Showing papers in "Obesity Surgery in 2015"
TL;DR: SG is currently the most frequently performed procedure in the USA/Canada and in the Asia/Pacific regions, and second to RYGB in the Europe and Latin/South America regions.
Abstract: The first global survey of bariatric/metabolic surgery based on data from the nations or national groupings of the International Federation for the Surgery of Obesity and Metabolic Diseases (IFSO) was published in 1998, followed by reports in 2003, 2009, 2011, and 2012. In this survey, we report a global overview of worldwide bariatric surgery in 2013. A questionnaire evaluating the number and the type of bariatric procedure performed in 2013 was emailed to all members of bariatric societies belonging to IFSO. Trend analyses from 2003 to 2013 were also performed. There were 49/54 (90.7 %) responders; 37 of the 49 with national registries. The total number of bariatric procedures performed worldwide in 2013 was 468,609, 95.7 % carried out laparoscopically. The highest number (n = 154,276) was from the USA/Canada region. The most commonly performed procedure in the world was Roux-en-Y gastric bypass (RYGB), 45 %; followed by sleeve gastrectomy (SG), 37 %; and adjustable gastric banding (AGB), 10 %. Most significant were the rise in prevalence of SG from 0 to 37 % of the world total from 2003 to 2013, and the fall in AGB of 68 % from its peak in 2008 to 2013. SG is currently the most frequently performed procedure in the USA/Canada and in the Asia/Pacific regions, and second to RYGB in the Europe and Latin/South America regions. The accuracy of the IFSO-based world survey of procedures would be enhanced if each nation or national group would create a national registry.
1,231 citations
TL;DR: Information is provided on the percentage of patients comprising the original study group who complete each follow-up period reported for the study and the reasons for patient attrition from the study should be reported when possible.
Abstract: ASMBS, SOARD, outcome reporting standards Standardized outcomes reporting in metabolic and bariatric surgery Stacy A Brethauer, MD*, Julie Kim, MD, Maher el Chaar, MD, Pavlos Papasavas, MD, Dan Eisenberg, MD, Ann Rogers, MD, Naveen Ballem, MD, Mark Kligman, MD, Shanu Kothari, MD for the ASMBS Clinical Issues Committee Bariatric and Metabolic Center, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio Department of Surgery, Tufts University, Boston, Massachusetts Department of Surgery, St Luke’s Hospital, Allentown, Pennsylvania Department of Surgery, Hartford Hospital, Hartford, Connecticut Department of Surgery, Stanford University and Palo Alto VA Health Care Center, Palo Alto, California Department of Surgery, Penn State University, Hershey, Pennsylvania Center for Advanced Surgical Weight Loss, Montclair, New Jersey Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland Department of Surgery, Gundersen Health System, La Crosse, Wisconsin Received February 2, 2015; accepted February 2, 2015
292 citations
TL;DR: This study confirms that the one anastomosis gastric bypass (OAGB) is an effective procedure for morbid obesity with comparable outcomes to RYGB; in addition, it seems to be safer with lower morbidity.
Abstract: A short-term randomized controlled trial shows that the one anastomosis gastric bypass (OAGB) is a safe and effective alternative to the Roux-en-Y gastric bypass (RYGB). The aim of this study is to evaluate the OAGB at our University Hospital between 2006 and 2013. One thousand patients have undergone an OAGB. Data were collected on all consecutive patients. The mean follow-up period was 31 months (SD, 26.3; range, 12–82.9), and complete follow-up was available in 126 of 175 patients (72 %) at 5 years after surgery. Mortality rate was 0.2 %. Overall morbidity was 5.5 %; 34 required reoperations: i.e., 6 leaks, 5 obstructions, 5 incisional hernias, 7 biliary refluxes, 2 perforated ulcers, 2 bleeds, 2 abscesses, and 1 anastomotic stricture. Four patients were reoperated for weight regain. Overall rate of marginal ulcers was 2 % (n = 20), all in heavy smokers. Conversion from an OAGB to a RYGB was required in nine cases (0.9 %): seven for intractable biliary reflux, two for a marginal ulcer. At 5 years, percent excess body mass index loss was 71.6 ± 27 %. One hundred patients with type-2 diabetes, with a mean preoperative HbA1C of 7.7 ± 1.9 %, were followed for >2 years; the total resolution rate was 85.7 %. This study confirms that the OAGB is an effective procedure for morbid obesity with comparable outcomes to RYGB; in addition, it seems to be safer with lower morbidity. Its technical simplicity represents a real advantage and makes it an option that should be considered by all bariatric surgeons.
