WorldWideScience

Sample records for bariatric surgery practiced

  1. Bariatric surgery: a best practice article.

    Science.gov (United States)

    Neff, Karl John Hans; le Roux, Carel W

    2013-02-01

    Bariatric surgery can effectively reduce body weight and treat obesity associated metabolic diseases such as diabetes mellitus. There are also benefits for an individual's functional status and psychological health. A multi-disciplinary evaluation should be offered to the individual as the first essential step in considering bariatric surgery as a treatment. This evaluation should include a thorough medical assessment, as well as psychological and dietetic assessments. In this best practice article, we outline the current recommendations for referral for bariatric surgery. We also present the data for pre-operative assessment before bariatric surgery, with particular reference to cardiovascular disease and obstructive sleep apnoea. We describe the literature on outcomes after bariatric surgery, including the results for mortality, weight loss, remission of diabetes and associated endocrine disorders such as hypogonadism. Within this review, we will illustrate the impact of bariatric surgery on self-image, psychological health and perceived health and functional status. Finally, we briefly detail the potential complications of bariatric surgery, and offer advice on post-operative care and surveillance.

  2. Bariatric Surgery

    Science.gov (United States)

    ... Metabolic and Bariatric Surgery MedlinePlus What is bariatric surgery? Bariatric surgery helps people who are very obese to ... What are the endocrine-related benefits of bariatric surgery? Bariatric surgery and the weight loss that results can: ...

  3. [Guidelines for clinical practice for bariatric surgery].

    Science.gov (United States)

    Ciangura, Cécile; Nocca, David; Lindecker, Valérie

    2010-09-01

    Bariatric surgery is intended for subjects with BMI ≥ 40 kg/m(2) or ≥ 35 kg/m(2) with comorbidities. In any case, the indication can only be envisaged in patients who have had access to specialized medical care, and agree with a prolonged medical follow-up. After 60 years old, physiological age and comorbidities need to be highly considered. In genetic obesity and craniopharyngioma, surgery is exceptional. Main contraindications consist in severe disorders in feeding behaviour, non-stabilized psychiatric disorders, alcoholism, drug addiction, inability to participate in prolonged medical follow-up. Surgical process includes many important stages: preparation and information by a multidisciplinary team (identify contraindication, give optimal information, look for and treat comorbidities [as sleep apneoas syndrome, diabetes, cardiopulmonary disease], assess nutritional and psychological status and feeding behaviour); the decision of intervention during a concerted analysis by a multidisciplinary team; follow-up (for life) led to screen for nutritional deficiencies and surgical complications, to reinforce diet and physical activity counselling, to adapt to new situations (as pregnancy), and advise psychological care if necessary.

  4. [Clinical Practice after Bariatric Surgery: Problems and Complications].

    Science.gov (United States)

    Gebhart, Martina

    2015-12-09

    The number of patients undergoing bariatric surgery because of morbid obesity is increasing rapidly. Therefore, it is an important issue to be aware of outcome and complications after bariatric surgery. This mini-review presents a compilation of important gastrointestinal symptoms, as pain, diarrhea and dumping, and includes treatment options. It characterizes possible micronutrient deficiencies, gives instructions concerning the adaptation of drugs and illustrates possible adverse outcomes, such as excessive weight loss, insufficient weight loss and weight gain after bariatric surgery.

  5. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by restricting the ... Online Education Directory Search Patient Learning Center Bariatric Surgery ... Surgery Procedures BMI Calculator Childhood and Adolescent Obesity ...

  6. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    Science.gov (United States)

    ... to Be Smart About Social Media Weight Loss Surgery (Bariatric Surgery) KidsHealth > For Parents > Weight Loss Surgery (Bariatric Surgery) ... bariatric surgery might be an option. About Bariatric Surgery Bariatric surgery had its beginnings in the 1960s, ...

  7. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by ... Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic ...

  8. Bariatric Surgery Misconceptions

    Science.gov (United States)

    ... from depression or anxiety and to have lower self-esteem and overall quality of life than someone who ... is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery ...

  9. Hyperoxaluria and Bariatric Surgery

    Science.gov (United States)

    Asplin, John R.

    2007-04-01

    Bariatric surgery as a means to treat obesity is becoming increasingly common in the United States. An early form of bariatric surgery, the jejunoileal bypass, had to be abandoned in 1980 due to numerous complications, including hyperoxaluria and kidney stones. Current bariatric procedures have not been systematically evaluated to determine if they cause hyperoxaluria. Presented here are data showing that hyperoxaluria is the major metabolic abnormality in patients with bariatric surgery who form kidney stones. Further studies are needed to assess the prevalence of hyperoxaluria in all patients with bariatric surgery.

  10. Integrated bariatric surgery residency

    Directory of Open Access Journals (Sweden)

    Eltorai AE

    2014-11-01

    Full Text Available Adam EM Eltorai Warren Alpert Medical School of Brown University, RI, USA Abstract: Obesity is a major public health concern. Given its lasting efficacy for improving obesity and obesity-related diseases, bariatric surgery is an increasingly common treatment option. As the implementation of the Affordable Care Act progresses, the impending physician shortage will become more severe. Thus there will be an even greater need for doctors specialized in the management and treatment of obese patients. The development of integrated bariatric surgery residency programs could be considered and is discussed herein. Keywords: obesity, bariatric surgery, integrated residency, surgery education

  11. [Bariatric surgery in Denmark.

    DEFF Research Database (Denmark)

    Funch-Jensen, P.; Iversen, M.G.; Kehlet, H.

    2008-01-01

    INTRODUCTION: In 2005 the National Board of Health (NBH) published guidelines on bariatric surgery in Denmark. The aim of the present study was to shed light on the national bariatric effort in relation to these guidelines. MATERIAL AND METHODS: The analysis is based on extraction of the following......, a tendency which was attributable to the activities of one of the private clinics. CONCLUSION: The frequency with which bariatric surgery is performed follows a strongly increasing trend and the procedures are only performed at the public departments selected by the National Board of Health...

  12. Bariatric surgery and the changing current scope of general surgery practice: implications for general surgery residency training.

    Science.gov (United States)

    Mostaedi, Rouzbeh; Ali, Mohamed R; Pierce, Jonathan L; Scherer, Lynette A; Galante, Joseph M

    2015-02-01

    The scope of general surgery practice has evolved tremendously in the last 20 years. However, clinical experience in general surgery residency training has undergone relatively little change. To evaluate the current scope of academic general surgery and its implications on surgical residency. The University HealthSystem Consortium and Association of American Medical Colleges established the Faculty Practice Solution Center (FPSC) to characterize physician productivity. The FPSC is a benchmarking tool for academic medical centers created from revenue data collected from more than 90,000 physicians who practice at 95 institutions across the United States. The FPSC database was queried to evaluate the annual mean procedure frequency per surgeon (PFS) in each calendar year from 2006 through 2011. The associated work relative value units (wRVUs) were also examined to measure physician effort and skill. During the 6-year period, 146 distinct Current Procedural Terminology codes were among the top 100 procedures, and 16 of these procedures ranked in the top 10 procedures in at least 1 year. The top 10 procedures accounted for more than half (range, 52.5%-57.2%) of the total 100 PFS evaluated for each year. Laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year (PFS, 18.2-24.6). The other most frequently performed procedures included laparoscopic cholecystectomy (PFS, 30.3-43.5), upper gastrointestinal tract endoscopy (PFS, 26.5-34.3), mastectomy (PFS, 16.5-35.0), inguinal hernia repair (PFS, 15.5-22.1), and abdominal wall hernia repair (PFS, 21.6-26.1). In all years, laparoscopic Roux-en-Y gastric bypass generated the highest number of wRVUs (wRVUs, 491.0-618.2), and laparoscopic cholecystectomy was regularly the next highest (wRVUs, 335.8-498.7). A significant proportion of academic general surgery is composed of bariatric surgery, yet surgical training does not sufficiently emphasize the necessary exposure to technical expertise

  13. Pregnancy Management After Bariatric Surgery.

    Science.gov (United States)

    Badreldin, Nevert; Kuller, Jeffrey; Rhee, Eleanor; Brown, Laura; Laifer, Steven

    2016-06-01

    Obesity is a source of major morbidity and mortality and is a growing concern worldwide. Maternal obesity is associated with increased maternal and fetal risks during pregnancy. Bariatric surgery has emerged as one of the most sustainable treatments for severe obesity and its comorbidities. Patients who have undergone bariatric surgery often experience drastic improvements in hypertension and diabetes. It is not surprising, therefore, that the incidence of bariatric surgery is increasing, particularly in women of childbearing age. In fact, many women undergoing bariatric surgery plan to become pregnant in the future. Bariatric surgery may have a beneficial effect on rates of fetal macrosomia, gestational diabetes, hypertension, and preeclampsia. Conversely, studies have showed that bariatric surgery may increase the risk of small for gestational age infants and preterm birth. Given its rising incidence, it is important that physicians be able to thoroughly and accurately counsel and treat patients who plan to, or do, become pregnant after bariatric surgery.

  14. Bariatric Surgery and the Endocrine System

    Science.gov (United States)

    ... Surgery and the Endocrine System Fact Sheet Bariatric Surgery and the Endocrine System February, 2012 Download PDFs ... Morton, MD Marzieh Salehi, MD What is bariatric surgery? Bariatric surgery helps people who are very obese ...

  15. [Indication for bariatric surgery].

    Science.gov (United States)

    Hanusch-Enserer, Ursula; Enserer, Christian; Rosen, Harald R; Prager, Rudolf

    2004-01-01

    Morbid obesity is defined as obesity with body mass index (BMI) > or = 40 kg/m2 with secondary serious diseases. Conservative treatment generally fails to produce long-term weight loss in these patients, since several bariatric surgical techniques have been developed which are based on gastric restriction and/or gastric malabsorption resulting in permanent weight loss over years. Preoperative evaluation might detect suitable patients and reduce both non-surgical and surgical complications. Postoperative follow-up in a multidisciplinary program, including specialists in various fields of medicine, e.g. surgery, internal medicine, radiology, paediatrics and nutritional surveillance are mandatory in the treatment of patients after obesity surgery. Bariatric surgery results in a major weight loss, with amelioration of most obesity-associated conditions. The most serious side effect of some surgical procedere is malnutrition.

  16. Pregnancy management following bariatric surgery.

    Science.gov (United States)

    Uzoma, A; Keriakos, R

    2013-02-01

    Bariatric surgery is gaining in popularity, due to globally increasing rates of obesity. In the UK, this has manifested as a 14-fold increase in bariatric surgery between 2004 and 2010, making it necessary to develop strategies to manage women who become pregnant following bariatric surgery. This review paper has explored all the current evidence in the literature and provided a comprehensive management strategy for pregnant women following bariatric surgery. The emphasis is on a multidisciplinary team approach to all aspects of care. Adequate pre-conception and antenatal and postnatal care is essential to good pregnancy outcomes with emphasis on appropriate nutritional supplementation. This is especially important following malabsorptive procedures. There is no evidence to suggest that pregnancy outcome is worse after bariatric surgery, though women who remain obese are prone to obesity-related risks in pregnancy. Neonatal outcome post-bariatric surgery is no different from the general population.

  17. A role for exercise after bariatric surgery?

    Science.gov (United States)

    Coen, Paul M; Goodpaster, Bret H

    2016-01-01

    Obesity predisposes an individual to develop numerous comorbidities, including type 2 diabetes, and represents a major healthcare issue in many countries worldwide. Bariatric surgery can be an effective treatment option, resulting in profound weight loss and improvements in metabolic health; however, not all patients achieve similar weight loss or metabolic improvements. Exercise is an excellent way to improve health, with well-characterized physiological and psychological benefits. In the present paper we review the evidence to determine whether there may be a role for exercise as a complementary adjunct therapy to bariatric surgery. Objectively measured physical activity data indicate that most patients who undergo bariatric surgery do not exercise enough to reap the health benefits of exercise. While there is a dearth of data on the effects of exercise on weight loss and weight loss maintenance after surgery, evidence from studies of caloric restriction and exercise suggest that similar adjunctive benefits may be extended to patients who perform exercise after bariatric surgery. Recent evidence from exercise interventions after bariatric surgery suggests that exercise may provide further improvements in metabolic health compared with surgery-induced weight loss alone. Additional randomized controlled exercise trials are now needed as the next step to more clearly define the potential for exercise to provide additional health benefits after bariatric surgery. This valuable evidence will inform clinical practice regarding much-needed guidelines for exercise after bariatric surgery.

  18. [Bariatric surgery: an update].

