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":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":"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":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":"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
Background: Laparoscopic sleeve gastrectomy has become a standalone procedure for the treatment of severe obesity with excellent short- and mid-term outcome. Staple-line leak is one of the most dreaded complications of this procedure. Following a standardized sequence of critical steps can help decrease the incidence of leaks. In this review, we examine the etiopathogenesis of leaks after laparoscopic sleeve gastrectomy and important implicated technical considerations. Materials and Methods: A comprehensive literature search of various databases was performed with relevant keywords. The published scientific literature was critically appraised. Results: Patient-, surgery-, and surgeon-related risk factors should be recognized and modifiable risk factors should be addressed. There are anatomical, physiological, and technical considerations that contribute to the pathogenesis of leaks, based on which a multitude of precautions need to be taken to prevent staple-line leak. Conclusion: The correct bougie size, distance from the pylorus, stapler size, orientation of staple line, and distance from angle of His and an intraoperative leak test are some of the crucial aspects for a successful outcome after sleeve gastrectomy. Staple size less than that of 1.5 mm should not be used on the stomach, stapling should be initiated at least 5 cm from pylorus and calibrated on a bougie that should not be <32 Fr size. Reinforcing the staple line reduces the incidence of hemorrhage, and current evidence indicates the incidence of leak. Performing a leak test, though offers less sensitivity to predict a leak, does help in detecting the immediate mechanical failure of staple line.
{"title":"Leaks after sleeve gastrectomy – A narrative review","authors":"N. Jain, R. Bhojwani, K. Mahawar","doi":"10.4103/jbs.jbs_2_21","DOIUrl":"https://doi.org/10.4103/jbs.jbs_2_21","url":null,"abstract":"Background: Laparoscopic sleeve gastrectomy has become a standalone procedure for the treatment of severe obesity with excellent short- and mid-term outcome. Staple-line leak is one of the most dreaded complications of this procedure. Following a standardized sequence of critical steps can help decrease the incidence of leaks. In this review, we examine the etiopathogenesis of leaks after laparoscopic sleeve gastrectomy and important implicated technical considerations. Materials and Methods: A comprehensive literature search of various databases was performed with relevant keywords. The published scientific literature was critically appraised. Results: Patient-, surgery-, and surgeon-related risk factors should be recognized and modifiable risk factors should be addressed. There are anatomical, physiological, and technical considerations that contribute to the pathogenesis of leaks, based on which a multitude of precautions need to be taken to prevent staple-line leak. Conclusion: The correct bougie size, distance from the pylorus, stapler size, orientation of staple line, and distance from angle of His and an intraoperative leak test are some of the crucial aspects for a successful outcome after sleeve gastrectomy. Staple size less than that of 1.5 mm should not be used on the stomach, stapling should be initiated at least 5 cm from pylorus and calibrated on a bougie that should not be <32 Fr size. Reinforcing the staple line reduces the incidence of hemorrhage, and current evidence indicates the incidence of leak. Performing a leak test, though offers less sensitivity to predict a leak, does help in detecting the immediate mechanical failure of staple line.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83159094","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}
Leaks after one anastomosis gastric bypass are managed based on the timing of presentation and the presence or absence of peritonitis. Reoperation is strongly advocated because of the potential severity of biliary peritonitis. Recently, nonoperative treatment is being increasingly employed, especially for staple line disruptions or unspecified leaks. We report successful usage of a covered esophageal stent in a gastrojejunostomy anastomosis leak with a favorable outcome.