210 citations
TL;DR: Bariatric surgery is associated with a significant improvement in both histological and biochemical markers ofNAFLD, and future studies must focus on higher levels of evidence to better identify the benefits of bariatric surgery on liver disease in order to enhance future treatment strategies in the management of NAFLD.
Abstract: Non-alcoholic fatty liver disease (NAFLD) is becoming a leading cause of global liver disease that is associated with the rising prevalence of obesity worldwide. There is now increasing clinical and mechanistic evidence reporting on the metabolic and weight loss effects of bariatric surgery on improving NAFLD in obese patients. The aim of this paper was to quantify the effects of bariatric surgery on NAFLD by appraising the modulation between pre- and post-operative liver enzyme levels (as markers of liver injury) and liver histology. A systematic review of studies reporting pre-operative and post-operative liver enzymes or liver histology was done in obese patients with NAFLD undergoing bariatric surgery. Data were meta-analysed using random-effects modelling. Subgroup analysis, quality scoring and risk of bias were assessed. Bariatric surgery is associated with a significant reduction in the weighted incidence of a number of histological features of NAFLD including steatosis (50.2 and 95 %CI of 35.5–65.0), fibrosis (11.9 and 95 %CI of 7.4–16.3 %), hepatocyte ballooning (67.7 and 95 %CI 56.9–78.5) and lobular inflammation (50.7 and 95 %CI 26.6–74.8 %). Surgery is also associated with a reduction in liver enzyme levels, with statistically significant reductions in ALT (11.36 u/l, 95 %CI 8.36–14.39), AST (3.91 u/l, 95 %CI 2.23–5.59), ALP (10.55 u/l, 95 %CI 4.40–16.70) and gamma-GT (18.39 u/l, 95 %CI 12.62–24.16). Heterogeneity in results was high. Bariatric surgery is associated with a significant improvement in both histological and biochemical markers of NAFLD. Future studies must focus on higher levels of evidence to better identify the benefits of bariatric surgery on liver disease in order to enhance future treatment strategies in the management of NAFLD.
189 citations
TL;DR: Despite the percentage of weight loss over the first year, all cohort patient groups regained on average between 21 and 29 % of lost weight and excessive weight gain was experienced by over one third of patients.
Abstract: The primary purpose of this study was to assess weight loss and occurrence of weight regain among patients who underwent Roux-en-Y gastric bypass (RYGB) using categorical analysis. Study participants were selected from patients who underwent RYGB from a single institution. Participants (n = 300, mean procedure age = 45.6 ± 9.9) completed surveys for self-reported preoperative weight, current weight, and subsequent weights over postoperative years. Measured weights and confirmed procedure dates were acquired from patient medical records. Mean preoperative weight and BMI were 140.8 kg ± 32.1 and 49.7 ± 9.9, respectively, and mean years since surgery was 6.9 ± 4.9. Study subjects were mostly Caucasian (56.7 %) and female (80.3 %). Participants were stratified a priori into four cohorts based on percent of weight loss at 1 year, 35 % (n = 113). General linear model analyses were conducted to assess the effect of year one weight loss on percent weight regain. The mean weight regain for all patients was 23.4 % of maximum weight loss. Using categorical analysis, mean weight regain in the 35 % weight loss cohorts was 29.1, 21.9, 20.9, and 23.8 %, respectively. Excessive weight regain, defined as ≥25 % of total lost weight, occurred in 37 % of patients. Weight gain is a common complication following RYGB surgery. Despite the percentage of weight loss over the first year, all cohort patient groups regained on average between 21 and 29 % of lost weight. Excessive weight gain was experienced by over one third of patients. Greater initial absolute weight loss leads to more successful long-term weight outcomes.
181 citations
TL;DR: All three bariatric procedures result in substantial weight loss and improvement of comorbidity with an acceptable complication rate, indicating that surgical intervention is applicable in appropriately selected morbidly obese adolescents.