    Science.gov (United States)

    Moreno Esteban, B; Zugasti Murillo, A

    2004-01-01

    The indication of bariatric surgery as therapeutic procedure for morbid obese patients requires the application of selection criteria which deal with the degree of obesity, associated complications and previous failure of conventional therapy. Alcohol or drug addiction and concomitant serious disease are contraindications for bariatric surgery. Before operation, a full assessment is needed to identify possible eating behaviour disturbances and associated comorbidity such as cardiovascular disease, sleep apnoea, metabolic and psychiatric alterations which might induce intra and postoperative complications. Surgical techniques can be classified as restrictive, malabsortive and mixed procedures. Gastroplasty and adjustable gastric banding are restrictive techniques, which are indicated in obese patients with body mass index less than 45 kg/m2. Mixed techniques are the most used procedures. They include gastric by-pass which causes a reduction of 60-70% of weight excess, biliopancreatic diversion and duodenal switch which can eliminate a 75% of body weight excess. Following bariatric surgery a dramatic improvement in associated comorbidity can be demonstrated, specially in what refers to diabetes, hypertension, dislipidaemia and apnoea. Postoperative mortality is around 1-2%. Peritonitis and venous thromboembolism are the most serious complications. Postoperative follow-up should be lifelong and requires a progressive nutrition planning and vitamin supplementation.

  19. Innovations in Bariatric Surgery.

    Science.gov (United States)

    Zhu, Catherine; Pryor, Aurora D

    2015-11-01

    Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.

  20. Bariatric Surgery and Precision Nutrition

    Directory of Open Access Journals (Sweden)

    Carolina F. Nicoletti

    2017-09-01

    Full Text Available This review provides a literature overview of new findings relating nutritional genomics and bariatric surgery. It also describes the importance of nutritional genomics concepts in personalized bariatric management. It includes a discussion of the potential role bariatric surgery plays in altering the three pillars of nutritional genomics: nutrigenetics, nutrigenomics, and epigenetics. We present studies that show the effect of each patient’s genetic and epigenetic variables on the response to surgical weight loss treatment. We include investigations that demonstrate the association of single nucleotide polymorphisms with obesity phenotypes and their influence on weight loss after bariatric surgery. We also present reports on how significant weight loss induced by bariatric surgery impacts telomere length, and we discuss studies on the existence of an epigenetic signature associated with surgery outcomes and specific gene methylation profile, which may help to predict weight loss after a surgical procedure. Finally, we show articles which evidence that bariatric surgery may affect expression of numerous genes involved in different metabolic pathways and consequently induce functional and taxonomic changes in gut microbial communities. The role nutritional genomics plays in responses to weight loss after bariatric surgery is evident. Better understanding of the molecular pathways involved in this process is necessary for successful weight management and maintenance.

  1. Bariatric Surgery and Stone Disease

    Science.gov (United States)

    Lieske, John C.; Kumar, Rajiv

    2008-09-01

    Bariatric surgery is an effective treatment strategy for patients with morbid obesity that can result in effective weight loss, resolution of diabetes mellitus and other weight related complications, and even improved mortality. However, it also appears that hyperoxaluria is common after modern bariatric surgery, perhaps occurring in up to 50% of patients after Rouxen-Y gastric bypass. Although increasing numbers of patients are being seen with calcium oxalate kidney stones after bariatric surgery, and even a few with oxalosis and renal failure, the true risk of these outcomes remains unknown. The mechanisms that contribute to this enteric hyperoxaluria are also incompletely defined, although fat malabsorption may be an important component. Since increasing numbers of these procedures are likely to be performed in the coming years, further study regarding the prevalence and mechanisms of hyperoxaluria and kidney stones after bariatric surgery is needed to devise effective methods of treatment in order to prevent such complications.

  2. Changing trends in bariatric surgery.

    Science.gov (United States)

    Lo Menzo, E; Szomstein, S; Rosenthal, R J

    2015-03-01

    Bariatric surgery is considered the only long-lasting treatment for morbid obesity. Techniques and procedures have changed dramatically. We report on some of the major changes in the field. We reviewed some of the major changes in trends in bariatric surgery based on some landmark paper published in the literature. We identified three major phases in the evolution of bariatric surgery. The pioneer phase was mostly characterized by discovery of weight loss procedures serendipitously from procedures done for other purposes. The second phase can be identified with the advent of laparoscopic techniques. This is considered the phase of greatest expansion of bariatric surgery. The metabolic phase derives from the improved understanding of the mechanisms of actions of the bariatric operations at the hormonal and molecular level. Bariatric surgery has changed significantly over the years. The safety of the laparoscopic approach, along with the better understanding of the metabolic changes obtained postoperatively, has led to a more individualized approach and also an attempt to expand the indications for these procedures. © The Finnish Surgical Society 2014.

  3. Creation of a Bariatric Surgery Medication Therapy Management Model.

    Science.gov (United States)

    Schuh, Michael J

    2015-07-01

    To describe how pharmacist-provided medication therapy management (MTM) services can be applied to bariatric surgery. A pharmacy MTM consult service located in a multispecialty medical clinic with a bariatric department attached to a hospital where bariatric surgeries are performed. MTM bariatric surgery office practice where patients are seen before surgery by a pharmacist to identify medication problems and determine how best to administer alternative dosage forms post-operatively to patients. Practice innovations are a creation of a specialized service and accompanying specialized medication database within a pharmacotherapy practice. Outcome measures are number of patients referred per month and polypharmacy consults scheduled downstream from the bariatric surgery. Improved patient outcomes and prescribing efficiency from usage of the newly developed database of drugs that can be crushed. All bariatric patients are now referred to the pharmacist MTM pharmacotherapy service for medication review before bariatric surgery. Bariatric surgery is a source of another useful MTM practice model. Utilizing MTM pharmacists to consult with bariatric patients presurgery helps ease the physician burden of writing alternative dose prescriptions and helps identify medication problems with patients before their surgery.

  4. Bariatric surgery in hypothalamic obesity

    Directory of Open Access Journals (Sweden)

    Nathan eBingham

    2012-02-01

    Full Text Available Craniopharyngiomas (CP are epithelial neoplasms generally found in the area of the pituitary and hypothalamus. Despite benign histology, these tumors and/or their treatment often result in significant, debilitating disorders of endocrine, neurological, behavioral, and metabolic systems. Severe obesity is observed in a high percentage of patients with CP resulting in significant comorbidities and negatively impacting quality of life. Obesity occurs as a result of hypothalamic damage and disruption of normal homeostatic mechanisms regulating energy balance. Such pathological weight gain, termed hypothalamic obesity (HyOb, is often severe and refractory to therapy.Unfortunately, neither lifestyle intervention nor pharmacotherapy has proven truly effective in the treatment of CP-HyOb. Given the limited choices and poor results of these treatments, several groups have examined bariatric surgery as a treatment alternative for patients with CP-HyOb. While a large body of evidence exists supporting the use of bariatric surgery in the treatment of exogenous obesity and its comorbidities, its role in the treatment of HyOb has yet to be well defined. To date, the existing literature on bariatric surgery in CP-HyOb is largely limited to case reports and series with short term follow-up. Here we review the current reports on the use of bariatric surgery in the treatment of CP-HyOb. We also compare these results to those reported for other populations of HyOb, including Prader-Willi Syndrome and patients with melanocortin signaling defects. While initial reports of bariatric surgery in CP-HyOb are promising, their limited scope makes it difficult to draw any substantial conclusions as to the long term safety and efficacy of bariatric surgery in CP-HyOb. There continues to be a need for more robust, controlled, prospective trials with long term follow-up in order to better define the role of bariatric surgery in the treatment of all types of hypothalamic

  5. Single-incision laparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Huang Chih-Kun

    2011-01-01

    Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

  6. Nutritional requirements after bariatric surgery.

    Science.gov (United States)

    Bosnic, Gordana

    2014-06-01

    This article presents an overview of postoperative nutritional requirements and goals following bariatric surgery. It summarizes current diet progression and nutrient intake guidelines geared toward optimizing weight loss and maintaining adequate nutritional status, nutrient absorption, as well as hydration. The article further emphasizes the importance of postoperative follow-up with a bariatric multidisciplinary team for appropriate postoperative care, diet management, and nutrient deficiency screenings. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Anesthesia management in laparoscopic bariatric surgery: Perioperative complications and outcomes in the third year of practice

    Directory of Open Access Journals (Sweden)

    Serkan Karaman

    2014-06-01

    Full Text Available Objective: In this study, we aimed to assess the perioperative and postoperative results of the patients who underwent bariatric surgery. Methods: After obtaining approval, a retrospectively designed observational study was conducted. All adult patients who underwent laparoscopic gastric plication, sleeve gastrectomy, or roux-en-Y anastomosis between January 2011 and May 2013 were included. Results: A total of 104 patients were included in the study period: 49 (47.1% underwent laparoscopic roux-en-Y anastomosis, 44 (42.3% underwent laparoscopic sleeve gastrectomy, and 11 (10.6% underwent laparoscopic gastric plication. The present study showed a mortality rate of 1.9% (n = 2, one after Roux-en-Y anastomosis operation, and the other one after gastric plication. Conclusion: The anesthesia methods and approaches have no association with morbidity and mortality in such procedures of bariatric surgery indicated in the present study. J Clin Exp Invest 2014; 5 (2: 200-205

  8. Bone Metabolism after Bariatric Surgery

    Science.gov (United States)

    Yu, Elaine W.

    2014-01-01

    Bariatric surgery is a popular and effective treatment for severe obesity, but may have negative effects on the skeleton. This review summarizes changes in bone density and bone metabolism from animal and clinical studies of bariatric surgery, with specific attention to Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG). Skeletal imaging artifacts from obesity and weight loss are also considered. Despite challenges in bone density imaging, the preponderance of evidence suggests that bariatric surgery procedures have negative skeletal effects that persist beyond the first year of surgery, and that these effects vary by surgical type. The long-term clinical implications and current clinical recommendations are presented. Further study is required to determine mechanisms of bone loss after bariatric surgery. Although early studies focused on calcium/vitamin D metabolism and mechanical unloading of the skeleton, it seems likely that surgically-induced changes in the hormonal and metabolic profile may be responsible for the skeletal phenotypes observed after bariatric surgery. PMID:24677277

  9. American Society for Metabolic and Bariatric Surgery

    Science.gov (United States)

    ... Change You can help ASMBS bring coverage for bariatric surgery to all states in America through ObesityPAC Read ... and as a leader in the field of bariatric surgery. About ASMBS Integrated Health Learn about the Integrated ...

  10. Nutritional deficiencies after bariatric surgery.

    Science.gov (United States)

    Bal, Bikram S; Finelli, Frederick C; Shope, Timothy R; Koch, Timothy R

    2012-09-01

    Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related comorbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the 'divided' Roux-en-Y gastric bypass (RYGB). This Review summarizes the current knowledge on nutrient deficiencies that can develop after bariatric surgery and highlights follow-up and treatment options for bariatric surgery patients who develop a micronutrient deficiency. The major macronutrient deficiency after bariatric surgery is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before bariatric surgery and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with diabetes mellitus. Recognition of the clinical presentations of micronutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. A major clinical concern is the relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia; metabolic bone diseases may explain the increased risk of hip fracture in patients after RYGB. Further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, clinicians should inquire about and treat symptoms that suggest nutrient deficiencies.

  11. Laparoscopic revolution in bariatric surgery

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    Sundbom, Magnus

    2014-01-01

    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery. PMID:25386062

  12. Oral Contraceptives after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Joël Schlatter

    2017-04-01

    Full Text Available Objective: Bariatric surgery offers a highly effective mode of treatment for obese patients. Some procedures such as bypass cause an alteration in normal gastrointestinal tract with possible consequences for the uptake of orally administered drugs. Methods: We assessed the literature to ascertain whether the use of oral drugs and especially oral contraceptives is effective and adequate after bariatric surgery. Results: The bioavailability of drugs could be affected by the solubility and pH of the modified medium after bariatric surgery and by the loss of gastrointestinal transporters. Bariatric surgery could potentially result in a transient change in the absorption of drugs such as analgesics, antibiotics, antiarrhythmics, anticoagulants, psychotropic, and oral contraceptive drugs. Effective contraception is especially critical in the postoperative period, and implants might be representing a safe contraceptive method in women undergoing bariatric surgery. Conclusion: Each drug will have to be evaluated with respect to its site of absorption and its mechanism of absorption, with special attention on parameters influencing the effectiveness of the absorption processes.

