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":"42 1","pages":"105 - 110"},"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":"9 1","pages":"61 - 67"},"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":"25 1","pages":"72 - 76"},"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":"62 1","pages":"77 - 81"},"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":"13 1","pages":"59 - 60"},"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}
Saba Khan, Astha Sachan, P. Arumugaswamy, Archna Singh, S. Aggarwal, Rakhee Yadav
Background: Micronutrient deficiency is common in obesity despite surplus weight and high caloric intake. Further exacerbation is often seen after bariatric surgery due to the resultant dietary restrictions, and physiological and anatomical alterations. Owing to the rising prevalence of obesity in India with a simultaneous surge in bariatric surgeries, an account of micronutrient status is required. This will help in identifying susceptible individuals and setting up priorities for prevention and intervention. Subjects and Methods: A retrospective study was designed to analyze the data collected before and until 1 year (3, 6, and 12 months) after bariatric surgery in individuals with severe obesity (body mass index ≥35 kg/m2, n = 150). We included the assessment of nutritional parameters, namely, serum iron, ferritin, total iron-binding capacity, Vitamin B12, folic acid, homocysteine, calcium, phosphorus, Vitamin D, and parathormone along with anthropometric and routine biochemical investigations. Results: Deficiency of Vitamin D was most prevalent (52%) at baseline, followed by anemia (21%). Ferritin deficiency was 9.3%, followed by iron (8.0%), Vitamin B12(7.3%), and folate deficiency (4.7%) at baseline. There was a remarkable improvement in Vitamin D deficiency (26%), whereas the percent prevalence of other micronutrients has shown deterioration in 12 months after bariatric surgery. No significant difference existed in the prevalence of micronutrient deficiency between laparoscopic sleeve gastrectomy (n = 75) and laparoscopic Roux-en-Y gastric bypass surgery (n = 75) over the 12-month follow-up period. Conclusion: Micronutrient deficiencies persisted after bariatric surgery underlining the need for fine adjustment of supplementations and monitoring compliance to ensure the best patient outcomes.
背景:微量营养素缺乏在肥胖中很常见，尽管体重过剩和高热量摄入。在减肥手术后，由于饮食限制以及生理和解剖学的改变，病情往往会进一步恶化。由于印度的肥胖患病率不断上升，同时减肥手术激增，因此需要对微量营养素状况进行说明。这将有助于确定易受影响的个人，并确定预防和干预的优先事项。研究对象和方法:本研究旨在分析重度肥胖患者(体重指数≥35 kg/m2, n = 150)在减肥手术前及手术后1年(3、6和12个月)收集的数据。我们包括了营养参数的评估，即血清铁、铁蛋白、总铁结合能力、维生素B12、叶酸、同型半胱氨酸、钙、磷、维生素D和甲状旁腺激素，以及人体测量和常规生化调查。结果:基线时维生素D缺乏症最为普遍(52%)，其次是贫血(21%)。基线时，铁蛋白缺乏症发生率为9.3%，其次是铁(8.0%)、维生素B12(7.3%)和叶酸缺乏症(4.7%)。维生素D缺乏症有显著改善(26%)，而其他微量营养素的患病率在减肥手术后的12个月内出现恶化。在12个月的随访期间，腹腔镜袖胃切除术(n = 75)和腹腔镜Roux-en-Y胃旁路手术(n = 75)的微量营养素缺乏症发生率无显著差异。结论:减肥手术后微量营养素缺乏持续存在，强调需要对补充剂进行微调并监测依从性，以确保患者的最佳预后。
{"title":"An evaluation of micronutrient status in severe obesity and follow-up assessment after bariatric surgery: A retrospective single-center study","authors":"Saba Khan, Astha Sachan, P. Arumugaswamy, Archna Singh, S. Aggarwal, Rakhee Yadav","doi":"10.4103/jbs.jbs_11_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_11_22","url":null,"abstract":"Background: Micronutrient deficiency is common in obesity despite surplus weight and high caloric intake. Further exacerbation is often seen after bariatric surgery due to the resultant dietary restrictions, and physiological and anatomical alterations. Owing to the rising prevalence of obesity in India with a simultaneous surge in bariatric surgeries, an account of micronutrient status is required. This will help in identifying susceptible individuals and setting up priorities for prevention and intervention. Subjects and Methods: A retrospective study was designed to analyze the data collected before and until 1 year (3, 6, and 12 months) after bariatric surgery in individuals with severe obesity (body mass index ≥35 kg/m2, n = 150). We included the assessment of nutritional parameters, namely, serum iron, ferritin, total iron-binding capacity, Vitamin B12, folic acid, homocysteine, calcium, phosphorus, Vitamin D, and parathormone along with anthropometric and routine biochemical investigations. Results: Deficiency of Vitamin D was most prevalent (52%) at baseline, followed by anemia (21%). Ferritin deficiency was 9.3%, followed by iron (8.0%), Vitamin B12(7.3%), and folate deficiency (4.7%) at baseline. There was a remarkable improvement in Vitamin D deficiency (26%), whereas the percent prevalence of other micronutrients has shown deterioration in 12 months after bariatric surgery. No significant difference existed in the prevalence of micronutrient deficiency between laparoscopic sleeve gastrectomy (n = 75) and laparoscopic Roux-en-Y gastric bypass surgery (n = 75) over the 12-month follow-up period. Conclusion: Micronutrient deficiencies persisted after bariatric surgery underlining the need for fine adjustment of supplementations and monitoring compliance to ensure the best patient outcomes.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"50 1","pages":"97 - 104"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84853649","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}