Abstract: Pubmed, Embase, and Cochrane were systematically reviewed for available evidence on bariatric surgery in adolescents. Thirty-seven included studies evaluated the effect of laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), or laparoscopic sleeve gastrectomy (LSG) in patients ≤18 years old. Fifteen of 37 studies were prospective, including one RCT. Mean body mass index (BMI) loss after LAGB was 11.6 kg/m2 (95 % CI 9.8–13.4), versus 16.6 kg/m2 (95 % CI 13.4–19.8) after RYGB and 14.1 kg/m2 (95 % CI 10.8–17.5) after LSG. Two unrelated deaths were reported after 495 RYGB procedures. All three bariatric procedures result in substantial weight loss and improvement of comorbidity with an acceptable complication rate, indicating that surgical intervention is applicable in appropriately selected morbidly obese adolescents.
173 citations
TL;DR: Empirical support is suggested for post-operative binge eating, uncontrolled eating/grazing, and presence of a depressive disorder as negative predictors of weight loss outcomes; whereas, adherence to dietary and physical activity guidelines emerged as positive predictorsof weight loss.
Abstract: Although there are several recent reviews of the pre-operative factors that influence treatment outcome for bariatric surgery, commensurate efforts to identify and review the predictive validity of post-operative variables are lacking. This review describes the post-operative psychosocial predictors of weight loss in bariatric surgery. Results suggest empirical support for post-operative binge eating, uncontrolled eating/grazing, and presence of a depressive disorder as negative predictors of weight loss outcomes; whereas, adherence to dietary and physical activity guidelines emerged as positive predictors of weight loss. With the exception of depression, psychological comorbidities were not consistently associated with weight loss outcomes. Results highlight the need for post-operative assessment of disordered eating and depressive disorder, further research on the predictive value of post-operative psychosocial factors, and development of targeted interventions.
161 citations
TL;DR: Weight loss and diabetes remission were greatest in patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, sleeve gastrectomy, and adjustable gastric banding.
Abstract: This study aims to assess the long-term effects of bariatric surgery on type 2 diabetic patients. We searched Cochrane Library, PubMed, and EMbase up to Dec 2013. Randomized controlled trials (RCTs) and cohort studies of bariatric surgery for diabetes patients that reported data with more than 2 years of follow-up were included. We used rigorous methods to screen studies for eligibility and collected data using standardized forms. Where applicable, we pooled data by meta-analyses. Twenty-six studies, including 2 RCTs and 24 cohort studies that enrolled 7883 patients, proved eligible. Despite the differences in the design, those studies consistently showed that bariatric surgery offered better treatment outcomes than non-surgical options. Pooling of cohort studies showed that BMI decreased by 13.4 kg/m2 (95 % confidence interval (CI), −17.7 to −9.1), fasting blood glucose by 59.7 mg/dl (95 % CI, −74.6 to −44.9), and glycated hemoglobin by 1.8 % (95 % CI, −2.4 to −1.3). Diabetes was improved or in remission in 89.2 % of patients, and 64.7 % of patients was in remission. Weight loss and diabetes remission were greatest in patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Bariatric surgery may achieve sustained weight loss, glucose control, and diabetes remission. Large randomized trials with long-term follow-up are warranted to demonstrate the effect on outcomes important to patients (e.g., cardiovascular events).
154 citations
TL;DR: SLR provided superior results for patients compared to no reinforcement for reducing SLC, and reinforcing with bovine pericardium resulted in the most favorable outcomes.
Abstract: Background
The objective of this study was to assess whether the use of staple line reinforcement (SLR) reduces staple line complications (SLC). Mechanical staple lines are essential for gastrointestinal surgery such as bariatric surgery. However, SLC, such as bleeding and leakage, still occur. The purposes of this study were to provide quantitative evidence on the relative efficacy of gastric SLR and to compare the rates of effectiveness of three commonly used methods.
145 citations
TL;DR: Both bariatric surgery and non-surgical weight loss may have significant beneficial effects on OSA through BMI and AHI reduction, however, bariatrics surgery may offer markedly greater improvement in BMI and aHI than non-Surgical alternatives.