  13. Cardiovascular benefits of bariatric surgery.

    Science.gov (United States)

    Lee, Glenn K; Cha, Yong-Mei

    2016-04-01

    The prevalence of obesity is increasing in the United States and worldwide, bringing with it an excess of morbidity and premature death. Obesity is strongly associated with both traditional cardiovascular risk factors as well as direct effects on hemodynamics and cardiovascular structure and function. In fact, cardiovascular disease is one of the major causes of morbidity and mortality in obese patients. Often, lifestyle and pharmacological weight-loss interventions are of limited efficacy in severely obese patients. Bariatric surgery has been shown to be a feasible option to achieve substantial and sustained weight loss in this group of patients. It is a safe procedure with low in-hospital and 30-day mortality rates even in groups that are considered higher risk for surgery (e.g., the elderly), especially if performed in high-volume centers. There is observational evidence that bariatric surgery in severely obese patients is associated with both a reduction of traditional cardiovascular risk factors as well as improvement in cardiac structure and function. Marked decreases in the levels of inflammatory and prothrombotic markers, as well as markers of subclinical atherosclerosis and endothelial dysfunction, are seen after bariatric surgery. This article summarizes the existing evidence regarding the cardiovascular benefits in patients following bariatric surgery.

  14. Health and Nutritional Status of Vegetarian Candidates for Bariatric Surgery and Practical Recommendations.

    Science.gov (United States)

    Sherf-Dagan, Shiri; Hod, Keren; Buch, Assaf; Mardy-Tilbor, Limor; Regev, Ziva; Ben-Porat, Tair; Sakran, Nasser; Goitein, David; Raziel, Asnat

    2017-07-11

    Data on vegetarianism and bariatric surgery (BS) are scarce. We herein describe the health and nutritional status of vegetarian patients who plan to undergo BS and propose combined recommendations for vegetarian patients who undergo BS, based on our clinical experience and current scientific literature in both nutrition fields. Cross-sectional analysis of a prospectively maintained database of all primary laparoscopic sleeve gastrectomies (LSG) performed at a bariatric center of excellence between January 2014 and November 2016 was carried out querying patients who declared a vegetarian or vegan lifestyle before surgery. Preoperative data collected included demographics, anthropometrics, dietary patterns, supplementation use, physical activity, smoking habits, co-morbidities, and blood tests. Each vegetarian was matched to five different omnivores based on age, gender, and BMI. During the study period, 1470 patients underwent primary LSG surgery (63.7% females). Twenty-one declared a vegetarian or vegan lifestyle (1.4%) pre-surgery. Most were classified as lacto-ovo (57.1%) and were driven from ethical reasons (85.7%). No differences were found between vegetarian and omnivore LSG candidates regarding co-morbidities and nutritional deficiencies, except for lower prevalence of impaired fasting glucose (14.3 vs. 47.1%;P = 0.007), lower ferritin levels (54.3 ± 50.5 vs. 96.8 ± 121.8 ng/ml; P = 0.052) and higher transferrin levels (313.9 ± 42.7 vs. 278.4 ± 40.4 mg/dl; P = 0.009) among the vegetarian cohort. Preoperative use of vitamin B12 and iron supplementation was higher among vegetarian LSG candidates than their omnivore counterparts (57.1 vs. 6.7%;P Vegetarians have comparable health status and nutritional deficiencies, lower iron stores, and higher supplementation use before surgery compared to omnivore LSG candidates.

  15. Neurological complications following bariatric surgery

    Directory of Open Access Journals (Sweden)

    Yara Dadalti Fragoso

    2012-09-01

    Full Text Available OBJECTIVE: It was to report on Brazilian cases of neurological complications from bariatric surgery. The literature on the subject is scarce. METHOD: Cases attended by neurologists in eight different Brazilian cities were collected and described in the present study. RESULTS: Twenty-six cases were collected in this study. Axonal polyneuropathy was the most frequent neurological complication, but cases of central demyelination, Wernicke syndrome, optical neuritis, radiculits, meralgia paresthetica and compressive neuropathies were also identified. Twenty-one patients (80% had partial or no recovery from the neurological signs and symptoms. CONCLUSION: Bariatric surgery, a procedure that is continuously increasing in popularity, is not free of potential neurological complications that should be clearly presented to the individual undergoing this type of surgery. Although a clear cause-effect relation cannot be established for the present cases, the cumulative literature on the subject makes it important to warn the patient of the potential risks of this procedure.

  16. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery.

    Science.gov (United States)

    Mechanick, Jeffrey I; Youdim, Adrienne; Jones, Daniel B; Garvey, W Timothy; Hurley, Daniel L; McMahon, M Molly; Heinberg, Leslie J; Kushner, Robert; Adams, Ted D; Shikora, Scott; Dixon, John B; Brethauer, Stacy

    2013-03-01

    The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

  17. Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery*

    Science.gov (United States)

    Mechanick, Jeffrey I.; Youdim, Adrienne; Jones, Daniel B.; Garvey, W. Timothy; Hurley, Daniel L.; McMahon, Molly; Heinberg, Leslie J.; Kushner, Robert; Adams, Ted D.; Shikora, Scott; Dixon, John B.; Brethauer, Stacy

    2014-01-01

    The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues. PMID:23529939

  18. Estimate of Bariatric Surgery Numbers, 2011-2015

    Science.gov (United States)

    ... to Care Toolkit EHB Access Toolkit Estimate of Bariatric Surgery Numbers, 2011-2015 Published July 2016 2011 2012 ... Online Education Directory Search Patient Learning Center Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity ...

  19. Bowel habits after bariatric surgery.

    Science.gov (United States)

    Potoczna, Natascha; Harfmann, Susanne; Steffen, Rudolf; Briggs, Ruth; Bieri, Norman; Horber, Fritz F

    2008-10-01

    Disordered bowel habits might influence quality of life after bariatric surgery. Different types of bariatric operations-gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion (BPD)-might alter bowel habits as a consequence of the surgical procedure used. Whether change in bowel habits affects quality of life after AGB, RYGB, or BPD differently is unknown. The study group contained 290 severely obese patients undergoing bariatric surgery between August 1996 and September 2004 [BPD: n = 103, 64.1% women, age 43 +/- 1 years (mean +/- SEM), BMI 53.9 +/- 0.9 kg/m(2), weight 153.4 +/- 2.9 kg; Roux-en-Y gastric bypass: n = 126, 73.0% women, age 43 +/- 1 years, BMI 44.2 +/- 0.3 kg/m(2), weight 123.8 +/- 1.5 kg; adjustable gastric banding (AGB): n = 61, 57.4% women, age 44 +/- 1 years, BMI 49.9 +/- 0.5 kg/m(2), weight 146.1 +/- 2.0 kg). Changes in bowel habits, flatulence, flatus odor, and effects on social life were estimated at least 4 months after surgery using a self-administered questionnaire. Fecal consistency changed significantly after surgery. Loose stools and diarrhea were more frequent after BPD and RYGB (P flatus affecting social life was more frequent after BPD than after either RYGB or AGB (P flatus frequency increased after BPD and RYGB, and patients were more bothered by their malodorous flatus than after AGB (all P Flatus severity score was highest in BPD, intermediate in RYGB, and lowest in AGB patients (all P < 0.001), a difference that was not influenced by frequency of metabolic syndrome before and after surgery. Moreover, observation period after surgery had no influence on overall results of bowel habits. Subsore quality of life bariatric analysis and reporting outcome system (BAROS) scores were largely similar between all three groups. However, flatulence severity score correlated inversely with quality of life estimated by BAROS in BPD and RYGB, but not in AGB patients. The type of bariatric surgery affects bowel

  20. Pregnancy after Bariatric Surgery: A Review

    Directory of Open Access Journals (Sweden)

    N. L. Hezelgrave

    2011-01-01

    Full Text Available Maternal obesity is a major cause of obstetric morbidity and mortality. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. This paper aims to synthesize the current evidence regarding pregnancy outcomes after bariatric surgery. It concludes that bariatric surgery appears to have positive effects on fertility and reduces the risk of gestational diabetes and preeclampsia. Moreover, there appears to be a reduced incidence of fetal macrosomia post-bariatric procedure, although there remains uncertainty about the increased rates of small-for-gestational age and intrauterine growth restricted infants, as well as premature rupture of membranes in this group. A number of case reports highlight that pregnancy following bariatric surgery is not without complications and it must be managed as high risk by the multidisciplinary team.

  1. Endocrine and Nutritional Management After Bariatric Surgery

    Science.gov (United States)

    Endocrine and Nutritional Management After Bariatric Surgery A Patient’s Guide Bariatric (weight loss) surgery is a treatment option for people who ... After surgery, you need to follow your doctor’s nutritional recommendations and exercise regularly (150 minutes per week ...

  2. Bariatric Surgery and Kidney-Related Outcomes.

    Science.gov (United States)

    Chang, Alex R; Grams, Morgan E; Navaneethan, Sankar D

    2017-03-01

    The prevalence of severe obesity in both the general and the chronic kidney disease (CKD) populations continues to rise, with more than one-fifth of CKD patients in the United States having a body mass index of ≥35 kg/m(2). Severe obesity has significant renal consequences, including increased risk of end-stage renal disease (ESRD) and nephrolithiasis. Bariatric surgery represents an effective method for achieving sustained weight loss, and evidence from randomized controlled trials suggests that bariatric surgery is also effective in improving blood pressure, reducing hyperglycemia, and even inducing diabetes remission. There is also observational evidence suggesting that bariatric surgery may diminish the long-term risk of kidney function decline and ESRD. Bariatric surgery appears to be relatively safe in patients with CKD, with postoperative complications only slightly higher than in the general bariatric surgery population. The use of bariatric surgery in patients with CKD might help prevent progression to ESRD or enable selected ESRD patients with severe obesity to become candidates for kidney transplantation. However, there are also renal risks in bariatric surgery, namely, acute kidney injury, nephrolithiasis, and, in rare cases, oxalate nephropathy, particularly in types of surgery involving higher degrees of malabsorption. Although bariatric surgery may improve long-term kidney outcomes, this potential benefit remains unproved and must be balanced with potential adverse events.

  3. Parkinsonism as a Complication of Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Walaa A. Kamel

    2015-11-01

    CONCLUSION: We conclude that with the increasing popularity of bariatric surgery, clinicians will need to recognize and manage neurologic complications that may appear soon after or years to decades later. Thorough evaluation is essential for any patient who has undergone bariatric surgery and develops neurologic symptoms.

  4. Mental Health Evaluations for Adolescents Prior to Bariatric Surgery: A Review of Existing Practices and a Specific Example of Assessment Procedures.

    Science.gov (United States)

    Sysko, Robyn; Zandberg, Laurie J; Devlin, Michael J; Annunziato, Rachel A; Zitsman, Jeffrey L; Walsh, B Timothy

    2013-06-01

    Best practice guidelines for adolescents considering bariatric surgery recommend a pre-operative mental health evaluation. However, only general information about these assessments appears in the literature, which makes consistency of administration challenging. This review proposes a specific empirically-derived format for pre-surgical mental health evaluations and summarizes currently available data on the psychiatric functioning of adolescents seeking bariatric surgery. Studies of mental health evaluations for adults preparing for bariatric surgery are reviewed, as is the limited literature relevant to adolescent evaluations. A specific and detailed example of an evaluation (clinical interview, self-report questionnaires, cognitive assessment) used for younger patients at a major metropolitan hospital center is presented, followed by data from an initial group of adolescents completing this evaluation. 200 adolescents (n=139 female; age: 14-18 y, BMI: 35.4-83.3 kg/m(2)) presenting for bariatric surgery. A notable subset of adolescents reported current Axis I conditions (31.5%) and current mental health treatment (29.5%), but reports of current illicit drug use (1.5%) and regular alcohol use (0.5%) were relatively rare. Procedures for using the completed evaluation and post-surgery monitoring of psychosocial issues are discussed. Adolescents considering weight loss surgery should receive comprehensive pre-surgical mental health evaluations, but additional data are needed to develop specific recommendations the use of these evaluations in post-operative care.