M. Hany, Hala M Demerdash, Asmaa. H. Ahmed, A. Agayby, Mohamed Ghaballa, Mohamed Ibrahim, P. Maged, B. Torensma
Background: Epigenetic changes after bariatric surgery are of increasing interest; we evaluated the levels of two circulating microRNAs (miRNA-222 and miRNA-146a) before and after the laparoscopic sleeve gastrectomy (LSG) and the effect of weight loss on the levels of metabolic biomarkers. Materials and Methods: We prospectively evaluated patients pre- and 12 months post-LSG for percent excess weight loss (%EWL), miRNAs levels, metabolic biomarkers (leptin, ghrelin, peptide YY, and glucagon peptide-1 [GLP-1]) levels from August 2019 to September 2021. Results: Significant differences were observed in the miRNA146a-3p (median: 0.64 (0.012-2.68) vs. 1.07 (0.1-3.6); P = 0.019) and miRNA222-5p (median 1.80 (0.1–3.61) vs. 1.19 (0.1-3.68); P = 0.003) levels before and after (12 months) LSG; fasting leptin, ghrelin, insulin, total cholesterol, high- and low-density lipoproteins, fasting blood sugar (FBS), and triglyceride levels also showed significant differences. Significant changes were observed in postprandial values of glucagon-like peptide l (GLP-1) (P = 0.0001) and peptide YY (P = 0.0006) 12 months after LSG. Homeostatic model assessment of insulin resistance (IR) was significantly correlated with %EWL, miRNA146a, and miRNA222-5p (P = 0.002). Postoperatively measured miR146a-39 and miRNA222-5p showed significant coefficient of determination R2 of 0.184 (P = 0.008) and 0.259, P = 0.0007 toward %EWL, respectively. Furthermore, significant correlations of miRNA146a were observed with FBS and IR. Conclusions: LSG-mediated weight loss affected the plasma levels of miR146a and miR222-5p. Due to the simultaneous decrease of ghrelin and increase of postprandial hormones (peptide YY and GLP-1), medical problems in patients with obesity were reduced. This study identified miRNAs as the new markers in the treatment, diagnosis, and therapeutic direction of patients with obesity.
{"title":"microRNA profiling and the effect on metabolic biomarkers and weight loss after laparoscopic sleeve gastrectomy: A prospective cohort study","authors":"M. Hany, Hala M Demerdash, Asmaa. H. Ahmed, A. Agayby, Mohamed Ghaballa, Mohamed Ibrahim, P. Maged, B. Torensma","doi":"10.4103/jbs.jbs_8_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_8_22","url":null,"abstract":"Background: Epigenetic changes after bariatric surgery are of increasing interest; we evaluated the levels of two circulating microRNAs (miRNA-222 and miRNA-146a) before and after the laparoscopic sleeve gastrectomy (LSG) and the effect of weight loss on the levels of metabolic biomarkers. Materials and Methods: We prospectively evaluated patients pre- and 12 months post-LSG for percent excess weight loss (%EWL), miRNAs levels, metabolic biomarkers (leptin, ghrelin, peptide YY, and glucagon peptide-1 [GLP-1]) levels from August 2019 to September 2021. Results: Significant differences were observed in the miRNA146a-3p (median: 0.64 (0.012-2.68) vs. 1.07 (0.1-3.6); P = 0.019) and miRNA222-5p (median 1.80 (0.1–3.61) vs. 1.19 (0.1-3.68); P = 0.003) levels before and after (12 months) LSG; fasting leptin, ghrelin, insulin, total cholesterol, high- and low-density lipoproteins, fasting blood sugar (FBS), and triglyceride levels also showed significant differences. Significant changes were observed in postprandial values of glucagon-like peptide l (GLP-1) (P = 0.0001) and peptide YY (P = 0.0006) 12 months after LSG. Homeostatic model assessment of insulin resistance (IR) was significantly correlated with %EWL, miRNA146a, and miRNA222-5p (P = 0.002). Postoperatively measured miR146a-39 and miRNA222-5p showed significant coefficient of determination R2 of 0.184 (P = 0.008) and 0.259, P = 0.0007 toward %EWL, respectively. Furthermore, significant correlations of miRNA146a were observed with FBS and IR. Conclusions: LSG-mediated weight loss affected the plasma levels of miR146a and miR222-5p. Due to the simultaneous decrease of ghrelin and increase of postprandial hormones (peptide YY and GLP-1), medical problems in patients with obesity were reduced. This study identified miRNAs as the new markers in the treatment, diagnosis, and therapeutic direction of patients with obesity.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"1 1","pages":"88 - 96"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74979681","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}