Abstract: Obstructive sleep apnoea (OSA) is a well-recognised complication of obesity. Non-surgical weight loss (medical, behavioural and lifestyle interventions) may improve OSA outcomes, although long-term weight control remains challenging. Bariatric surgery offers a successful strategy for long-term weight loss and symptom resolution. To comparatively appraise bariatric surgery vs. non-surgical weight loss interventions in OSA treatment utilising body mass index (BMI) and apnoea-hypopnoea index (AHI) as objective measures of weight loss and apnoea severity. A systematic literature review revealed 19 surgical (n = 525) and 20 non-surgical (n = 825) studies reporting the primary endpoints of BMI and AHI before and after intervention. Data were meta-analysed using random effects modelling. Subgroup analysis, quality scoring and risk of bias were assessed. Surgical patients had a mean pre-intervention BMI of 51.3 and achieved a significant 14 kg/m2 weighted decrease in BMI (95%CI [11.91, 16.44]), with a 29/h weighted decrease in AHI (95%CI [22.41, 36.74]). Non-surgical patients had a mean pre-intervention BMI of 38.3 and achieved a significant weighted decrease in BMI of 3.1 kg/m2 (95%CI [2.42, 3.79]), with a weighted decrease in AHI of 11/h (95%CI [7.81, 14.98]). Heterogeneity was high across all outcomes. Both bariatric surgery and non-surgical weight loss may have significant beneficial effects on OSA through BMI and AHI reduction. However, bariatric surgery may offer markedly greater improvement in BMI and AHI than non-surgical alternatives. Future studies must address the lack of randomised controlled and comparative trials in order to confirm the exact relationship between metabolic surgery and non-surgical weight loss interventions in OSA resolution.
143 citations
TL;DR: The reduction in arterial hypertension reached a nadir earlier than the risk of diabetes and hyperlipidemia, thus indicating a possible link between weight reduction and positive hemodynamic effects.
Abstract: Background
The first aim of the study was to estimate weight loss and major modifiable risk factors after bariatric surgery. The second aim was to investigate the relationship between the reduction in cardiovascular risk and weight loss over time.
TL;DR: EID proved to be a valid, curative, and safe mini-invasive approach for treatment of leaks following SG, which achieves complete drainage of perigastric collections and stimulates mucosal growth over the stent.
Abstract: Leaks are considered one of the major complications of laparoscopic sleeve gastrectomy (LSG) with a reported rate up to 7 %. Drainage of the collection coupled with SEMS deployment is the most frequent treatment. Its success is variable and burdened by high morbidity and not irrelevant mortality. The aim of this paper is to suggest and establish a new approach by endoscopic internal drainage (EID) for the management of leaks. Since March 2013, 67 patients presenting leak following LSG were treated with deployment of double pigtail plastic stents across orifice leak, positioning one end inside the collection and the other end in remnant stomach. The aim of EID is to internally drain the collection and at the same time promote leak healing. Double pigtails stent were successfully delivered in 66 out of 67 patients (98.5 %). Fifty patients were cured by EID after a mean time of 57.5 days and an average of 3.14 endoscopic sessions. Two died for event not related to EID. Nine are still under treatment; five failure had been registered. Six patients developed late stenosis treated endoscopically. EID proved to be a valid, curative, and safe mini-invasive approach for treatment of leaks following SG. EID achieves complete drainage of perigastric collections and stimulates mucosal growth over the stent. EID is well tolerated, allows early re-alimentation, and it is burdened by fewer complications than others technique. Long-term follow-up confirms good outcomes with no motility or feeding alterations.
TL;DR: Sweden is ideally suited to the task of data collection and audit, with universal use of personal identification numbers, nation-wide registries permitting cross-matching to analyze causes of death, in-hospital care, and health-related absenteeism, and the Scandinavian Obesity Surgery Registry was initiated and government financing secured.