{"title":"Management of gastrojejunostomy anastomotic leak post one anastomosis gastric bypass with a covered stent alone","authors":"P. Bhatia, H. Sheth, S. Bhatia, S. Baig","doi":"10.4103/jbs.jbs_6_21","DOIUrl":"https://doi.org/10.4103/jbs.jbs_6_21","url":null,"abstract":"Leaks after one anastomosis gastric bypass are managed based on the timing of presentation and the presence or absence of peritonitis. Reoperation is strongly advocated because of the potential severity of biliary peritonitis. Recently, nonoperative treatment is being increasingly employed, especially for staple line disruptions or unspecified leaks. We report successful usage of a covered esophageal stent in a gastrojejunostomy anastomosis leak with a favorable outcome.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84194804","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}
R. Singhal, V. Cardoso, C. Ludwig, J. Super, Yashasvi Rajeev, G. Rudge, G. Gkoutos, K. Mahawar, GENEVA collaborators, Ashraf M Shoma
Introduction: There is a paucity of data in the scientific literature on the morbidity and mortality of bariatric and metabolic surgery (BMS) in individuals suffering from Type 2 diabetes mellitus (T2D). The current study is a secondary analysis of the GENEVA dataset to understand this. Materials and Methods: Logistic regressions were performed to investigate the influence of diabetes on complication rates and procedure selection. Ethical approval was not required. Results: One thousand four hundred and seventy-five of these patients were suffering from T2D at the time of the surgery (416 diet-treated type 2 diabetes), 806 oral agent-treated type 2 diabetes, and 253 insulin-treated type 2 diabetes [ITD]). Six hundred and fifty (44.1%) of these patients underwent laparoscopic sleeve gastrectomy (LSG); 487 (33%) underwent Roux-en-Y gastric bypass; 230 (15.6%) underwent a one anastomosis gastric bypass (OAGB); and 108 (7.3%) underwent some other procedures. The 30-day mortality of BMS in those without T2D was 0.07% (4/5609) as compared to 0.4% (6/1475) and 0.8% (2/253) in those with T2D and ITD, respectively. 7.9% of those with T2D developed a 30-day complication compared to 6.5% without T2D (P = 0.0475). There was an increased risk of complications in patients with ITD on univariate and multivariate analysis. Patients with T2D were significantly less likely to undergo an LSG and significantly more likely to undergo an OAGB. Conclusions: ITD patients undergoing BMS experienced significantly higher 30-day morbidity and mortality. Although LSG was the most common procedure in patients with T2D, these patients were less likely to undergo LSG than patients without T2D.
{"title":"Thirty-day morbidity and mortality of bariatric and metabolic surgery in patients with type 2 diabetes mellitus: A subset analysis of the GENEVA cohort study","authors":"R. Singhal, V. Cardoso, C. Ludwig, J. Super, Yashasvi Rajeev, G. Rudge, G. Gkoutos, K. Mahawar, GENEVA collaborators, Ashraf M Shoma","doi":"10.4103/jbs.jbs_1_21","DOIUrl":"https://doi.org/10.4103/jbs.jbs_1_21","url":null,"abstract":"Introduction: There is a paucity of data in the scientific literature on the morbidity and mortality of bariatric and metabolic surgery (BMS) in individuals suffering from Type 2 diabetes mellitus (T2D). The current study is a secondary analysis of the GENEVA dataset to understand this. Materials and Methods: Logistic regressions were performed to investigate the influence of diabetes on complication rates and procedure selection. Ethical approval was not required. Results: One thousand four hundred and seventy-five of these patients were suffering from T2D at the time of the surgery (416 diet-treated type 2 diabetes), 806 oral agent-treated type 2 diabetes, and 253 insulin-treated type 2 diabetes [ITD]). Six hundred and fifty (44.1%) of these patients underwent laparoscopic sleeve gastrectomy (LSG); 487 (33%) underwent Roux-en-Y gastric bypass; 230 (15.6%) underwent a one anastomosis gastric bypass (OAGB); and 108 (7.3%) underwent some other procedures. The 30-day mortality of BMS in those without T2D was 0.07% (4/5609) as compared to 0.4% (6/1475) and 0.8% (2/253) in those with T2D and ITD, respectively. 7.9% of those with T2D developed a 30-day complication compared to 6.5% without T2D (P = 0.0475). There was an increased risk of complications in patients with ITD on univariate and multivariate analysis. Patients with T2D were significantly less likely to undergo an LSG and significantly more likely to undergo an OAGB. Conclusions: ITD patients undergoing BMS experienced significantly higher 30-day morbidity and mortality. Although LSG was the most common procedure in patients with T2D, these patients were less likely to undergo LSG than patients without T2D.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73224757","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: Roux en Y gastric bypass (RYGB) has been highly effective in weight loss and it has been the procedure of choice for patients suffering from diabetes. There is a high attrition rate in long-term follow-up. Hence, limited long-term data are available. Methodology: We collected retrospectively data from a prospectively maintained institutional database. To increase the long-term follow-up rate, a telephonic interview was conducted with patients who had not come for long-term follow-up. Standard definitions were used for weight loss, weight regain, comorbidities, comorbidity resolution, and nutritional parameters. Results: Of 142 patients who underwent laparoscopic RYGB between 2008 and 2018, 125 patients (M: 33, F: 92; Age: 42.4 ± 5.2 years) were included in the study. The mean % weight loss at 1, 3, 5, and 7 years was 28.9, 31.8, 31.3, and 31.7, respectively. Mean % excess body mass index loss (% EBMIL) at 1, 3, 5, and 7 years was 67.6 ± 18, 73.7 ± 17.9, 71.7 ± 20.7, and 69.5 ± 24.6, respectively. Median weight regain at 3, 5, and 7 years was 8.4%, 12.7%, and 24% of weight lost. Significant weight regain was seen in 1 patient at 3 years and 3 patients at 5 and 7 years of follow-up. Among patients suffering from diabetes, 50.9% had remission and 45.3% had improvement at 1 year. At 5 years, this was 56% and 40%, respectively. Among patients suffering from hypertension, at 5 years, remission was seen in 11 (64.7%) out of 17. Significant improvements were seen in hypothyroidism, OSA, gastroesophageal reflux disease, and lipid profile. There was a statistically significant decrease in mean levels of fasting blood sugar, glycated hemoglobin (HbA1c), hemoglobin, serum calcium, insulin, c-peptide, serum albumin, and total protein and there was an increase in mean Vitamin D levels at 1 year follow-up. There was a decrease in mean levels of folate, total iron-binding capacity, parathyroid hormone, and alkaline phosphatase and an increase in mean Vitamin B12, iron, and ferritin postsurgery. However, this was statistically not significant. Nutritional deficiencies were noted. Seven complications were noted out of 142 procedures and no surgery-related mortality. Three patients had significant weight regain beyond 5 years. Conclusion: RYGB is a safe and effective bariatric procedure with well-sustained results in long run. Nutritional supplementation is required to correct deficiencies.