Pub Date : 2022-06-01DOI: 10.17476/jmbs.2022.11.1.1
Ji Yeon Park
Sleeve gastrectomy (SG) has demonstrated excellent outcomes in terms of weight loss and resolution of obesity-related comorbidities as a single procedure. It has gained rapidly increasing popularity among bariatric surgeons and patients over the last two decades. This is due to its relative ease of use and less frequent morbidities related to the procedure. Even though the overall complication rate after SG is reported to be lower than conventional Roux-en-Y gastric bypass or biliopancreatic diversion, it still affects 1-10% of the patients undergoing SG, which is not negligible. Early postoperative complications that can occur within 30 days after SG include hemorrhage, leakage, sleeve stenosis, and reflux. Thromboembolic events are rare but can occur after surgery. Here, we review the incidence, diagnosis, and management of these early postoperative complications.
{"title":"Diagnosis and Management of Postoperative Complications After Sleeve Gastrectomy.","authors":"Ji Yeon Park","doi":"10.17476/jmbs.2022.11.1.1","DOIUrl":"https://doi.org/10.17476/jmbs.2022.11.1.1","url":null,"abstract":"<p><p>Sleeve gastrectomy (SG) has demonstrated excellent outcomes in terms of weight loss and resolution of obesity-related comorbidities as a single procedure. It has gained rapidly increasing popularity among bariatric surgeons and patients over the last two decades. This is due to its relative ease of use and less frequent morbidities related to the procedure. Even though the overall complication rate after SG is reported to be lower than conventional Roux-en-Y gastric bypass or biliopancreatic diversion, it still affects 1-10% of the patients undergoing SG, which is not negligible. Early postoperative complications that can occur within 30 days after SG include hemorrhage, leakage, sleeve stenosis, and reflux. Thromboembolic events are rare but can occur after surgery. Here, we review the incidence, diagnosis, and management of these early postoperative complications.</p>","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"11 1","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/3b/jmbs-11-1.PMC9848960.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9132378","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}
Dhananjay Pandey, L. Yadav, Kona Lakshmi, R. Trivikraman
Background: Obesity is increasing at an alarming rate in India along with rest of the world. In the National Family and Health survey - IV conducted in 2015-16; 31.3% women and 26.6% men in urban area were obese or over weight. Bariatric surgery has long been introduced for weight control and is well established measure and superior to other weight control measures. Procedures like laparoscopic Roux en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are more commonly performed than Laparoscopic One Anastomosis Gastric Bypass (LOAGB). Although sufficient data has accumulated in literature regarding the safety and efficacy of LOAGB, some of standard textbooks still mention it as an experimental procedure and not the mainstream procedure. Aims and Objective: The present study was conducted with objective to find out changes in pre-operative and post-operative status of diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnoea, osteoarthritis, GERD and quality of life after laparoscopic one anastomosis gastric bypass along with its safety and efficacy in Indian population. Material and Methods: The study was conducted at a tertiary care bariatric surgical centre and included 75 consecutive individual operated between January 2016 to December 2017 who underwent Laparoscopic One Anastomosis Gastric Bypass and followed prospectively for minimum 1 year (mean 18 months) and statistical analysis was done using SPSS 21 software. Result: One Anastomosis Gastric Bypass was completed laparoscopically in all the patients without need for conversion to an open procedure. The overall complication with Laparoscopic One Anastomosis Gastric Bypass was 1.3% without any mortality. Mean percentage of excess weight loss (% EWL) achieved was 72.73. 93.9 % patients with diabetes, 67.43% patients with hypertension, 87.1% patient with hyperlipidemia, all the patient with obstructive sleep apnoea and osteoarthritis of knee showed improvement in their disease status. None of the patient showed worsening of gastroesophageal reflux or development of new symptoms of gastro esophageal reflux. All patients had improvement in their quality of life as seen in the improvement of their SF 36 scores. Conclusion: Laparoscopic One Anastomosis Gastric Bypass is a safe and effective bariatric procedure. The post procedure improvement in diabetes, hypertension, hyperlipidemia, obstructive sleep apnoea, osteoarthritis of knee and quality of life is significant in Indian context.