  5. Adolescent Bariatric Surgery — Thoughts and Perspectives from the UK

    Science.gov (United States)

    Penna, Marta; Markar, Sheraz; Hewes, James; Fiennes, Alberic; Jones, Niall; Hashemi, Majid

    2013-01-01

    Opinions of healthcare professionals in the United Kingdom regarding bariatric surgery in adolescents are largely unknown. This study aims to explore the perspectives of medical professionals regarding adolescent bariatric surgery. Members of the British Obesity and Metabolic Surgery Society and groups of primary care practitioners based in London were contacted by electronic mail and invited to complete an anonymous online survey consisting of 21 questions. Ninety-four out of 324 questionnaires were completed. 66% of professionals felt that adolescents with a body mass index (BMI) >40 or BMI >35 with significant co-morbidities can be offered surgery. Amongst pre-requisites, parental psychological counseling was chosen most frequently. 58% stated 12 months as an appropriate period for weight management programs, with 24% regarding 6 months as sufficient. Most participants believed bariatric surgery should only be offered ≥16 years of age. However, 17% of bariatric surgeons marked no minimum age limit. Over 80% of the healthcare professionals surveyed consider bariatric surgery in adolescents to be acceptable practice. Most healthcare professionals surveyed feel that adolescent bariatric surgery is an acceptable therapeutic option for adolescent obesity. These views can guide towards a consensus opinion and further development of selection criteria and care pathways. PMID:24384777

  6. Adolescent Bariatric Surgery — Thoughts and Perspectives from the UK

    Directory of Open Access Journals (Sweden)

    Marta Penna

    2013-12-01

    Full Text Available Opinions of healthcare professionals in the United Kingdom regarding bariatric surgery in adolescents are largely unknown. This study aims to explore the perspectives of medical professionals regarding adolescent bariatric surgery. Members of the British Obesity and Metabolic Surgery Society and groups of primary care practitioners based in London were contacted by electronic mail and invited to complete an anonymous online survey consisting of 21 questions. Ninety-four out of 324 questionnaires were completed. 66% of professionals felt that adolescents with a body mass index (BMI >40 or BMI >35 with significant co-morbidities can be offered surgery. Amongst pre-requisites, parental psychological counseling was chosen most frequently. 58% stated 12 months as an appropriate period for weight management programs, with 24% regarding 6 months as sufficient. Most participants believed bariatric surgery should only be offered ≥16 years of age. However, 17% of bariatric surgeons marked no minimum age limit. Over 80% of the healthcare professionals surveyed consider bariatric surgery in adolescents to be acceptable practice. Most healthcare professionals surveyed feel that adolescent bariatric surgery is an acceptable therapeutic option for adolescent obesity. These views can guide towards a consensus opinion and further development of selection criteria and care pathways.

  7. Neuroendocrine adaptations to bariatric surgery.

    Science.gov (United States)

    Dixon, J B; Lambert, E A; Lambert, G W

    2015-12-15

    The global epidemic of obesity and its related disease in combination with robust physiological defence of intentional weight loss generates a pressing need for effective weight loss therapies. Bariatric surgery, which works very effectively at delivering substantial sustained weight loss, has been an enigma with respect to mechanism of action. Naive concepts of restriction and malabsorption do not explain the efficacy of the most commonly used bariatric procedures. This century has seen increased interest in unravelling the mystery of the mechanisms underlying surgery associated weight loss with a focus on integrative gastrointestinal (GI) physiology, gut-brain signalling, and beyond weight loss effects on metabolism. GI interventions, some very minor, can alter GI wall stretch and pressure receptors; a range of GI hormones affecting hunger and satiety; bile acid metabolism and signalling; the characteristics of GI microbiome; portal vein nutrient sensing; and circulating concentrations of amino acids. Understanding the mechanisms involved should present targets for less invasive effective therapies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. [Bariatric surgery--indication and contraindication].

    Science.gov (United States)

    Kasama, Kazunori; Seki, Yosuke

    2013-02-01

    The field of obesity surgery (bariatric surgery) expands as a consequence of the rapid increase of overweight and obesity not only in the western countries but also in Asia. Japan is still far behind the western progression but the problem of obesity is rising in our country so that necessity for bariatric surgery will also rise in Japan. A few statements of indication of bariatric surgery for Asian are published recently. According to the statements from IFSO-APC (International Federation of Surgery for Obesity and Metabolic Disorders, Asian Pacific Chapter) consensus 2011, bariatric surgery for Asian should be considered for the patient with BMI over 35 without co-morbidity and for the patient with BMI over 30 with co-morbidities.

  9. Quality of Life Outcomes of Bariatric Surgery: A Systematic Review.

    Science.gov (United States)

    Hachem, Aleeya; Brennan, Leah

    2016-02-01

    Bariatric surgery is often pursued to improve quality of life (QOL). This paper systematically reviews the literature examining QOL following bariatric surgery. Fifteen controlled trials examined changes in QOL in obese (BMI > 30) adults (18–65 years) following bariatric surgery; seven compared bariatric surgery to non-surgical interventions and six compared different types of bariatric surgery. Bariatric surgery resulted in greater improvements in QOL than other obesity treatments. Significant differences in QOL improvements were found between different types of bariatric surgery. QOL improvements were more likely to occur within the first 2 years following surgery, with greater improvements in physical QOL than mental QOL. Bariatric surgery improves QOL. Future research is needed to investigate changes in QOL in different domains in the short- and long-term following bariatric surgery.

  10. Aortic rupture during reoperative bariatric surgery

    Directory of Open Access Journals (Sweden)

    Sorin Hostiuc

    2015-08-01

    Full Text Available Abstract Morbid obesity has become a very common problem worldwide, causing severe health-related consequences including cardiovascular or metabolic diseases, arthritis, sleep apnea, or an increased risk of cancer. Bariatric surgery was shown to be the only way to achieve sustainable weight loss and to decrease the frequency and severity of metabolic and cardiovascular comorbidities. The purpose of this article is to present a case of bariatric surgery complicated with lesion of the aorta with a lethal outcome.

  11. Bariatric surgery for obesity and diabetes.

    Science.gov (United States)

    Azizi, Fereidoun

    2013-03-01

    With the imminent threat of a global health crisis of obesity and diabetes or "diabesity" as it is referred to today, healthcare professionals urgently need an effective range of treatment options for management of these two epidemics. After many decades in obscurity, bariatric surgery has emerged as an impressive treatment of obesity and type 2 diabetes. The field of bariatric surgery has seen a rapid evolution over the last 30 years and current procedures are safe, effective, less invasive, and relatively cost- effective. Bariatric procedures produce durable weight loss, long -term remission of type 2 diabetes, and beneficial effects on other comorbidities; they lead to a significant reduction in mortality in the long term. The adverse events after surgery are not uncommon but in majority of cases are not fatal. Bariatric surgery is costly, but cost-efficacy analysis consistently shows that the additional years of lives gained through bariatric surgery can be obtained at a reasonable and affordable cost. However, universal surgical treatment of obesity is not achievable with the world's current healthcare and surgical resources. The conclusion of this review is that although bariatric surgery is a good addition to management of obesity and diabetes, these epidemics must be addressed by more comprehensive and long-term health policy efforts and appropriate research to determine the most effective ways of prevention and nonsurgical alternatives to treat obesity and type 2 diabetes.

  12. Does bariatric surgery decrease gastric cancer risk?

    Science.gov (United States)

    Menéndez, Pablo; Padilla, David; Villarejo, Pedro; Menéndez, Jose M; Lora, David

    2012-01-01

    In the attempt to establish the different incidence between cancer in anatomically whole stomachs and cancer in patients who have undergone a surgical procedure for morbid obesity, a review on the epidemiology of bariatric surgery and stomach cancer and a correlation with the global incidence of stomach cancer (comparing it with the median age of patients who developed neoplasms after bariatric surgery) have been conducted. This was a descriptive study of the gastric neoplasms located at the gastric pouch, bypassed stomach or in the esophagogastric junction, following bariatric surgery described in the medical literature. Twenty-one cases of gastric neoplasm located at the gastric pouch, in the bypassed stomach or in the esophagogastric junction were described after bariatric surgery. Bariatric surgery seems to produce a decrease in the incidence of cancer when comparing obese patients who were operated and obese patients who have not, so additional studies are needed to compare the cancer incidence between the general population and patients undergoing bariatric surgery. New studies will determine if it is necessary to focus on the early detection of pathological processes at the excluded digestive tract.

  13. CLINICAL PRACTICE GUIDELINES FOR THE PERIOPERATIVE NUTRITIONAL, METABOLIC, AND NONSURGICAL SUPPORT OF THE BARIATRIC SURGERY PATIENT—2013 UPDATE: COSPONSORED BY AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, THE OBESITY SOCIETY, AND AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY★

    Science.gov (United States)

    Mechanick, Jeffrey I.; Youdim, Adrienne; Jones, Daniel B.; Garvey, W. Timothy; Hurley, Daniel L.; McMahon, M. Molly; Heinberg, Leslie J.; Kushner, Robert; Adams, Ted D.; Shikora, Scott; Dixon, John B.; Brethauer, Stacy

    2014-01-01

    The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE- TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues. PMID:23529351

  14. Kidney stone risk following modern bariatric surgery.

    Science.gov (United States)

    Gonzalez, Ricardo D; Canales, Benjamin K

    2014-05-01

    Over the past 10 years, a variety of reports have linked bariatric surgery to metabolic changes that alter kidney stone risk. Most of these studies were retrospective, lacked appropriate controls, or involved bariatric patients with a variety of inclusion criteria. Despite these limitations, recent clinical and experimental research has contributed to our understanding of the pathophysiology of stone disease in this high-risk population. This review summarizes the urinary chemistry profiles that may be responsible for the increased kidney stone incidence seen in contemporary epidemiological bariatric studies, outlines the mechanisms of hyperoxaluria and potential therapies through a newly described experimental bariatric animal model, and provides a focused appraisal of recommendations for reducing stone risk in bariatric stone formers.

  15. Gastric cancer following bariatric surgery: a review.

    Science.gov (United States)

    Orlando, Giulio; Pilone, Vincenzo; Vitiello, Antonio; Gervasi, Rita; Lerose, Maria A; Silecchia, Gianfranco; Puzziello, Alessandro

    2014-10-01

    Bariatric procedures can induce a massive weight loss that lasts for >15 years after surgery; in addition, they achieve important metabolic effects including diabetes resolution in the majority of morbidly obese patients. However, some bariatric interventions may cause gastroesophageal reflux disease and other serious complications. The aim of our study is to evaluate the risk of cancer after bariatric surgery. We conducted a review of the literature about the cases of gastric cancer arising after any bariatric procedure, including a case of adenocarcinoma incidentally discovered by the authors 6 months after laparoscopic adjustable gastric banding. Globally, 17 case reports describing 18 patients were retrieved, including the case study by the authors. The diagnosis of tumor was at a mean of 8.6 years after bariatric surgery, 9.3 years after RYGB, and 8.1 years after restrictive procedures. The adenocarcinoma represented most cases (15 patients, 83%). In the patients with RYGB, the adenocarcinoma was localized in the excluded stomach in 5 patients (83%) and in the pouch in 1 patient (17%). After a restrictive procedure, the cancer was localized in the pouch in 5 patients (62.5%), in the pylorus in 2 patients (25%), and in lesser curvature only in 1 patient (12.5%). There is a lack of evidence about a connection between the late occurrence of gastric adenocarcinoma and the bariatric surgery. For this reason, although the preoperative upper endoscopy is still mandatory, there is no need for a regular endoscopic evaluation of patients after surgery.

  16. Medical tourism and bariatric surgery: who pays?

    Science.gov (United States)

    Sheppard, Caroline E; Lester, Erica L W; Chuck, Anderson W; Kim, David H; Karmali, Shahzeer; de Gara, Christopher J; Birch, Daniel W

    2014-12-01

    The objective of this study was to determine the short-term cost impact that medical tourism for bariatric surgery has on a public healthcare system. Due to long wait times for bariatric surgery services, Canadians are venturing to private clinics in other provinces/countries. Postoperative care in this population not only burdens the provincial health system with intervention costs required for complicated patients, but may also impact resources allotted to patients in the public clinic. A chart review was performed from January 2009 to June 2013, which identified 62 medical tourists requiring costly interventions related to bariatric surgery. Secondarily, a survey was conducted to estimate the frequency of bariatric medical tourists presenting to general surgeons in Alberta, necessary interventions, and associated costs. A threshold analysis was used to compare costs of medical tourism to those from our institution. A conservative cost estimate of $1.8 million CAD was calculated for all interventions in 62 medical tourists. The survey established that 25 Albertan general surgeons consulted 59 medical tourists per year: a cost of approximately $1 million CAD. Medical tourism was calculated to require a complication rate ≤ 28% (average intervention cost of $37,000 per patient) to equate the cost of locally conducted surgery: a rate less than the current supported evidence. Conducting 250 primary bariatric surgeries in Alberta is approximately $1.9 million less than the modeled cost of treating 250 medical tourists returning to Alberta. Medical tourism has a substantial impact on healthcare costs in Alberta. When compared to bariatric medical tourists, the complication rate for locally conducted surgery is less, and the cost of managing the complications is also much less. Therefore, we conclude that it is a better use of resources to conduct bariatric surgery for Albertan residents in Alberta than to fund patients to seek surgery out of province/country.