背景:Roux en Y胃旁路术(RYGB)在减肥方面非常有效，已成为糖尿病患者的首选手术。在长期随访中有很高的流失率。因此，可获得的长期数据有限。方法:我们从前瞻性维护的机构数据库中收集回顾性数据。为了提高长期随访率，对未来长期随访的患者进行电话访谈。标准定义用于体重减轻、体重恢复、合并症、合并症解决和营养参数。结果:在2008年至2018年期间接受腹腔镜RYGB治疗的142例患者中，125例(男33例，女92例;年龄:42.4±5.2岁)纳入研究。1年、3年、5年和7年的平均体重下降百分比分别为28.9、31.8、31.3和31.7。1年、3年、5年和7年的平均超重体重指数损失率(% ebil)分别为67.6±18、73.7±17.9、71.7±20.7和69.5±24.6。3年、5年和7年的中位体重恢复率分别为8.4%、12.7%和24%。1例患者在3年随访时体重明显回升，3例患者在5年和7年随访时体重明显回升。在患有糖尿病的患者中，50.9%的患者在1年内得到缓解，45.3%的患者得到改善。5年后，这一比例分别为56%和40%。在患有高血压的患者中，17例患者中有11例(64.7%)在5年时得到缓解。甲状腺功能减退、OSA、胃食管反流病和血脂均有显著改善。随访1年后，空腹血糖、糖化血红蛋白(HbA1c)、血红蛋白、血清钙、胰岛素、c肽、血清白蛋白、总蛋白的平均水平均有统计学意义的下降，维生素D的平均水平有所上升。术后叶酸、总铁结合能力、甲状旁腺激素和碱性磷酸酶的平均水平下降，维生素B12、铁和铁蛋白的平均水平上升。然而，这在统计学上并不显著。注意到营养缺乏。142例手术中出现7例并发症，无手术相关死亡。3例患者在5年后体重明显回升。结论:RYGB是一种安全有效的减肥方法，长期效果良好。需要补充营养来纠正缺陷。
{"title":"Medium-Term outcomes after Roux-en-Y-Gastric Bypass: Experience from a Tertiary Healthcare Center from India","authors":"P. Arumugaswamy, Vitish Singla, S. Aggarwal","doi":"10.4103/jbs.jbs_2_22","DOIUrl":"https://doi.org/10.4103/jbs.jbs_2_22","url":null,"abstract":"Background: Roux en Y gastric bypass (RYGB) has been highly effective in weight loss and it has been the procedure of choice for patients suffering from diabetes. There is a high attrition rate in long-term follow-up. Hence, limited long-term data are available. Methodology: We collected retrospectively data from a prospectively maintained institutional database. To increase the long-term follow-up rate, a telephonic interview was conducted with patients who had not come for long-term follow-up. Standard definitions were used for weight loss, weight regain, comorbidities, comorbidity resolution, and nutritional parameters. Results: Of 142 patients who underwent laparoscopic RYGB between 2008 and 2018, 125 patients (M: 33, F: 92; Age: 42.4 ± 5.2 years) were included in the study. The mean % weight loss at 1, 3, 5, and 7 years was 28.9, 31.8, 31.3, and 31.7, respectively. Mean % excess body mass index loss (% EBMIL) at 1, 3, 5, and 7 years was 67.6 ± 18, 73.7 ± 17.9, 71.7 ± 20.7, and 69.5 ± 24.6, respectively. Median weight regain at 3, 5, and 7 years was 8.4%, 12.7%, and 24% of weight lost. Significant weight regain was seen in 1 patient at 3 years and 3 patients at 5 and 7 years of follow-up. Among patients suffering from diabetes, 50.9% had remission and 45.3% had improvement at 1 year. At 5 years, this was 56% and 40%, respectively. Among patients suffering from hypertension, at 5 years, remission was seen in 11 (64.7%) out of 17. Significant improvements were seen in hypothyroidism, OSA, gastroesophageal reflux disease, and lipid profile. There was a statistically significant decrease in mean levels of fasting blood sugar, glycated hemoglobin (HbA1c), hemoglobin, serum calcium, insulin, c-peptide, serum albumin, and total protein and there was an increase in mean Vitamin D levels at 1 year follow-up. There was a decrease in mean levels of folate, total iron-binding capacity, parathyroid hormone, and alkaline phosphatase and an increase in mean Vitamin B12, iron, and ferritin postsurgery. However, this was statistically not significant. Nutritional deficiencies were noted. Seven complications were noted out of 142 procedures and no surgery-related mortality. Three patients had significant weight regain beyond 5 years. Conclusion: RYGB is a safe and effective bariatric procedure with well-sustained results in long run. Nutritional supplementation is required to correct deficiencies.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74639503","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}
Sigin Satheesh, A. Shetty, A. Nasta, Madhu Goel, Ramen Goel