Abstract: Obesity surgery is expanding, the quality of care is ever more important, and learning curve assessment should be established. A large registry cohort can show long-term effects on obesity and its comorbidities, complications, and long-term side effects of surgery, as well as changes in health-related quality of life (QoL). Sweden is ideally suited to the task of data collection and audit, with universal use of personal identification numbers, nation-wide registries permitting cross-matching to analyze causes of death, in-hospital care, and health-related absenteeism. In 2004, the Scandinavian Obesity Surgery Registry (SOReg) was initiated and government financing secured. A project group created a national database covering all public as well as private hospitals. Data entry was to be made online, operative definitions of comorbidity were formed, and complication severity scored. Several forms of audit were devised. After pilot studies, the system has been running in its present form since 2007. Since 15 January 2013, SOReg covers all bariatric surgery centers in Sweden. The number of operations in the database exceeded 40,000 (March 2014), with a median follow-up of 2.94 years. Audit shows that >98 % of data are correct. All results are publicized annually on the Internet. Using this systematic approach, it has been possible to cover >99 % of all bariatric surgery, cross-matching our data with nation-wide registries for in-hospital care, cause of death, and permitting regular nation-wide audit. Several scientific studies have used, or are using, what seems to be the most comprehensive database in obesity surgery.
TL;DR: Patients with younger age, short diabetes duration, better glucose control, and better β cell function were more likely to achieve T2DM remission after bariatric surgery, but further randomized controlled trials with uniform remission criteria should be conducted to provide more reliable evidence.
Abstract: Background
Although a few studies have been reported on predictive factors of postoperative diabetes remission, the conclusions remain inconsistent. This meta-analysis aimed to assess the preoperative clinical factors for type 2 diabetes mellitus (T2DM) remission after bariatric surgery.
TL;DR: Bariatric surgery effectively attenuates PCOS and its clinical symptomatology including hirsutism and menstrual irregularity in severely obese women and its effect on polycystic ovary syndrome.
Abstract: Bariatric surgery has been proven to be a successful management strategy for morbid obesity, but limited studies exist on its effect on polycystic ovary syndrome (PCOS). A comprehensive search of electronic databases was completed. Meta-analysis was performed on PCOS, hirsutism, and menstrual irregularity outcomes following bariatric surgery. Thirteen primary studies involving a total of 2130 female patients were identified. The incidence of PCOS preoperatively was 45.6 %, which significantly decreased to 6.8 % (P < 0.001) and 7.1 % (P < 0.0002) at 12-month follow-up and study endpoint, respectively. The incidences of preoperative menstrual irregularity and hirsutism both significantly decreased at 12-month and at study end follow-up. Bariatric surgery effectively attenuates PCOS and its clinical symptomatology including hirsutism and menstrual irregularity in severely obese women.
TL;DR: LRYGB is superior to LSG in efficacy but inferior to LSg in safety, and there were more adverse events in LRYGB compared with LSG.
Abstract: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are two most common weight loss procedures; our meta-analysis aims to compare these two in the treatment of morbid obesity and its related comorbidities. An electronic literature research of published studies concerning LRYGB and LSG was performed from inception to October 2013. Percentage of excess weight loss (%EWL), resolution or improvement rate of comorbidities, and adverse events were all pooled and compared by the software Review Manager 5.1. As a result, a total of 21 studies involving 18,766 morbidly obese patients were eventually selected according to the inclusion criteria. No significant difference was found in %EWL during 0.5- to 1.5-year follow-up (P > 0.05), but after that, LRYGB achieved higher %EWL than LSG (P 0.05). There were more adverse events in LRYGB compared with LSG (P < 0.01). In conclusion, LRYGB is superior to LSG in efficacy but inferior to LSG in safety.
TL;DR: There is an acceptably higher overall risk of complications and perioperative mortality with bariatric surgery in cirrhotic patients, and surgeons must discuss the possibility of an unexpected intraoperative diagnosis of cirrhosis preoperatively with all bariatric patients and agree on a course of action.
Abstract: Nonalcoholic steatohepatitis is becoming a common cause of liver cirrhosis and a significant number of patients undergoing bariatric surgery suffer with it. There is currently lack of consensus among surgeons regarding safety of bariatric surgery in patients with liver cirrhosis and the best bariatric procedure in these patients. This review investigates published English language scientific literature systematically in an attempt to answer these questions. Eleven studies that reported experience of bariatric surgery in cirrhotic obese patients were included in this review. This review shows an acceptably higher overall risk of complications and perioperative mortality with bariatric surgery in cirrhotic patients. Surgeons must discuss the possibility of an unexpected intraoperative diagnosis of cirrhosis preoperatively with all bariatric surgery patients and agree on a course of action.