背景:与世界其他地区一样，印度的肥胖症正以惊人的速度增长。在2015-16年进行的第四次全国家庭与健康调查中;31.3%的女性和26.6%的男性肥胖或超重。减肥手术长期以来一直被用于控制体重，是一种完善的措施，优于其他体重控制措施。腹腔镜Roux en Y胃旁路术(LRYGB)和腹腔镜袖胃切除术(LSG)等手术比腹腔镜一次吻合胃旁路术(LOAGB)更常见。虽然LOAGB的安全性和有效性在文献中积累了足够的数据，但一些标准教科书仍然将其作为实验程序而不是主流程序。目的:本研究旨在了解印度人群腹腔镜单吻合术胃旁路术后糖尿病、高血压、血脂异常、阻塞性睡眠呼吸暂停、骨关节炎、胃反流及生活质量的变化及其安全性和有效性。材料和方法:该研究在一家三级保健减肥外科中心进行，包括2016年1月至2017年12月期间连续手术的75名患者，他们接受了腹腔镜一次吻合胃旁路术，前瞻性随访至少1年(平均18个月)，使用SPSS 21软件进行统计分析。结果:1例吻合胃旁路手术均在腹腔镜下完成，无需转开腹手术。腹腔镜一次吻合胃旁路术的总并发症为1.3%，无死亡。超额减重的平均百分比(% EWL)达到72.73。93.9%的糖尿病患者、67.43%的高血压患者、87.1%的高脂血症患者、阻塞性睡眠呼吸暂停和膝关节骨关节炎患者病情均有改善。所有患者均未出现胃食管反流恶化或胃食管反流新症状。从SF - 36评分来看，所有患者的生活质量都有所改善。结论:腹腔镜一次吻合胃旁路术是一种安全、有效的减肥手术。在印度，糖尿病、高血压、高脂血症、阻塞性睡眠呼吸暂停、膝关节骨关节炎和生活质量的术后改善是显著的。
{"title":"Outcomes of 75 consecutive cases of laparoscopic one-anastomosis gastric bypass: A prospective study","authors":"Dhananjay Pandey, L. Yadav, Kona Lakshmi, R. Trivikraman","doi":"10.4103/jbs.jbs_13_21","DOIUrl":"https://doi.org/10.4103/jbs.jbs_13_21","url":null,"abstract":"Background: Obesity is increasing at an alarming rate in India along with rest of the world. In the National Family and Health survey - IV conducted in 2015-16; 31.3% women and 26.6% men in urban area were obese or over weight. Bariatric surgery has long been introduced for weight control and is well established measure and superior to other weight control measures. Procedures like laparoscopic Roux en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are more commonly performed than Laparoscopic One Anastomosis Gastric Bypass (LOAGB). Although sufficient data has accumulated in literature regarding the safety and efficacy of LOAGB, some of standard textbooks still mention it as an experimental procedure and not the mainstream procedure. Aims and Objective: The present study was conducted with objective to find out changes in pre-operative and post-operative status of diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnoea, osteoarthritis, GERD and quality of life after laparoscopic one anastomosis gastric bypass along with its safety and efficacy in Indian population. Material and Methods: The study was conducted at a tertiary care bariatric surgical centre and included 75 consecutive individual operated between January 2016 to December 2017 who underwent Laparoscopic One Anastomosis Gastric Bypass and followed prospectively for minimum 1 year (mean 18 months) and statistical analysis was done using SPSS 21 software. Result: One Anastomosis Gastric Bypass was completed laparoscopically in all the patients without need for conversion to an open procedure. The overall complication with Laparoscopic One Anastomosis Gastric Bypass was 1.3% without any mortality. Mean percentage of excess weight loss (% EWL) achieved was 72.73. 93.9 % patients with diabetes, 67.43% patients with hypertension, 87.1% patient with hyperlipidemia, all the patient with obstructive sleep apnoea and osteoarthritis of knee showed improvement in their disease status. None of the patient showed worsening of gastroesophageal reflux or development of new symptoms of gastro esophageal reflux. All patients had improvement in their quality of life as seen in the improvement of their SF 36 scores. Conclusion: Laparoscopic One Anastomosis Gastric Bypass is a safe and effective bariatric procedure. The post procedure improvement in diabetes, hypertension, hyperlipidemia, obstructive sleep apnoea, osteoarthritis of knee and quality of life is significant in Indian context.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"1 1","pages":"42 - 48"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88134394","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}
N. Verma, R. Wadhawan, L. Sehgal, D. Veetil, Muneendra Gupta