  17. Perioperative Optimization of Patients Undergoing Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    C. E. Owers

    2012-01-01

    Full Text Available Bariatric surgery is fast becoming an efficient and safe method of weight reduction, especially for patients in whom conservative measures have failed. As the obese population of the world increases, so will the number of patients requesting or requiring surgical weight loss methods. Bariatric patients however have numerous co-morbidities that make their operative course more difficult, and therefore is important to have a good understanding of the important issues surrounding their pre, peri and post operative management. This article aims to educate the reader about optimal management of the bariatric surgical patient.

  18. The risk of adverse pregnancy outcome after bariatric surgery

    DEFF Research Database (Denmark)

    Kjær, Mette Karie Mandrup; Lauenborg, Jeannet; Breum, Birger Michael

    2013-01-01

    The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery.......The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery....

  19. Bariatric surgery: assessing opportunities for value innovation.

    Science.gov (United States)

    Tarantino, David P; Smith, Darlene B

    2005-03-01

    Obesity has been increasing over the past two decades, and the amount of medical and media attention given to bariatric surgery as a promising option for morbidly obese individuals is growing. The growth of bariatric surgery also has been attributed to improved surgical technique, the increase in surgeons trained in laparoscopic procedures, as well increased public awareness with celebrities having successfully undergone surgery. The number of surgeons and hospitals offering bariatric services is increasing. How then does a surgeon or a hospital develop a competitive strategy? The first step is to understand the health-care industry. The key forces are rivalry among present competitors, and the bargaining power of suppliers and buyers. While bariatric surgery currently is in a growth phase, time and competition will force practitioners to compete on the basis of price, unless they find true competitive advantage. Value innovation, is a means of creating new marketing space by looking across the conventionally defined boundaries of business--across substitute industries, across strategic groups, across buyer groups, across complementary product and service offerings, and across the functional-emotional orientation of an industry. One can compete by offering similar services focusing primarily on cost efficiencies as the key to profitability. Alternatively, one can break free from the pack by innovating and focusing on delivering superior value to the customer. As the market for bariatric surgery becomes increasingly overcrowded, profitable growth is not sustainable without developing a clear differential advantage in the market. Value innovation allows you to develop that advantage.

  20. Routine Liver Biopsy During Bariatric Surgery: an Analysis of Evidence Base.

    Science.gov (United States)

    Mahawar, Kamal K; Parmar, Chetan; Graham, Yitka; Abouleid, Ayman; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Small, Peter K

    2016-01-01

    Non-alcoholic fatty liver disease and non-alcoholic steato-hepatitis are common in patients undergoing bariatric surgery. Non-alcoholic steato-hepatitis can progress to cirrhosis of the liver and hepatocellular carcinoma. Non-invasive methods of diagnosing non-alcoholic steato-hepatitis are not as accurate as liver biopsy, and bariatric surgery presents a unique opportunity to carry out a simultaneous liver biopsy. Routine liver biopsy can help early and accurate diagnosis of obesity-associated liver conditions. This has led some surgeons to argue for routine liver biopsy at the time of bariatric surgery. However, most bariatric surgeons remain unconvinced and liver biopsy is currently not routine practice with bariatric surgery. This review examines published scientific literature to ascertain the usefulness of routine liver biopsy at the time of bariatric surgery.

  1. [Bariatric surgery and patient therapeutic education].

    Science.gov (United States)

    Mével, Katell

    2015-11-01

    Weight loss surgery or "bariatric surgery", used in cases of severe obesity, is a complex procedure aiming to reduce food intake. An increasingly accessible technique, it requires a long postoperative follow-up and a change in eating habits. Patient therapeutic education encourages the patient to become a player in their care.

  2. Vitamin D alteration associated with obesity and bariatric surgery.

    Science.gov (United States)

    Lespessailles, Eric; Toumi, Hechmi

    2017-05-01

    Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries. Interactions and relationships between obesity and bone tissue and its metabolism are complex but are more and more studied and recognized. Obesity is associated with an altered hormonal profile including particularly bone-regulating hormones like vitamin D. Bariatric surgery procedures, thanks to their effectiveness to achieve therapeutic endpoints for comorbidities associated with obesity, have had an increasing success. However, these surgeries by producing mechanical restriction and or malabsorption syndrome lead to nutritional deficiencies including vitamin D. In this review, we aim to (1) discuss the nutritional deficiency of vitamin D in the obese, (2) to summarize the different surgical options in bariatric surgery and to present the evidence concerning these procedures and their associated profile in vitamin D post-operative insufficiency, (3) to present the different recommendations in clinical practice to prevent or treat vitamin D deficiencies or insufficiencies in patients treated by bariatric surgery and finally to introduce emerging assumptions on the relationship between vitamin D, microbiota composition and circulating bile acids. Impact statement Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries with a prevalence increasing from 6.4 in 1975 to 14.9% in 2014. This present review summarizes currently available data on vitamin D deficiencies in the obese population before and after bariatric surgery. The important evidence emerging from our evaluation confirms that obese patients are at risk of multiple nutritional deficiencies, especially vitamin D deficiency, before bariatric surgery. Our survey confirms that the precise role of the gut microbiome and its associated changes on the vitamin D metabolism after the different bariatric surgery procedures has not yet been

  3. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    Science.gov (United States)

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  4. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    Science.gov (United States)

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  5. Should bariatric surgery be performed in adolescents?

    Science.gov (United States)

    Beamish, Andrew J; Reinehr, Thomas

    2017-04-01

    Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.

  6. Bariatric Surgery, Polycystic Ovary Syndrome, and Infertility

    Directory of Open Access Journals (Sweden)

    James Butterworth

    2016-01-01

    Full Text Available Background. Polycystic ovary syndrome (PCOS is the commonest cause of female infertility. Visceral obesity and insulin resistance are key pathophysiological mechanisms behind PCOS. Women suffering from this syndrome and infertility often seek bariatric surgery hoping that they would be able to conceive postoperatively. Objective. At present, there is no consensus on the role of bariatric surgery in the management of PCOS-associated infertility within the medical community, making it difficult to give specific advice to these women, so a review of the literature was necessary. Results. A detailed review of the literature was performed. Only 6 manuscripts were relevant and contained quantitative data. They demonstrated that bariatric surgery results in postoperative conception rates varying from 33% to 100%. Surgery is also associated with amelioration of menstrual irregularities, hormonal abnormalities, and hirsutism that are associated with PCOS. These studies were retrospective and only had a small number of participants with infertility. Conclusions. Bariatric surgery has been shown to conclusively improve life expectancy, quality of life, and comorbidities like type 2 diabetes and obstructive sleep apnea. However, further research is required to identify whether weight loss surgery results in significant improvement in fertility of women with PCOS and to investigate which operation has the best results.

  7. Bariatric Surgery, Polycystic Ovary Syndrome, and Infertility.

    Science.gov (United States)

    Butterworth, James; Deguara, Jean; Borg, Cynthia-Michelle

    2016-01-01

    Background. Polycystic ovary syndrome (PCOS) is the commonest cause of female infertility. Visceral obesity and insulin resistance are key pathophysiological mechanisms behind PCOS. Women suffering from this syndrome and infertility often seek bariatric surgery hoping that they would be able to conceive postoperatively. Objective. At present, there is no consensus on the role of bariatric surgery in the management of PCOS-associated infertility within the medical community, making it difficult to give specific advice to these women, so a review of the literature was necessary. Results. A detailed review of the literature was performed. Only 6 manuscripts were relevant and contained quantitative data. They demonstrated that bariatric surgery results in postoperative conception rates varying from 33% to 100%. Surgery is also associated with amelioration of menstrual irregularities, hormonal abnormalities, and hirsutism that are associated with PCOS. These studies were retrospective and only had a small number of participants with infertility. Conclusions. Bariatric surgery has been shown to conclusively improve life expectancy, quality of life, and comorbidities like type 2 diabetes and obstructive sleep apnea. However, further research is required to identify whether weight loss surgery results in significant improvement in fertility of women with PCOS and to investigate which operation has the best results.

  8. Bariatric Surgery and the Neuro-Ophthalmologist.

    Science.gov (United States)

    Moss, Heather E

    2016-03-01

    As the prevalence of obesity increases, so, too, do the prevalences of weight-related diseases and surgical procedures to promote weight loss. It is important for neuro-ophthalmologists to be familiar with these procedures and possible downstream effects on afferent and efferent visual function. Review of ophthalmology, neurology, general surgery, obesity, endocrinology, nutrition, psychiatry, and neurosurgery literature. Bariatric surgery is a safe and effective treatment for weight loss in obese individuals. There is Level IV evidence that it is associated with improvement in idiopathic intracranial hypertension (IIH). Laboratory nutrient deficiencies are common following some types of bariatric procedures. Symptomatic deficiencies are less common but can be devastating. Thiamine deficiency can cause nystagmus and other symptoms in weeks to months after surgery, whereas B12 or copper deficiency can cause optic neuropathy in years to decades following bariatric surgery. Bariatric surgery is a potential treatment for IIH. Postoperative vitamin deficiencies may cause nystagmus, optic neuropathy, nyctalopia, and/or ophthalmoparesis weeks to years after surgery.

  9. Treatment of Adult Obesity with Bariatric Surgery.

    Science.gov (United States)

    Schroeder, Robin; Harrison, T Daniel; McGraw, Shaniqua L

    2016-01-01

    In 2013, approximately 179,000 bariatric surgery procedures were performed in the United States, including the laparoscopic sleeve gastrectomy (42.1%), Roux-en-Y gastric bypass (34.2%), and laparoscopic adjustable gastric banding (14.0%). Choice of procedure depends on the medical conditions of the patient, patient preference, and expertise of the surgeon. On average, weight loss of 60% to 70% of excess body weight is achieved in the short term, and up to 50% at 10 years. Remission of type 2 diabetes mellitus occurs in 60% to 80% of patients two years after surgery and persists in about 30% of patients 15 years after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with nutritional supplementation and surveillance. Overall, these procedures have a mortality risk of less than 0.5%. Cohort studies show that bariatric surgery reduces all-cause mortality by 30% to 50% at seven to 15 years postsurgery compared with patients with obesity who did not have surgery. Dietary changes, such as consuming protein first at every meal, and regular physical activity are critical for patient success after bariatric surgery. The family physician is well positioned to counsel patients about bariatric surgical options, the risks and benefits of surgery, and to provide long-term support and medical management postsurgery.

  10. Predictors of Vitamin Adherence After Bariatric Surgery.

    Science.gov (United States)

    Sunil, Supreet; Santiago, Vincent A; Gougeon, Lorraine; Warwick, Katie; Okrainec, Allan; Hawa, Raed; Sockalingam, Sanjeev

    2017-02-01

    Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

  11. Bariatric surgery, a risk factor for rhabdomyolysis.

    Science.gov (United States)

    García-García, M L; Campillo-Soto, A; Martín-Lorenzo, J G; Torralba-Martínez, J A; Lirón-Ruiz, R; Aguayo-Albasini, J L

    2013-11-01

    Rhabdomyolysis has been increasingly recognized as a complication of bariatric surgery. We report a case of this complication and its consequences, in a patient who had undergone bariatric surgery, with a very high creatine kinase (CK) concentration, and whose renal function failed. Obesity causes a range of effects on all major organ systems. Knowledge of these effects and issues specific to the intensive care unit care of bariatric patients can help to predict and manage this underestimated complication in this population in which early diagnosis can alter the outcome. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  12. Value of routine polysomnography in bariatric surgery

    NARCIS (Netherlands)

    de Raaff, C.A.L.; Pierik, A.S.; Coblijn, U.K.; de Vries, N.; Bonjer, H.J.; van Wagensveld, B.A.

    2017-01-01

    Background: Obstructive sleep apnea (OSA), present in 60–70 % of bariatric surgery patients, is a potentially life-threatening condition when not detected and managed appropriately. The best available method to identify the severity of OSA is polysomnography. However, routine polysomnography

  13. Advanced laparoscopic bariatric surgery Is safe in general surgery training.

    Science.gov (United States)

    Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

    2017-05-01

    Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

  14. Difficulties of Bariatric Surgery after Abdominoplasty

    Directory of Open Access Journals (Sweden)

    Bora Karip

    2014-01-01

    Full Text Available During laparoscopy, the main problems of patients who have undergone previous abdominoplasty are inadequate pneumoperitoneum secondary to fibrosis and reconstructed anatomic landmarks for trocar placement. In this study, we present our laparoscopic bariatric experience in two patients with previous abdominoplasty. The procedures were a laparoscopic sleeve gastrectomy and a robotic Roux-en-Y gastric bypass. Both operations were done successfully by an abdominal wall traction technique, cutting fibrotic tissue and choosing new landmarks. We conclude that after abdominoplasty bariatric surgery can be performed safely either using conventional laparoscopic technique or robotically.