TL;DR: BPD deserves more consideration as a primary procedure for eligible patients in experienced centers with sufficient resources for delivering high-quality care and long-term follow-up, and side effects were considered minor by the great majority of patients.
Abstract: Biliopancreatic diversion (BPD) is a complex bariatric operation requiring meticulous surveillance which has impeded its broad adoption. Improvements in surgical care and technique, better teaching programs, and stringent norms for follow-up have contributed to increased safety of BPD for patients with BMI <50, achieving better long-term results than other bariatric operations. Here we report 20-year outcomes of 2615 consecutive patients (median 8) having open BPD with duodenal switch (DS) between 1992 and 2010. Chart of 92 % of patients with complete clinical, biochemical, and physical examinations completed before 2013 was reviewed. The research was conducted at Academic Medical Center, Quebec City. There was total mortality of 4.7 %, equivalent to that of the general population of Quebec. Incident diabetes (38.8 %) was cured in 93.4 % (blood glucose <6 mmol/l; HbA1c <6.5 %) with 4 % relapse rate after mean 9.6 years with no new cases. Dyslipidemia (24.2 %) was cured in 80 %. Hypertension (60 %) was cured in 64 % and improved in 31 %. Mean weight loss of 55.3 kg (71 % excess weight loss (EWL); 20 BMI units) was maintained for 5 to 20 years. Operative mortality was reduced from 1.3 % in 1992 to 0.2 % during 2005–2010, with cumulated rate surgical mortality of 0.5, revision rate 3, and reoperations in 13 %. Nutritional deficiencies were present in 2 % for calcium, iron, and vitamin A. Side effects were considered minor by the great majority of patients, rating global satisfaction as 4.5/5 (91 % “satisfied”). BPD deserves more consideration as a primary procedure for eligible patients in experienced centers with sufficient resources for delivering high-quality care and long-term follow-up.
TL;DR: A nationwide changes in trend of bariatric procedures performed, using data from the National Surgical Quality Improvement Program from 2010 to 2013, underlines the exponential adoption of SG and alerts patients, physicians, and funding agencies of the need for longitudinal prospective long-term data.
Abstract: The growth of bariatric surgery in the USA followed the adoption of gastric bypass (RYGB). The recent introduction of sleeve gastrectomy (SG) has been met with wide adoption. A single state report suggests that the popularity of SG has surpassed that of RYGB. Our study aimed to assess the nationwide changes in trend of bariatric procedures performed, using data from the National Surgical Quality Improvement Program from 2010 to 2013. In this cohort of 74,790 bariatric patients, there was a significant difference in trend between laparoscopic RYGB and SG. By 2013, SG was the most common bariatric procedure performed (49.4 %). This report underlines the exponential adoption of SG and aims to alert patients, physicians, and funding agencies of the need for longitudinal prospective long-term data.
TL;DR: Obesity surgery seems feasible in this population of patients in the setting of liver transplantation (LT), but mortality and morbidity are higher.
Abstract: This study aims to conduct a systematic review on bariatric surgery (BS) for patients in the setting of liver transplantation (LT). A literature review was conducted on the PubMed, Embase, and Cochrane Library databases. Studies in the English language on adults reporting on BS prior to, during, or after LT were included. Eleven studies with 56 patients were retrieved. Two studies reported on BS before, two during, and seven after LT. Sleeve gastrectomy was the most common procedure, followed by Roux-en-Y gastric bypass, biliopancreatic diversion, and gastric banding. The overall mortality rate was nil in the early postoperative period and 5.3 % in the first postoperative year. The reoperation rate was 12.2 %. Obesity surgery seems feasible in this population, but mortality and morbidity are higher.
TL;DR: The majority of published studies do not define failure of bariatric surgery, and <50 % excess weight loss at 18 months was the most frequent definition identified.
Abstract: There are no agreed definitions as to what constitutes a ‘failure’ of the primary bariatric procedure in relation to weight loss. The MEDLINE database for primary research articles was searched using obesity [title] or bariatric [title] and revision [title] or revisional [title]. The MEDLINE search retrieved 174 studies. After duplicates and exclusions were removed, 60 articles underwent analysis. Fifty-one studies included inadequate weight loss or weight regain as an indication for revision: 31/51 (61 %) gave no definition of failure, 7/20 quoted <50 % of excess weight loss at 18 months and 6/20 used <25 % excess weight loss. The majority of published studies do not define failure of bariatric surgery, and <50 % excess weight loss at 18 months was the most frequent definition identified.
