation (P = 0.001). After creating pneumoperitoneum and reverse Trendelenburg, the fall in hemodynamic parameters was also significant (P = 0.001). Conclusions: The esCCO noninvasive CO monitor can be used in patients undergoing bariatric surgeries and predict CO during surgery.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73868050","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}
Laparoscopic sleeve gastrectomy (LSG) has achieved high approval rates as stand-alone weight loss procedure in recent years. Its safety and effectiveness have been clearly established by numerous published studies. On the other hand, there has been great concern about complications related to the long staple line, mainly bleeding and leaks. Although this concern is universal among bariatric surgeons, strategies to prevent complications related to the staple line are not consensual. Accordingly, staple-line reinforcement methods have been widely proposed in an attempt to reduce the risk of these adverse events. However, nonreinforced but technically well-performed staple line can also be a very safe option, saving operative time and procedure-related costs. Therefore, the purpose of this narrative review is to discuss current options for minimizing the risk of staple line-related bleeding and leaks in LSG, focusing on technical issues and reinforcement methods.
{"title":"Staple-line reinforcement in laparoscopic sleeve gastrectomy: Needful or excessive care?","authors":"Eduardo Bastos, A. Ramos","doi":"10.4103/jbs.jbs_7_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_7_22","url":null,"abstract":"Laparoscopic sleeve gastrectomy (LSG) has achieved high approval rates as stand-alone weight loss procedure in recent years. Its safety and effectiveness have been clearly established by numerous published studies. On the other hand, there has been great concern about complications related to the long staple line, mainly bleeding and leaks. Although this concern is universal among bariatric surgeons, strategies to prevent complications related to the staple line are not consensual. Accordingly, staple-line reinforcement methods have been widely proposed in an attempt to reduce the risk of these adverse events. However, nonreinforced but technically well-performed staple line can also be a very safe option, saving operative time and procedure-related costs. Therefore, the purpose of this narrative review is to discuss current options for minimizing the risk of staple line-related bleeding and leaks in LSG, focusing on technical issues and reinforcement methods.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75623064","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}
Kiran Yelkur, M. Valeti, Sumanth Kankanala, Sahithi Jekkyreddy, Mithila Gade
Background: Nonalcoholic fatty liver disease (NAFLD) is present in the majority of the patients undergoing bariatric surgery. Weight loss induced by bariatric surgery has been shown to improve clinical measurements and liver histology of NAFLD. The present study aims to evaluate the impact of bariatric surgery on NAFLD in Indian patients with severe obesity using noninvasive parameters. Materials and Methods: This prospective study was conducted on 67 patients who underwent bariatric surgery (laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass). The Asia-Pacific Metabolic and Bariatric Surgery Society guidelines were followed to ensure the indications for bariatric surgery. Data collected included anthropometrics, biochemical parameters, and other noninvasive parameters. Results: Fifty-four patients were included in the final analysis, with the majority being males (54.2%). The mean age was 44.77 ± 12.64 years old. One-year follow-up postsurgery demonstrated a statistically significant improvement in total weight loss and body mass index (BMI) reduction (P < 0.00001). Mean NAFLD fibrosis scores improved from −1.70 to −1.95; however, the improvement was not statistically significant (P = 0.4295). Biochemical improvement was found in the serum levels of alanine aminotransferase (P = 0.0169) and aspartate aminotransferase (P = 0.0004). Concomitantly, significant improvements in AST to Platelet Ratio Index score, BMI, AST/alanine aminotransferase ratio, diabetes score, and liver stiffness measurement on Fibroscan (8.9 ± 1.01 pka [initial] to 7.2 ± 0.40 pka [follow-up]) were observed. Conclusions: Our findings suggest a beneficial association of bariatric surgery in NAFLD patients. Bariatric surgery is found to induce weight loss significantly and improve liver functions as measured by noninvasive parameters. Further, long-term studies are needed to consolidate these results.