  15. Bariatric Surgery and Liver Transplantation.

    Science.gov (United States)

    Suraweera, Duminda; Saab, Elena G; Choi, Gina; Saab, Sammy

    2017-03-01

    Obesity is an important public health and medical concern in the United States. The rate of obesity has steadily risen for the past several decades. Obesity is associated with the development of nonalcoholic steatohepatitis, which is one of the leading indications for liver transplantation. After liver transplantation, recipients tend to gain weight and develop recurrent fatty liver. Over time, recurrent fatty liver may impact patient and graft survival. A bariatric surgical approach may be beneficial in select patients.

  16. Bariatric surgery and vitamin D: key messages for surgeons and clinicians before and after bariatric surgery.

    Science.gov (United States)

    Peterson, Leigh A

    2016-10-01

    Obesity is the most widespread nutritional problem globally. Bariatric surgery is the preeminent long-term obesity treatment. Bariatric procedures manipulate the intestines to produces malabsorption and/or restrict the size of the stomach. The most enduring bariatric procedure is the Roux-en-Y gastric bypass, which utilizes both restriction (small stomach pouch) and malabsorption (duodenum bypass). The in-vogue procedure is the vertical sleeve gastrectomy - resection of the greater curvature of the stomach (predominantly restrictive). Malabsorptive procedures function by decreasing nutrient absorption, primarily fat and fat-soluble nutrients (vitamins A, D, E, and K). Most studies of vitamin D status in bariatric surgery candidates reported a prevalence of over 50% vitamin D deficiency (vitamin D deficiency is also associated with chronic inflammation, obese individuals with vitamin D deficiency have extraordinary risk of adverse surgical outcomes, particularly delayed wound healing and infection due to the role of vitamin D in re-epithelialization and innate immunity. When the risk of adverse surgical outcomes in obesity is combined with that of vitamin D deficiency, there is likely an additive or potentially a synergistic effect. Furthermore, deficiency in fat-soluble vitamins, such as vitamin D, is considered a metabolic complication of bariatric surgery. Thus, determining the vitamin D status of bariatric surgery candidates and amending it preoperatively may prove greatly beneficial acutely and lifelong.

  17. Does bariatric surgery improve adipose tissue function?

    Science.gov (United States)

    Frikke-Schmidt, H.; O’Rourke, R. W.; Lumeng, C. N.; Sandoval, D. A.; Seeley, R. J.

    2017-01-01

    Summary Bariatric surgery is currently the most effective treatment for obesity. Not only do these types of surgeries produce significant weight loss but also they improve insulin sensitivity and whole body metabolic function. The aim of this review is to explore how altered physiology of adipose tissue may contribute to the potent metabolic effects of some of these procedures. This includes specific effects on various fat depots, the function of individual adipocytes and the interaction between adipose tissue and other key metabolic tissues. Besides a dramatic loss of fat mass, bariatric surgery shifts the distribution of fat from visceral to the subcutaneous compartment favoring metabolic improvement. The sensitivity towards lipolysis controlled by insulin and catecholamines is improved, adipokine secretion is altered and local adipose inflammation as well as systemic inflammatory markers decreases. Some of these changes have been shown to be weight loss independent, and novel hypothesis for these effects includes include changes in bile acid metabolism, gut microbiota and central regulation of metabolism. In conclusion bariatric surgery is capable of improving aspects of adipose tissue function and do so in some cases in ways that are not entirely explained by the potent effect of surgery. PMID:27272117

  18. Does bariatric surgery improve adipose tissue function?

    Science.gov (United States)

    Frikke-Schmidt, H; O'Rourke, R W; Lumeng, C N; Sandoval, D A; Seeley, R J

    2016-09-01

    Bariatric surgery is currently the most effective treatment for obesity. Not only do these types of surgeries produce significant weight loss but also they improve insulin sensitivity and whole body metabolic function. The aim of this review is to explore how altered physiology of adipose tissue may contribute to the potent metabolic effects of some of these procedures. This includes specific effects on various fat depots, the function of individual adipocytes and the interaction between adipose tissue and other key metabolic tissues. Besides a dramatic loss of fat mass, bariatric surgery shifts the distribution of fat from visceral to the subcutaneous compartment favoring metabolic improvement. The sensitivity towards lipolysis controlled by insulin and catecholamines is improved, adipokine secretion is altered and local adipose inflammation as well as systemic inflammatory markers decreases. Some of these changes have been shown to be weight loss independent, and novel hypothesis for these effects includes include changes in bile acid metabolism, gut microbiota and central regulation of metabolism. In conclusion bariatric surgery is capable of improving aspects of adipose tissue function and do so in some cases in ways that are not entirely explained by the potent effect of surgery. © 2016 World Obesity.

  19. Determinants of weight regain after bariatric surgery.

    Science.gov (United States)

    Bastos, Emanuelle Cristina Lins; Barbosa, Emília Maria Wanderley Gusmão; Soriano, Graziele Moreira Silva; dos Santos, Ewerton Amorim; Vasconcelos, Sandra Mary Lima

    2013-01-01

    Bariatric surgery leads to an average loss of 60-75% of excess body weight with maximum weight loss in the period between 18 and 24 months postoperatively. However, several studies show that weight is regained from two years of operation. To identify the determinants of weight regain in post-bariatric surgery users. Prospective cross-sectional study with 64 patients who underwent bariatric surgery with postoperative time > 2 years valued at significant weight regain. The variables analyzed were age, sex, education, socioeconomic status, work activity related to food, time after surgery, BMI, percentage of excess weight loss, weight gain, attendance monitoring nutrition, lifestyle, eating habits, self-perception of appetite, daily use of nutritional supplements and quality of life. There were 57 (89%) women and 7 (11%) men, aged 41.76 ± 7.93 years and mean postoperative period of 53.4 ± 18.4 months. The average weight and BMI were respectively 127.48 ± 24.2 kg and 49.56 ± 6.7 kg/m2 at surgery. The minimum weight and BMI were achieved 73.0 ± 18.6 kg and 28.3 ± 5.5 kg/m2, reached in 23.7 ± 12 months postoperatively. Regained significant weight occurred in 18 (28.1%) cases. The mean postoperative period of 66 ± 8.3 months and work activities related to food showed statistical significance (p=000 and p=0.003) for the regained weight. Bariatric surgery promotes adequate reduction of excess body weight, with significant weight regain observed after five years; post-operative time and work activity related to eating out as determining factors for the occurrence of weight regain.

  20. Prevention of Weight Regain Following Bariatric Surgery.

    Science.gov (United States)

    Kushner, Robert F; Sorensen, Kirsten Webb

    2015-06-01

    Bariatric surgery is an effective treatment for patients with severe or moderate obesity; however, long-term studies have identified that weight regain occurs post-operatively among a portion of patients. The underlying factors that influence weight regain following bariatric surgery are multifactorial and include endocrine/metabolic alterations, anatomic surgical failure, nutritional indiscretion, mental health issues, and physical inactivity. The extent and significance of these factors is currently uncertain and likely varies between individuals and the operative procedure performed. Multiple observational and non-randomized studies and a few randomized controlled trials have been reported that focus on improving post-operative weight loss. Across all of the behavioral and group support studies, patients in the treatment groups showed either no benefit or modestly greater weight loss than patients in the control groups. There are no randomized controlled trials that have specifically targeted weight regain. Additional clinical research is needed to identify etiological factors and interventional strategies.

  1. Food cravings among bariatric surgery candidates.

    Science.gov (United States)

    Crowley, Nina; Madan, Alok; Wedin, Sharlene; Correll, Jennifer A; Delustro, Laura M; Borckardt, Jeffery J; Byrne, T Karl

    2014-01-01

    Food cravings are common, more prevalent in the obese, and may differ in those who pursue surgical treatment for obesity. Food craving tools are most often validated in non-clinical, non-obese samples. In this retrospective study, 227 bariatric surgery candidates at a large medical center completed the Food Cravings Questionnaire-Trait (FCQ-T). The aim was to explore the factor structure of the FCQ-T. Principal components analysis with varimax rotation revealed a seven-factor structure that explained 70.89 % of the variance. The seven factors were: (1) preoccupation with food, (2) emotional triggers, (3) environmental cues, (4) loss of control, (5) relief from negative emotions, (6) guilt, and (7) physiological response. The preoccupation with food factor accounted for 49.46 % of the variance in responses. Unlike other populations, food cravings in bariatric surgery candidates appear to be related most to preoccupations with food.

  2. Exercise following bariatric surgery: systematic review.

    Science.gov (United States)

    Livhits, Masha; Mercado, Cheryl; Yermilov, Irina; Parikh, Janak A; Dutson, Erik; Mehran, Amir; Ko, Clifford Y; Gibbons, Melinda Maggard

    2010-05-01

    The contribution of physical activity on the degree of weight loss following bariatric surgery is unclear. To determine impact of exercise on postoperative weight loss. Medline search (1988-2009) was completed using MeSH terms including bariatric procedures and a spectrum of patient factors with potential relationship to weight loss outcomes. Of the 934 screened articles, 14 reported on exercise and weight loss outcomes. The most commonly used instruments to measure activity level were the Baecke Physical Activity Questionnaire, the International Physical Activity Questionnaire, and a variety of self-made questionnaires. The definition of an active patient varied but generally required a minimum of 30 min of exercise at least 3 days per week. Thirteen articles reported on exercise and degree of postoperative weight loss (n = 4,108 patients). Eleven articles found a positive association of exercise on postoperative weight loss, and two did not. Meta-analysis of three studies revealed a significant increase in 1-year postoperative weight loss (mean difference = 4.2% total body mass index (BMI) loss, 95% confidence interval (CI; 0.26-8.11)) for patients who exercise postoperatively. Exercise following bariatric surgery appears to be associated with a greater weight loss of over 4% of BMI. While a causal relationship cannot be established with observational data, this finding supports the continued efforts to encourage and support patients' involvement in post-surgery exercise. Further research is necessary to determine the recommended activity guidelines for this patient population.

  3. Influence of obesity and bariatric surgery on gastric cancer

    OpenAIRE

    Dantas,Anna Carolina Batista; SANTO, Marco Aurelio; de Cleva, Roberto; Sallum,Rubens Antônio Aissar; Cecconello, Ivan

    2016-01-01

    Esophageal and gastric cancer (GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.

  4. Influence of obesity and bariatric surgery on gastric cancer.

    Science.gov (United States)

    Dantas, Anna Carolina Batista; Santo, Marco Aurelio; de Cleva, Roberto; Sallum, Rubens Antônio Aissar; Cecconello, Ivan

    2016-06-01

    Esophageal and gastric cancer (GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.

  5. Influence of obesity and bariatric surgery on gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Anna Carolina Batista Dantas; Marco Aurelio Santo; Roberto de Cleva; Rubens Antônio Aissar Sallum; Ivan Cecconello

    2016-01-01

    Esophageal and gastric cancer (GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.

  6. Exploring Partners' Experiences in Living with Patients Who Undergo Bariatric Surgery.

    Science.gov (United States)

    Wallwork, Anna; Tremblay, Lynn; Chi, Monica; Sockalingam, Sanjeev

    2017-08-01

    Bariatric surgery is effective in assisting persons with severe obesity in achieving significant weight loss and improved health; however, success depends on one's lifelong commitment to lifestyle modifications post-operatively. Life partners can be essential to the success of bariatric patients as they can serve as a primary resource to patients and healthcare teams. This study aimed to explore bariatric patients' partner's experiences in order to help inform clinical practice in bariatric care to better address patient and partner needs. This study utilized a grounded theory analysis of ten semi-structured interviews of male partners of bariatric surgery patients to form a general explanatory framework of the partner experience. Participants described three interconnected processes of change that followed after their spouses surgeries: (1) effort put forth to engage in the surgical process with their spouses, (2) adoption of the behavioural changes made by their spouses and (3) adjustment to a "new normal". For those who engaged in all three processes, optimism for the future and an enriching and synergistic harmonized lifestyle with their spouse was reached. Bariatric surgery in one partner can impact couples' dietary behaviours, physical and leisure activities, physical and emotional intimacy and relationship quality as a whole. Pursuing bariatric surgery as a couple is a unique process. This study highlights the necessity to approach bariatric care in a way that targets the whole spousal unit as engaging both members in lifestyle modification may improve the quality of both their health and relationship overall.