TL;DR: This review systematically investigates the results and techniques of simultaneous sleeve gastrectomy and hiatus hernia repair for the treatment of obesity in accordance with PRISMA guidelines.
Abstract: Sleeve gastrectomy can exacerbate gastro-oesophageal reflux disease in some patients and cause de novo reflux in others. Some surgeons believe Roux-en-Y gastric bypass is the best bariatric surgical procedure for obese patients with hiatus hernia. Others believe that even patients with hiatus hernia can also be safely offered sleeve gastrectomy if combined with a simultaneous hiatus hernia repair. Still, others will offer these patients sleeve gastrectomy without any attempt to diagnose or repair hiatus hernia repair. The effectiveness of concurrent hiatal hernia repair in reducing the incidence of postoperative reflux after sleeve gastrectomy is unclear. This review systematically investigates the results and techniques of simultaneous sleeve gastrectomy and hiatus hernia repair for the treatment of obesity in accordance with PRISMA guidelines.
TL;DR: The frequency of elevated depressive symptoms decreases substantially following gastric bypass surgery but increases gradually over 24 months, and postoperative depressive symptoms prospectively predict greater eating disorder psychopathology and poorer quality of life through 24 Months.
Abstract: Background
This study examined the prognostic significance of depressive symptoms in bariatric surgery patients over 24 months of follow-ups.
TL;DR: A new algorithm based on leak size permits standardization of endoscopic management and reduces procedures after LSG.
Abstract: Leaks after laparoscopic sleeve gastrectomy (LSG) are estimated to be the most serious complication of this procedure due to difficult healing process using non-standardized endoscopic approaches. Initially, endoscopic management recommended the use of stents. A total of 19 patients received endoscopic treatment after LSG to manage leaks. The leak was classified depending on the primary orifice’s size (more or less than 10 mm) or on the presence of gastric stenosis. The primary aim was to develop a therapeutic algorithm in order to reduce the number of endoscopic procedures. The average number of endoscopic procedures was 2.8 (range 2–5) in group A (leak size 10 mm). Two out of 13 patients had stent migration (15.4 %) and required an additional procedure, one in group A and another in group B. The average duration to achieve complete healing was 3.4 months (range 2–14 months), 2.8 months for group A and 3.9 months for group B. Limited data can be found in the literature on leaks after LSG. A new algorithm based on leak size permits standardization of endoscopic management and reduces procedures after LSG.
TL;DR: Bariatric surgery was cost saving in comparison with conservative management and led to a substantial reduction in lifetime risk of events, and may lead to significant cost savings to health care systems in addition to the known clinical benefits.
Abstract: Background
The objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective.
TL;DR: Smoking, the use of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) was significantly associated with the development of marginal ulcers and most patients were managed conservatively.
Abstract: One of the long-term complications of laparoscopic Roux-and-Y gastric bypass (LRYGB) is the development of marginal ulcers (MU). The aim of the present study is to assess the incidence, risk factors, symptomatology and management of patients with symptomatic MU after LRYGB surgery. A consecutive series of patients who underwent a LRYGB from 2006 until 2011 were evaluated in this study. Signs of abdominal pain, pyrosis, nausea or other symptoms of ulcer disease were analysed. Acute symptoms of (perforated) MU such as severe abdominal pain, vomiting, melena and haematemesis were also collected. Patient baseline characteristics, medication and intoxications were recorded. Statistical analysis was performed to identify risk factors associated with MU. A total of 350 patients underwent a LRYGB. Minimal follow-up was 24 months. Twenty-three patients (6.6 %) developed a symptomatic MU of which four (1.1 %) presented with perforation. Smoking, the use of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) was significantly associated with the development of MU. Five out of 23 patients (22 %) underwent surgery. All other patients could be treated conservatively. Marginal ulcers occurred in 6.6 % of the patients after a LRYGB. Smoking, the use of corticosteroids and the use of NSAIDs were associated with an increased risk of MU. Most patients were managed conservatively.