{"title":"Impact of bariatric surgery on non-alcoholic fatty liver disease - Role of non-invasive tests","authors":"Kiran Yelkur, M. Valeti, Sumanth Kankanala, Sahithi Jekkyreddy, Mithila Gade","doi":"10.4103/jbs.jbs_8_21","DOIUrl":"https://doi.org/10.4103/jbs.jbs_8_21","url":null,"abstract":"Background: Nonalcoholic fatty liver disease (NAFLD) is present in the majority of the patients undergoing bariatric surgery. Weight loss induced by bariatric surgery has been shown to improve clinical measurements and liver histology of NAFLD. The present study aims to evaluate the impact of bariatric surgery on NAFLD in Indian patients with severe obesity using noninvasive parameters. Materials and Methods: This prospective study was conducted on 67 patients who underwent bariatric surgery (laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass). The Asia-Pacific Metabolic and Bariatric Surgery Society guidelines were followed to ensure the indications for bariatric surgery. Data collected included anthropometrics, biochemical parameters, and other noninvasive parameters. Results: Fifty-four patients were included in the final analysis, with the majority being males (54.2%). The mean age was 44.77 ± 12.64 years old. One-year follow-up postsurgery demonstrated a statistically significant improvement in total weight loss and body mass index (BMI) reduction (P < 0.00001). Mean NAFLD fibrosis scores improved from −1.70 to −1.95; however, the improvement was not statistically significant (P = 0.4295). Biochemical improvement was found in the serum levels of alanine aminotransferase (P = 0.0169) and aspartate aminotransferase (P = 0.0004). Concomitantly, significant improvements in AST to Platelet Ratio Index score, BMI, AST/alanine aminotransferase ratio, diabetes score, and liver stiffness measurement on Fibroscan (8.9 ± 1.01 pka [initial] to 7.2 ± 0.40 pka [follow-up]) were observed. Conclusions: Our findings suggest a beneficial association of bariatric surgery in NAFLD patients. Bariatric surgery is found to induce weight loss significantly and improve liver functions as measured by noninvasive parameters. Further, long-term studies are needed to consolidate these results.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89510267","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}
Context: Bariatric surgery is an effective method in inducing significant weight loss in patients suffering from obesity. Despite the strong evidence on its clinical effects, the data on its mid- and long-term follow-ups and durability are limited. This study is to evaluate the impact of bariatric surgical procedures on weight loss and resolution of comorbidities after surgery. Subjects and Methods: This was a retrospective, single-center cohort study including 1468 participants in whom laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, one-anastomosis gastric bypass, and balloon were performed between 2010 and 2019. Standardized weight loss measures were compared using an analysis of covariance. Results: The mean (standard deviation) age of patients involved in this study is 43.41 ± 12.09 years with a preoperative weight and body mass index (BMI) of 117.23 ± 23.027 and 44.93 ± 8.02, respectively. The mean follow-up period is 2.9 years (0.83–9 years). Patients reported a mean percentage total weight loss (%TWL) of 8.1 ± 15.66%, percentage excess weight loss (%EWL) of 18.92 ± 40.56, and excess BMI loss of 18.38 ± 42.7 at the follow-up point of 9 years. The remission of diabetes was significantly improved by 17%. 0.89% of patients adhered to follow-up visits till the end of the study. Conclusions: Bariatric surgery demonstrated a beneficial association resulting in substantial weight loss and remission of diabetes. Further large, multi-site cohort studies on Indian population are needed to substantiate the evidence.
{"title":"Retrospective evaluation of mid- and long-term outcomes of bariatric surgery on obesity control in Indian population","authors":"M. Khaitan, Riddhish Gadani, K. Pokharel","doi":"10.4103/jbs.jbs_5_21","DOIUrl":"https://doi.org/10.4103/jbs.jbs_5_21","url":null,"abstract":"Context: Bariatric surgery is an effective method in inducing significant weight loss in patients suffering from obesity. Despite the strong evidence on its clinical effects, the data on its mid- and long-term follow-ups and durability are limited. This study is to evaluate the impact of bariatric surgical procedures on weight loss and resolution of comorbidities after surgery. Subjects and Methods: This was a retrospective, single-center cohort study including 1468 participants in whom laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, one-anastomosis gastric bypass, and balloon were performed between 2010 and 2019. Standardized weight loss measures were compared using an analysis of covariance. Results: The mean (standard deviation) age of patients involved in this study is 43.41 ± 12.09 years with a preoperative weight and body mass index (BMI) of 117.23 ± 23.027 and 44.93 ± 8.02, respectively. The mean follow-up period is 2.9 years (0.83–9 years). Patients reported a mean percentage total weight loss (%TWL) of 8.1 ± 15.66%, percentage excess weight loss (%EWL) of 18.92 ± 40.56, and excess BMI loss of 18.38 ± 42.7 at the follow-up point of 9 years. The remission of diabetes was significantly improved by 17%. 0.89% of patients adhered to follow-up visits till the end of the study. Conclusions: Bariatric surgery demonstrated a beneficial association resulting in substantial weight loss and remission of diabetes. Further large, multi-site cohort studies on Indian population are needed to substantiate the evidence.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89692993","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 Trust","authors":"Ramen Goel","doi":"10.4103/jbs.jbs_17_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_17_22","url":null,"abstract":"","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78303650","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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