Background: Bariatric surgery is the most effective weight loss intervention for patients with severe obesity. Several studies have shown wide variability in weight loss response between patients. The aim of the study is to identify comparative poor responders based on weight loss in the early postoperative period. Methods: A retrospective analysis of 125 patients who underwent primary bariatric surgery by a single surgeon and completed 1 year of follow-up was performed. Patients were divided into two groups based on % Total Weight loss (%TWL) at 1 month after surgery: Group 1-who lost <10% TWL and Group 2-who lost >10% TWL. The comparison of factors in both groups at different time points was executed using paired t-tests or analysis of variance. The relationships between Group 1 and Group 2 after 1 year follow-up period were assessed through linear regression analyses. Results: Seventy (56%) patients lost <10% TWL and 55 (44%) patients lost more than 10% TWL in 1 month after surgery. Mean weight loss at 1 month and 1 year after surgery was 9 ± 5.5 kg and 37 ± 13.3 kg in Group 1 compared to 16 ± 5.2 and 46 ± 16.4 kg in Group 2, respectively. Patients with >10%TWL at 1 month had significantly greater %TWL at 1 year (P = 0.001). Linear regression analysis showed a positive correlation between patients who lost >10%TWL 1 month after surgery and weight loss at 1 year. Conclusion: Postoperative percentage TWL of <10% at 1 month can be used as an early determinant of comparatively poor weight loss at 1 year. Early initiation of aggressive and multimodal treatment strategies is likely to improve overall weight loss outcomes after surgery.
{"title":"Early weight loss: A determinant of total weight loss after bariatric surgery","authors":"Sigin Satheesh, A. Shetty, A. Nasta, Madhu Goel, Ramen Goel","doi":"10.4103/jbs.jbs_3_21","DOIUrl":"https://doi.org/10.4103/jbs.jbs_3_21","url":null,"abstract":"Background: Bariatric surgery is the most effective weight loss intervention for patients with severe obesity. Several studies have shown wide variability in weight loss response between patients. The aim of the study is to identify comparative poor responders based on weight loss in the early postoperative period. Methods: A retrospective analysis of 125 patients who underwent primary bariatric surgery by a single surgeon and completed 1 year of follow-up was performed. Patients were divided into two groups based on % Total Weight loss (%TWL) at 1 month after surgery: Group 1-who lost <10% TWL and Group 2-who lost >10% TWL. The comparison of factors in both groups at different time points was executed using paired t-tests or analysis of variance. The relationships between Group 1 and Group 2 after 1 year follow-up period were assessed through linear regression analyses. Results: Seventy (56%) patients lost <10% TWL and 55 (44%) patients lost more than 10% TWL in 1 month after surgery. Mean weight loss at 1 month and 1 year after surgery was 9 ± 5.5 kg and 37 ± 13.3 kg in Group 1 compared to 16 ± 5.2 and 46 ± 16.4 kg in Group 2, respectively. Patients with >10%TWL at 1 month had significantly greater %TWL at 1 year (P = 0.001). Linear regression analysis showed a positive correlation between patients who lost >10%TWL 1 month after surgery and weight loss at 1 year. Conclusion: Postoperative percentage TWL of <10% at 1 month can be used as an early determinant of comparatively poor weight loss at 1 year. Early initiation of aggressive and multimodal treatment strategies is likely to improve overall weight loss outcomes after surgery.","PeriodicalId":73828,"journal":{"name":"Journal of metabolic and bariatric surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84668918","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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