  7. Robotic bariatric surgery: A general review of the current status.

    Science.gov (United States)

    Jung, Minoa K; Hagen, Monika E; Buchs, Nicolas C; Buehler, Leo H; Morel, Philippe

    2017-05-23

    While conventional laparoscopy is the gold standard for almost all bariatric procedures, robotic assistance holds promise for facilitating complex surgeries and improving clinical outcomes. Since the report of the first robotic-assisted bariatric procedure in 1999, numerous publications, including those reporting comparative trials and meta-analyses across bariatric procedures with a focus on robotic assistance, can be found. This article reviews the current literature and portrays the perspectives of robotic bariatric surgery. While there are substantial reports on robotic bariatric surgery currently in publication, most studies suffer from low levels of evidence. As such, although robotics technology is without a doubt superior to conventional laparoscopy, the precise role of robotics in bariatric surgery is not yet clear. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Development of a Pilot Telehealth Bariatric Surgery Support Group

    Science.gov (United States)

    Schofield, Carin K.

    2013-01-01

    The prevalence of obesity in the United States continues to grow. Bariatric surgery is becoming more common and accepted in the treatment of obesity. Clinical candidates for bariatric surgery should have a BMI > 40 kg/m[superscript 2] alone, or a BMI > 35 kg/m[superscript 2] plus one comorbidity. A trend is emerging in the literature showing…

  9. Gonadal status and outcome of bariatric surgery in obese men

    NARCIS (Netherlands)

    Aarts, E.O.; Wageningen, B. van; Loves, S.C.; Janssen, I.; Berends, F.; Sweep, F.C.; Boer, H. de

    2014-01-01

    BACKGROUND: Obesity-related hypogonadotrophic hypogonadism (OrHH) occurs in over 40% of morbidly obese men. Obesity-related hypogonadotrophic hypogonadism may reduce the beneficial effects of bariatric surgery. OBJECTIVE: To assess the impact of OrHH on the outcome of bariatric surgery in men. PATIE

  10. Pregnancy after bariatric surgery - a review of benefits and risks

    DEFF Research Database (Denmark)

    Kjær, Mette Karie Mandrup; Nilas, Lisbeth

    2013-01-01

    Background. When other weight loss attempts have failed, bariatric surgery offers a successful alternative against obesity. Since operations are performed during women´s reproductive years, the number of pregnant women with prior bariatric surgery is increasing. Bariatric surgery results in restr......Background. When other weight loss attempts have failed, bariatric surgery offers a successful alternative against obesity. Since operations are performed during women´s reproductive years, the number of pregnant women with prior bariatric surgery is increasing. Bariatric surgery results...... in restriction of food intake and/or malabsorption leading to weight loss, but may induce a risk for malnutrition and pregnancy complications. Method. Systematically conducted review addressing pregnancy after bariatric surgery using the PubMed and Cochrane databases. Main Outcome Measures. Birthweight......, gestational age, birth defects, preeclampsia, gestational diabetes mellitus, and mode of delivery. Results. We included 17 articles in English, comparing pregnancies in women with prior bariatric surgery to pregnancies in a control group without this. There was considerable heterogeneity in study design...

  11. Influence of bariatric surgery on the use of medication

    NARCIS (Netherlands)

    Yska, Jan Peter; van der Meer, Douwe H.; Dreijer, Albert R.; Eilander, Willeke; Apers, Jan A.; Emous, Marloes; Totte, Erik R. E.; Wilffert, Bob; van Roon, Eric N.

    PURPOSE: Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. This study aimed to assess the influence of bariatric surgery on the use of medication in patients before and after

  12. Development of a Pilot Telehealth Bariatric Surgery Support Group

    Science.gov (United States)

    Schofield, Carin K.

    2013-01-01

    The prevalence of obesity in the United States continues to grow. Bariatric surgery is becoming more common and accepted in the treatment of obesity. Clinical candidates for bariatric surgery should have a BMI > 40 kg/m[superscript 2] alone, or a BMI > 35 kg/m[superscript 2] plus one comorbidity. A trend is emerging in the literature showing…

  13. Risk for hospital readmission following bariatric surgery.

    Directory of Open Access Journals (Sweden)

    Robert B Dorman

    Full Text Available BACKGROUND AND OBJECTIVES: Complications resulting in hospital readmission are important concerns for those considering bariatric surgery, yet present understanding of the risk for these events is limited to a small number of patient factors. We sought to identify demographic characteristics, concomitant morbidities, and perioperative factors associated with hospital readmission following bariatric surgery. METHODS: We report on a prospective observational study of 24,662 patients undergoing primary RYGB and 26,002 patients undergoing primary AGB at 249 and 317 Bariatric Surgery Centers of Excellence (BSCOE, respectively, in the United States from January 2007 to August 2009. Data were collected using standardized assessments of demographic factors and comorbidities, as well as longitudinal records of hospital readmissions, complications, and mortality. RESULTS: The readmission rate was 5.8% for RYGB and 1.2% for AGB patients 30 days after discharge. The greatest predictors for readmission following RYGB were prolonged length of stay (adjusted odds ratio [OR], 2.3; 95% confidence interval [CI], 2.0-2.7, open surgery (OR, 1.8; CI, 1.4-2.2, and pseudotumor cerebri (OR, 1.6; CI, 1.1-2.4. Prolonged length of stay (OR, 2.3; CI, 1.6-3.3, history of deep venous thrombosis or pulmonary embolism (OR, 2.1; CI, 1.3-3.3, asthma (OR, 1.5; CI, 1.1-2.1, and obstructive sleep apnea (OR, 1.5; CI, 1.1-1.9 were associated with the greatest increases in readmission risk for AGB. The 30-day mortality rate was 0.14% for RYGB and 0.02% for AGB. CONCLUSION: Readmission rates are low and mortality is very rare following bariatric surgery, but risk for both is significantly higher after RYGB. Predictors of readmission were disparate for the two procedures. Results do not support excluding patients with certain comorbidities since any reductions in overall readmission rates would be very small on the absolute risk scale. Future research should evaluate the efficacy of

  14. Gastropulmonary Fistula after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Maya Doumit

    2009-01-01

    Full Text Available The Roux-en-Y gastric bypass is one of the most common operations for morbid obesity. Although rare, gastropulmonary fistulas are an important complication of this procedure. There is only one recently reported case of this complication. The present report describes the serious nature of this complication in a patient after an uneventful laparoscopic gastric bypass surgery.

  15. Quality criteria in bariatric surgery: Consensus review and recommendations of the Spanish Association of Surgeons and the Spanish Society of Bariatric Surgery.

    Science.gov (United States)

    Sabench Pereferrer, Fátima; Domínguez-Adame Lanuza, Eduardo; Ibarzabal, Ainitze; Socas Macias, María; Valentí Azcárate, Víctor; García Ruiz de Gordejuela, Amador; García-Moreno Nisa, Francisca; González Fernández, Jesús; Vilallonga Puy, Ramón; Vilarrasa García, Nuria; Sánchez Santos, Raquel

    2017-01-01

    Bariatric surgery has proven to be highly effective in controlling obesity and metabolic syndrome; the results of this surgery are not only expressed in terms of weight loss, but also in terms of resolution of comorbidities, improved quality of life and complications. The different parameters used to measure these outcomes require uniformity and reference patterns. Therefore, it is essential to identify those indicators and quality criteria that are helpful in defining the «best practice» principles in bariatric surgery. In this regard, the Section of Obesity of the Spanish Association of Surgeons, in collaboration with the Spanish Society for Bariatric Surgery (SECO), present as an objective to identify the key points that define «quality» in this type of surgery. We describe the main indicators based on the published literature as well as the criteria for referral of the main comorbidities according to the evidence found and grades of recommendation.

  16. Effect of bariatric surgery on future general surgical procedures

    Directory of Open Access Journals (Sweden)

    Subhash Kini

    2011-01-01

    Full Text Available Bariatric surgery is now accepted as a safe and effective procedure for morbid obesity. The frequency of bariatric procedures is increasing with the adoption of the laparoscopic approach. The general surgeons will be facing many more of such patients presenting with common general surgical problems. Many of the general surgeons, faced with such situations, may not be aware of the changes in the gastrointestinal anatomy following bariatric procedures and management of these clinical situations will therefore present diagnostic and therapeutic challenges. We hereby present a review of management of few common general surgical problems in patients with a history of bariatric surgery.

  17. Developing criteria for pediatric/adolescent bariatric surgery programs.

    Science.gov (United States)

    Michalsky, Marc; Kramer, Robert E; Fullmer, Michelle A; Polfuss, Michele; Porter, Renee; Ward-Begnoche, Wendy; Getzoff, Elizabeth A; Dreyer, Meredith; Stolzman, Stacy; Reichard, Kirk W

    2011-09-01

    The prevalence of morbid obesity in adolescents is rising at an alarming rate. Comorbidities known to predispose to cardiovascular disease are increasingly being diagnosed in these children. Bariatric surgery has become an acceptable treatment alternative for morbidly obese adults, and criteria have been developed to establish center-of-excellence designation for adult bariatric surgery programs. Evidence suggests that bariatric surgical procedures are being performed with increasing numbers in adolescents. We have examined and compiled the current expert recommendations for guidelines and criteria that are needed to deliver safe and effective bariatric surgical care to adolescents.

  18. Liver Transplantation and Bariatric Surgery: Best Approach.

    Science.gov (United States)

    Suraweera, Duminda; Dutson, Erik; Saab, Sammy

    2017-05-01

    Obesity has become increasingly prevalent, and the number of obese patients in need of liver transplant is expected to continue to increase. In addition, liver disease due to nonalcoholic fatty liver disease is expected to become the leading cause of liver transplantation in the near future. However, obesity remains a relative contraindication in liver transplant. New strategies in managing this patient population are clearly needed. To this end, the authors review the current literature on the efficacy of bariatric surgery in the setting of liver transplantation in obese patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. A comparison of revisional and primary bariatric surgery.

    Science.gov (United States)

    Fulton, Courtney; Sheppard, Caroline; Birch, Daniel; Karmali, Shazeer; de Gara, Christopher

    2017-06-01

    Revisional surgery is an important component of addressing weight regain and complications following primary bariatric surgery. Owing to provincial need and the complexity of this patient population, a specialized multidisciplinary revision clinic was developed. We sought to characterize patients who undergo revision surgery and compare their outcomes with primary bariatric surgery clinic data. We completed a retrospective chart review of bariatric revision clinic patients compared with primary bariatric surgery patients from December 2009 to June 2014. We reviewed the charts of 2769 primary bariatric clinic patients, 886 of whom had bariatric surgery, and 534 revision bariatric clinic patients, 83 of whom had revision surgery. Fewer revision clinic patients underwent surgery than primary clinic patients (22% v. 32%). The mean preoperative body mass index (BMI) was 44.7 ± 9.5 in revision patients compared with 45.7 ± 7.6 in primary bariatric surgery patients. Most revision patients had a prior vertical banded gastroplasty (VBG; 48%) or a laparoscopic adjustable gastric band (LAGB; 24%). Bands were removed in 36% of all LAGB patients presenting to clinic. Of the 134 procedures performed in the revision clinic, 83 were bariatric weight loss surgeries, and 51 were band removals. Revision clinic patients experienced a significant decrease in BMI (from 44.7 ± 9.5 to 33.8 ± 7.5, p bariatric revision clinic manages a wide variety of complex patients distinct from those seen in a primary clinic. Operative candidates at the revision clinic are chosen based on favourable medical, anatomic and psychosocial factors, keeping in mind the resource constraints of a public health care system.

  20. Bariatric surgery and pregnancy: literature review

    Directory of Open Access Journals (Sweden)

    Pedro Ferrand Miranda

    2014-01-01

    Full Text Available Obesity has currently reached epidemic proportions, both in Chile and in the world. This condition is associated to a variety of maternal complications in all stages of the vital cycle and during pregnancy. Medical treatment has not proved successful thus resulting in an increase in bariatric surgery in recent years, even when it is not first line treatment. This literature review aims to report updated results of surgical treatment for obesity before and during pregnancy with respect to fertility, gestational diabetes, pre-eclampsia and pregnancy-induced hypertension. It also looks into the possible effects of surgery on fetal development, and its relation to premature delivery, fetal macrosomy, low birth weight and neural tube defects, as well as effects on maternal and fetal outcomes, mainly in nutrition. Lastly, we suggest some recommendations that arise from this review on the role of contraception, nutrition and time between surgery and pregnancy.