TL;DR: Improvement was observed in the treatment of obesity-related diseases and the quality of life was enhanced significantly after surgical treatments, in the context of the surgical procedure type and degree of body weight loss.
Abstract: Introduction and Purpose
Morbid obesity together with obesity-related diseases has a negative impact on the quality of life. The aim of the study was to assess the quality of life amongst patients with morbid obesity as well as the impact of bariatric treatment on body weight and obesity-related diseases in addition to conducting an analysis of changes in the quality of life after surgical treatments, in the context of the surgical procedure type and degree of body weight loss.
TL;DR: High numbers of vitamin and mineral deficiencies were found after BPD and BPD/DS despite vitamin supplementation, and a stringent multivitamin supplementation regimen should be implemented after malabsorptive procedures.
Abstract: Malabsorptive bariatric procedures, like the biliopancreatic diversion (BPD) and BPD with duodenal switch (BPD/DS), have excellent results in terms of weight loss. However, these malabsorptive techniques are associated with severe malnutrition and vitamin deficiencies. The aim of this study was to evaluate the vitamin and mineral status after BPD and BPD/DS in the long term. All patients who underwent BPD or BPD/DS were selected and invited for an additional follow-up (FU) visit, including blood sampling for vitamin and mineral levels. Forty patients completed the blood sampling with a median FU of 42 (range 12–90) months. At that time, all patients used some kind of supplementation. However, 93 % of all patients were diagnosed with a deficiency. There were no significant differences in mean serum level vitamins and minerals between BPD and BPD/DS. Forty-three per cent of the patients were anaemic, and 40 % had an iron deficiency (ID). High deficiency rates for fat-soluble vitamins were present: vitamin A in 28 %, vitamin D in 60 %, vitamin E in 10 % and vitamin K in 60 % of the patients. Hypervitaminosis was found in 43 % of the patients for vitamin B1 and in 50 % for vitamin B6. High numbers of vitamin and mineral deficiencies were found after BPD and BPD/DS despite vitamin supplementation. Anaemia, ID and deficiencies for fat-soluble vitamins are frequently diagnosed. Repeated monitoring is necessary to detect deficiencies at an early stage. Taking all of this into consideration, a stringent multivitamin supplementation regimen should be implemented after malabsorptive procedures.
TL;DR: This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy.
Abstract: Gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH) are one of the most common disorders of the upper gastrointestinal tract. Despite the positive effect of sleeve gastrectomy (SG) regarding weight loss and improvement in obesity co-morbidities, there are concerns about the development of de novo gastroesophageal reflux disease or worsening the existing GERD after this bariatric operation. Furthermore, controversy exists on the consequences of SG in lower esophageal sphincter function and about the ideal procedure when a hiatus hernia is preoperatively diagnosed or discovered during the laparoscopic SG. This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy.
TL;DR: The introduction of a fast-track programme after primary LRYGB improves short-term recovery and may reduces direct hospital-related resources.
Abstract: Due to the increased incidence of morbid obesity, the demand for bariatric surgery is increasing. Therefore, the methods for optimising perioperative care for the improvement of surgical outcome and to increase efficacy are necessary. The aim of this prospective matched cohort study is to objectify the effect of the fast-track surgery (FTS) programme in patients undergoing primary Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) surgery compared to conventional perioperative care (CPC). This study compared the perioperative outcome data of two groups of 75 consecutive morbid obese patients who underwent a primary LRYGB according to international guidelines in the periods January 2011–April 2011 (CPC group) and April 2012–June 2012 (FTS group). The two groups were matched for age and sex. Primary endpoints were surgery and hospitalisation time, while secondary endpoints were intraoperative medication use and complication rates. Baseline patient characteristics for age, sex, weight and ASA classification were similar (p > 0.05) for CPC and FTS patients. BMI and waist circumference were significantly lower (p < 0.05) in the FTS compared to CPC. The total time from arrival at the operating room to the arrival at the recovery was reduced from 119 to 82 min (p < 0.001). Surgery time was reduced from 80 to 56 min (p < 0.001); mean hospital stay was reduced from 65 to 43 h (p < 0.001). Major complications occurred in 3 versus 4 % in the FTS and CPC, respectively. The introduction of a fast-track programme after primary LRYGB improves short-term recovery and may reduces direct hospital-related resources.