Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery最新文献

Background: Bariatric surgery has profound effects on weight loss, metabolic regulation, and gut hormone modulation, which make it an efficient tool for managing obesity and improving diabetes outcomes.

Objectives: The objective of this study is to evaluate the atherogenic indices, including atherogenic index of plasma (AIP), atherogenic coefficient (AC), Castelli's risk index II (CRI-II), and lipoprotein combine index (LCI) in individuals with type 2 diabetes (T2D) living with excess weight, who have undergone bariatric surgery.

Setting: Three types of surgery including one-anastomosis gastric bypass/mini gastric bypass (OAGB/MGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) were performed on patients with obesity and T2D in the period of August 2009 to February 2021 at the Surgical Department of Hazrat-e Rasool Hospital (University Hospital), Tehran, Iran.

Methods: In this retrospective cohort, 1246 individuals with obesity and T2D who underwent 3 types of bariatric surgery including RYGB, SG, and OAGB/MGB were studied for 2years after the surgery; the data were derived from the National Iranian Obesity Surgery Database. Afterward, the trend of biochemical parameters, total weight loss (TWL%), and atherogenesis-related indices were evaluated from baseline up to 2years in 5 follow-up visits.

Results: A total of 1246 patients with T2D and obesity who underwent bariatric surgery were included in this study. The trend of all atherogenesis-related indices, including AIP, LCI, CRI-II, and AC, showed a significant reduction (49.2%, 53.4%, 20.8%, 22%, respectively) 2years after the bariatric surgery (P < .05). In the 6-month follow-up, 1-year follow-up, and 2-year follow-up, 1023 (83.10%), 719 (57.70%), and 341 (27.36%) individuals participated, respectively. In addition, a significant increase in high-density lipoprotein cholesterol levels was observed 2years after the surgery in both sexes (P < .05).

Conclusions: The bariatric surgery significantly reduced the levels of atherogenic indices including AIP, CRI-II, LCI, and AC.

Background: Early reoperation after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) is a severe adverse event that may increase the risk of perioperative mortality if there is a delay in care. However, it is unclear what proportion of reoperations occur within 24 hours of surgery and who is at greater risk, which may impact the safety of performing safe same-day surgery.

Objectives: To evaluate the incidence of reoperation in the first 24 hours after primary SG and RYGB.

Setting: Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan.

Methods: Using a statewide bariatric surgery data registry, patients undergoing primary SG (n = 49,848) and RYGB (n = 11,267) cases were analyzed. Patients who had a subsequent reoperation were identified and reasons for reoperation were compared between those occurring <24 hours versus >24 hours. In addition, patients who underwent a reoperation <24 hours were compared with patients who underwent primary SG or RYGB and did not experience any complications.

Results: The overall rate of reoperation was .72% for SG and 2.1% for RYGB. Reoperation <24 hours of index procedure was 32.0% after SG and 24.2%, after gastric bypass, with the most common reason being hemorrhage (86.15%% and 55.4% respectively). Older age, hypertension, liver disease, and longer operative times were associated with reoperation <24 hours after SG, whereas longer operative times were associated with reoperation <24 hours after RYGB. Concurrent hiatal hernia repair was not associated with increased risk.

Conclusions: Reoperation after primary bariatric surgery is rare but occurs within 24 hours in approximately one third of the cases after SG and one quarter of cases after RYGB. Older patients with significant comorbidities are at increased risk and should be considered poor candidates for same-day surgery given the possibility of an early life-threatening event.

Background: More than 80% of patients seeking metabolic and bariatric surgery (MBS) report disturbance in sleep function. No studies have assessed the psychometric properties of sleep measures in MBS samples.

Objectives: This study assessed the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) in a large sample of patients seeking MBS.

Setting: Two academic medical centers.

Methods: Measures of sleep (PSQI and ISI) and psychological functioning, including the Quick Inventory of Depressive Symptomatology (QIDS), were administered presurgically. Internal consistency was assessed with mean inter-item correlations and item-total correlations. Construct validity was assessed using confirmatory factor analyses (CFAs) based on models identified in the literature and by measuring convergent and discriminant validity.