Background: The indications for revision bariatric surgery include inadequate weight loss, weight regain, failure to resolve comorbidities, and complications associated with primary surgery. Objectives: The objective is to evaluate the outcome of revision of Roux-en-Y gastric bypass (RYGB) and compare the efficacy of different revision procedures for weight regain, resolution of comorbidities, and complications, if any. Methods: Revision cases performed between May 2017 and April 2021 were included. The analysis of collected data was carried out for weight loss, resolution of comorbidities, and adverse outcomes. Results: Twenty three revision procedures were performed. Two patients were lost to follow-up. The overall complication and reoperation rates were 14.29% and 4.76%, respectively. The follow-up duration was at 6, 12, and 36 months. Twenty-one (91.3%) patients completed 6-month, 18 (78.3%) 12-month, and nine (39.1%) completed 36-month follow-up. The mean postoperative body-mass index at 6, 12, 36 months were 33.07+/−4.15, 33.11+/−4.05, 34.5 ± 8.81, respectively. The mean %excess weight loss (EWL) at 6, 12, 36 months were 39.47+/−13.76, 43.70+/−13.70, 41.14+/−8.48%, respectively. The patients were divided into three groups. Group A - lengthening of biliopancreatic limb (BPL) by 100 cm (n = 6); Group B - placement of ring with a diameter of 7.5 cm in addition to BPL lengthening (n = 12); and Group C - pouch trimming with BPL lengthening by 100 cm (n = 3). %EWL at 6 months was 31.86, 47.69, and 53.49, in Groups A, B, and C, respectively. Similar trends in %EWL were observed in three groups at 12 and 36 months. Conclusion: Revision bariatric surgeries are complex procedures. In our study, banded RYGB with BPL lengthening had better outcomes, though a statistical significance could not be established due to the small sample size and retrospective nature of the study.
{"title":"Revision of Roux-en-Y-Gastric bypass – Our experience in Indian patients","authors":"N. Verma, R. Wadhawan, L. Sehgal, D. Veetil, Muneendra Gupta","doi":"10.4103/jbs.jbs_11_21","DOIUrl":"https://doi.org/10.4103/jbs.jbs_11_21","url":null,"abstract":"Background: The indications for revision bariatric surgery include inadequate weight loss, weight regain, failure to resolve comorbidities, and complications associated with primary surgery. Objectives: The objective is to evaluate the outcome of revision of Roux-en-Y gastric bypass (RYGB) and compare the efficacy of different revision procedures for weight regain, resolution of comorbidities, and complications, if any. Methods: Revision cases performed between May 2017 and April 2021 were included. The analysis of collected data was carried out for weight loss, resolution of comorbidities, and adverse outcomes. Results: Twenty three revision procedures were performed. Two patients were lost to follow-up. The overall complication and reoperation rates were 14.29% and 4.76%, respectively. The follow-up duration was at 6, 12, and 36 months. Twenty-one (91.3%) patients completed 6-month, 18 (78.3%) 12-month, and nine (39.1%) completed 36-month follow-up. The mean postoperative body-mass index at 6, 12, 36 months were 33.07+/−4.15, 33.11+/−4.05, 34.5 ± 8.81, respectively. The mean %excess weight loss (EWL) at 6, 12, 36 months were 39.47+/−13.76, 43.70+/−13.70, 41.14+/−8.48%, respectively. The patients were divided into three groups. Group A - lengthening of biliopancreatic limb (BPL) by 100 cm (n = 6); Group B - placement of ring with a diameter of 7.5 cm in addition to BPL lengthening (n = 12); and Group C - pouch trimming with BPL lengthening by 100 cm (n = 3). %EWL at 6 months was 31.86, 47.69, and 53.49, in Groups A, B, and C, respectively. Similar trends in %EWL were observed in three groups at 12 and 36 months. Conclusion: Revision bariatric surgeries are complex procedures. In our study, banded RYGB with BPL lengthening had better outcomes, though a statistical significance could not be established due to the small sample size and retrospective nature of the study.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":"37 1","pages":"49 - 54"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75321314","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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