Results: Participants (N = 939) were primarily female (83.4%) with a mean age of 41.7 (SD = 11.5) years and mean body mass index (BMI) of 47.5 kg/m² (SD = 8.5). CFAs indicated excellent fit for 2-factor solutions for the PSQI and ISI. Internal consistency for the PSQI and ISI were acceptable. Convergent validity was demonstrated by large correlations between the PSQI and ISI (r = .80, p < .001), and moderate correlation between the PSQI, ISI, and QIDS (rs > .50, ps < .001). The PSQI and ISI were moderately correlated with QIDS items assessing sleep function (P < .001), but correlations with items assessing appetite change were small (r < .10), demonstrating good discriminant validity.

Conclusions: Results support the reliability and validity of the PSQI and ISI for patients undergoing MBS.

Background: Metabolic and bariatric surgery is a safe and effective treatment strategy for severe childhood obesity, affecting 10% of US adolescents.

Objectives: This prospective observational study addresses knowledge gaps related to changes in weight, cardiometabolic risk, and weight-related quality of life (WRQOL) in adolescents 10 years after laparoscopic adjustable gastric band (LAGB) insertion.

Setting: Five Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) US centers.

Methods: Anthropometric, micronutrient, cardiometabolic risk, and WRQOL data were collected on 274 adolescents undergoing metabolic and bariatric surgery, of which 14 participants underwent LAGB insertion (2008-2011). Descriptive analyses compared outcomes from baseline to 10 years.

Results: Participants were mostly female (86%), White (71%), with a median age of 18.5 years and preoperative median BMI of 49. Baseline prevalence of type 2 diabetes, hypertension, and dyslipidemia were 1 of 14 (7%), 8 of 14 (57%), and 8 of 13 (62%), respectively, versus 10-year prevalence of 1 of 8 (13%), 4 of 10 (40%), and 3 of 9 (33%), respectively. Two participants underwent LAGB removal (years 2 and 3), whereas two converted from LAGB to Roux-en-Y gastric bypass (years 2 and 6). Following initial BMI reduction (-10%) at year 1, 10-year median BMI in the LAGB retention group was 51, representing a 9.2% increase versus baseline. Micronutrient abnormalities and WRQOL remained similar between baseline and 10 years. One participant (1 of 14) withdrew from the study at year 7.

Conclusions: Long-term follow-up of this cohort reveals that LAGB had minimal impact on BMI, cardiometabolic risk factors, and WRQOL among adolescents. These results confirm the limited efficacy of LAGB in the pediatric population.

Background: Obstructive sleep apnea (OSA) is highly prevalent in patients with morbid obesity, prompting interest in bariatric surgery as a potential management strategy. Sleeve gastrectomy (SG), being the primary bariatric surgical option, offers simplicity, reduced postoperative complications, and favorable outcomes for obesity and its associated conditions.

Objectives: This study aims to assess the efficacy of SG in treating populations with obesity and OSA.

Setting: University-affiliated hospital, China.

Methods: We conducted a comprehensive literature search across PubMed, Embase, Cochrane Library, and Web of Science databases to identify pertinent studies published up to March 28, 2024. Our review encompassed studies that assessed the effectiveness of SG on primary outcomes, including the apnea-hypopnea index (AHI), as well as secondary outcomes such as forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), nonrapid eye movement sleep stage 3 (NREM 3), rapid eye movement sleep (REM), sleep efficiency (SE), arousal index, Epworth sleepiness scale (ESS), oxygen desaturation index (ODI), apnea index (AI), meanSpO2, body mass index (BMI), weight, neck circumference (NC), waist circumference (WC), waist-to-hip ratio (WHR), subcutaneous fat area (SFA), visceral fat area (VFA), systolic blood pressure(SBP)/diastolic blood pressure(DBP), and measurements related to glucolipid metabolism. A total of 12 eligible studies underwent a systematic screening process and were subsequently subjected to meta-analysis using either randomized effects model or fixed-effect models.

Results: Significant reductions in AHI, BMI, weight, SFA, and VFA were observed following SG. Correspondingly, enhancements in FVC, meanSpO2, NREM 3%, REM%, and SE, were noted after SG. Additionally, the populations with obesity and OSA exhibited decreases in arousal index, ODI, AI, ESS, NC, WC, WHR, and DBP post-SG. Moreover, reductions in HOMA-IR and glycosylated hemoglobin were also observed after SG.

Conclusion: SG demonstrates favorable outcomes in the populations with obesity and OSA.