  1. Bariatric surgery in the elderly: 2009-2013.

    Science.gov (United States)

    Gebhart, Alana; Young, Monica T; Nguyen, Ninh T

    2015-01-01

    Ample evidence supports the safety and effectiveness of bariatric surgery in the general adult population but more information is needed in patients age 60 years and older (elderly). We previously examined the outcome of bariatric surgery performed in the elderly between 1999 and 2005 using the University HealthSystem Consortium (UHC) Clinical Database. The aim of this study was to analyze contemporary outcomes of bariatric surgery in the elderly and to compare them to previous data from 1999-2005. Using International Classification of Diseases, 9(th) Revision diagnosis and procedure codes, we obtained data from the UHC database for all elderly (age >60 yr) and adult nonelderly (age 19-60 yr) patients who underwent bariatric surgery for the treatment of morbid obesity between 2009 and 2013. Outcome measures, such as patient characteristics, LOS, morbidity, and observed-to-expected (risk-adjusted) mortality ratio were compared between elderly and nonelderly patients. Bariatric surgery in the elderly made up 2.7% of all bariatric operations in 1999-2005. This represents an increase to 10.1% of all bariatric operations in 2009-2013. In-hospital mortality was .30% for the nonelderly and .70% for the elderly in 1999-2005, whereas contemporary in-hospital mortality has decreased to .11% for the nonelderly and .05% for the elderly. Our results show that the number of bariatric procedures performed in the elderly is increasing and now represents 10% of all bariatric operations performed at academic centers. In-hospital mortality in bariatric surgery in the elderly has improved so much that it is now even better than in-hospital mortality in the nonelderly in 1999-2005. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    Science.gov (United States)

    ... Health Growth & Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & ... Surgery Types of Surgery Gastric Bypass ... or intestines removed due to ulcers or cancer tended to lose a lot of weight after ...

  3. Bariatric surgery: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Obesity is defined as a body mass index (BMI) of at last 30 kg/m(2).() Morbid obesity is defined as a BMI of at least 40 kg/m(2) or at least 35 kg/m(2) with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m(2) has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m(2). An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999-2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25-29.9 kg/m(2)) or obese (BMI ≥ 30 kg/m(2)). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the "normal" range may begin at slightly above 18.5 kg/m(2) and extend into the "overweight" range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight

  4. Fracture risk following bariatric surgery: a population-based study.

    Science.gov (United States)

    Nakamura, K M; Haglind, E G C; Clowes, J A; Achenbach, S J; Atkinson, E J; Melton, L J; Kennel, K A

    2014-01-01

    The effects of bariatric surgery on skeletal health are poorly understood. We found that bariatric surgery patients are more prone to fracture when compared to the general population. While further studies of fracture risk in this population are needed, bone health should be discussed in bariatric surgery clinics. Bariatric surgery is an increasingly common treatment for medically complicated obesity. Adverse skeletal changes after bariatric surgery have been reported, but their clinical importance remains unknown. We hypothesized that bariatric surgery patients are at increased risk of fracture. We conducted a historical cohort study of fracture incidence among 258 Olmsted County, Minnesota, residents who underwent a first bariatric surgery in 1985-2004. Relative fracture risk was expressed as standardized incidence ratios (SIRs), while potential risk factors were evaluated by hazard ratios (HR) obtained from a time-to-fracture regression model. The mean (±SD) body mass index at bariatric surgery was 49.0 ± 8.4 kg/m(2), with an average age of 44 ± 10 years and 82% (212) females. Gastric bypass surgery was performed in 94% of cases. Median follow-up was 7.7 years (range, 6 days to 25 years), during which 79 subjects experienced 132 fractures. Relative risk for any fracture was increased 2.3-fold (95% confidence interval (CI), 1.8-2.8) and was elevated for a first fracture at the hip, spine, wrist, or humerus (SIR, 1.9; 95% CI, 1.1-2.9), as well as for a first fracture at any other site (SIR, 2.5; 95% CI, 2.0-3.2). Better preoperative activity status was associated with a lower age-adjusted risk (HR, 0.4; 95% CI, 0.2-0.8) while prior fracture history was not associated with postoperative fracture risk. Bariatric surgery, which is accompanied by substantial biochemical, hormonal, and mechanical changes, is associated with an increased risk of fracture.

  5. Bariatric surgery: an IDF statement for obese Type 2 diabetes

    Science.gov (United States)

    Dixon, J B; Zimmet, P; Alberti, K G; Rubino, F

    2011-01-01

    The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m2 or more. PMID:21480973

  6. Bariatric surgery: A review of normal postoperative anatomy and complications

    Energy Technology Data Exchange (ETDEWEB)

    Quigley, S., E-mail: shaun.quigley@bartsandthelondon.nhs.uk [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Colledge, J. [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Mukherjee, S. [Bariatric Surgery Unit, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Patel, K. [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom)

    2011-10-15

    The number of bariatric surgery procedures performed is increasing every year. Patients may be referred for radiological investigations to exclude complications not only in the early postoperative period but many months later. Radiologists who do not work in bariatric centres are therefore required to have an understanding of the complex normal anatomy and complications associated with bariatric surgery to interpret imaging studies correctly. The purpose of this article is to describe the surgical techniques and normal anatomy of the four bariatric operations performed today, review the most common problems encountered in this patient group, and to describe the imaging findings that allow the accurate diagnosis of complications. In particular, we focus on identification of the internal hernia, a grave complication of bariatric surgery often missed by radiologists.

  7. The impact of bariatric surgery on esophageal function.

    Science.gov (United States)

    Tolone, Salvatore; Savarino, Edoardo; Yates, Robert B

    2016-10-01

    Obesity is a worldwide epidemic. There is increasing evidence that obesity is associated with benign gastroesophageal disease, including gastroesophageal reflux disease (GERD) and esophageal dysmotility. Bariatric surgery-including sleeve gastrectomy, gastric bypass, and adjustable gastric band placement-can effectively result in weight loss and control of obesity-related conditions, including GERD. However, there is increasing evidence that bariatric surgery itself can have a deleterious effect on esophageal function. In this review, we address the effect of obesity and bariatric surgery on esophageal dysfunction. © 2016 New York Academy of Sciences.

  8. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Bartlett MA

    2015-08-01

    Full Text Available Matthew A Bartlett, Karen F Mauck, Paul R Daniels Division of General Internal Medicine, Mayo Clinic Thrombophilia Center, Department of Medicine, Mayo Clinic, Rochester, MN, USA Abstract: Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. Keywords: bariatric surgery, venous thromboembolism, prophylaxis, vena cava filter, heparin

  9. Risk of completed suicide after bariatric surgery: a systematic review.

    Science.gov (United States)

    Peterhänsel, C; Petroff, D; Klinitzke, G; Kersting, A; Wagner, B

    2013-05-01

    Bariatric surgery is one of the most effective treatments for morbid obesity, and a large body of research indicates significant long-term weight loss. While overall mortality decreases in patients who received bariatric surgery, a number of studies have shown that suicide rates are higher in bariatric patients than in control groups. The objective of this study was to present a systematic review of suicide mortality after bariatric surgery and calculate an estimate for the suicide rate. Literature researches of the databases PubMed, Web of Knowledge, PsychInfo, ScienceDirect and Google Scholar were conducted. Thirty studies concerning bariatric surgery and completed suicides met the inclusion criteria. We included 28 studies in the estimation of a suicide rate for the bariatric population. Only one study (Tindle et al.) put a main focus on suicide after bariatric surgery; this was therefore chosen as an adequate reference figure for comparison. The other 27 chosen studies were compared with World Health Organization data and the suicide rate reported by Tindle et al. Twenty-three thousand eight hundred eighty-five people were included in the analysis. In the literature, we found a total of 95 suicides when examining 190,000 person-years of post-bariatric surgery data. Little information was provided describing the reasons for suicide and the time-point of these events after surgery. We estimated a suicide rate of 4.1/10,000 person-years (95% confidence interval [3.2, 5.1]/10,000 person-years). A comparison with Tindle et al. demonstrates that their rate is significantly higher than our estimate (P = 0.03). Bariatric surgery patients show higher suicide rates than the general population. Therefore, there is a great need to identify persons at risk and post-operative psychological monitoring is recommended.

  10. The Inequity of Bariatric Surgery: Publicly Insured Patients Undergo Lower Rates of Bariatric Surgery with Worse Outcomes.

    Science.gov (United States)

    Hennings, Dietric L; Baimas-George, Maria; Al-Quarayshi, Zaid; Moore, Rachel; Kandil, Emad; DuCoin, Christopher G

    2017-06-30

    Bariatric surgery has been shown to be the most effective method of achieving weight loss and alleviating obesity-related comorbidities. Yet, it is not being used equitably. This study seeks to identify if there is a disparity in payer status of patients undergoing bariatric surgery and what factors are associated with this disparity. We performed a case-control analysis of National Inpatient Sample. We identified adults with body mass index (BMI) greater than or equal to 25 kg/m(2) who underwent bariatric surgery and matched them with overweight inpatient adult controls not undergoing surgery. The sample was analyzed using multivariate logistic regression. We identified 132,342 cases, in which the majority had private insurance (72.8%). Bariatric patients were significantly more likely to be privately insured than any other payer status; Medicare- and Medicaid-covered patients accounted for a low percentage of cases (Medicare 5.1%, OR 0.33, 95% CI 0.29-0.37, p bariatric surgery had an increased risk of complications compared to privately insured patients. Publicly insured patients are significantly less likely to undergo bariatric surgery. As a group, these patients experience higher rates of obesity and related complications and thus are most in need of bariatric surgery.

  11. Gender effect on vascular inflammation following bariatric surgery.

    Science.gov (United States)

    Blum, Arnon; Tamir, Snait; Hazzan, David; Podvitzky, Oxana; Sirchan, Rizak; Keinan-Boker, Lital; Ben-Shushan, Rotem Shelly; Blum, Nava; Suliman, Laylee Shaich; Geron, Nissim

    2012-01-01

    Studies have shown that mortality was reduced by 31.6% in patients that underwent bariatric surgery compared with the non-operative control group. However, in most surgical series the majority of patients were women, and men had higher post-operative mortality rates and a higher postoperative morbidity, regardless of weight. Our primary end point was to study gender effects on vascular inflammation following bariatric surgery for weight loss. Methods. A prospective study evaluated vascular inflammation in obese patients before and three months after bariatric surgery. Markers of vascular inflammation were measured - before surgery and three months afterwards. Results. One hundred and two patients (73 women and 29 men, 40.5 ± 12.3 years old) underwent bariatric surgery. Correlation was found between BMI change and waist circumference change (r = 0.658, P women; P = 0.05) and hypertension (men > women; P = 0.06). In women, following bariatric surgery, BMI was decreased (pbariatric surgery, BMI was decreased (p = 0.001) (a decrease of 8.1), waist circumference was reduced (pbariatric surgery on vascular inflammation. Bariatric surgery had no significant effect on biochemical inflammatory markers in male patients, while females undergoing the same kind of bariatric surgery for weight loss showed a significant decrease in these markers of inflammation. These results may explain the epidemiological data that described higher morbidity and mortality among obese men undergoing bariatric operation for weight loss. This is the first study that has demonstrated a gender difference in the inflammatory responses that may affect clinical outcome, and cardiovascular morbidity and mortality.

  12. Impact of minimally invasive/bariatric surgery fellowship on perioperative complications and outcomes in the first year of practice

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2013-01-01

    Full Text Available Background: Several reports have described worse perioperative outcomes of laparoscopic gastric bypass procedure during learning curve, which improved after completion of one-year fellowship training. Aims: The aim of this study was to evaluate the immediate impact of fellowship training on perioperative complications and outcomes of various bariatric procedures. Materials and Methods: One hundred initial patients who underwent laparoscopic gastric banding, laparoscopic Roux-en-Y gastric bypass, laparoscopic vertical sleeve gastrectomy, and robotically-assisted laparoscopic biliopancreatic diversion with duodenal switch by a single fellowship trained surgeon were analyzed. Results: Overall average Body Mass Index (BMI of the patients was 45.9 kg/m 2 , age was 47.5 years, and the American Society of Anesthesiologist Score was 2.89. There were no intraoperative, major 30-day complications, or open conversions. Average operative time was 62 minutes in gastric banding, 160 minutes in gastric bypass, 119 minutes in vertical sleeve gastrectomy, and 320 minutes in biliopancreatic diversion. Length of stay ranged from 0.5 day after gastric banding to 3.9 days after biliopancreatic diversion. The perioperative complications and outcomes are comparable with those reported by experienced surgeons. No mortality occurred in this series. Conclusions: Bariatric fellowship ensured skills acquisition for new surgeons to safely and effectively perform various types of bariatric operations, with minimal perioperative complications and excellent outcomes.

  13. Bariatric surgery, gut morphology and enteroendocrine cells

    DEFF Research Database (Denmark)

    Hansen, Carl Frederik

    Considering that obesity and diabetes are some of the most important health problems in the world today, a lot studies have investigated the powerful effects of bariatric surgery on weight loss and diabetes remission during the past decade. An increased release of gut hormones is believed...... 40 hormones. In this PhD study, gut morphology and the population of endocrine cells have been examined in three rodent animal models using stereological techniques. First, in a rodent model of type-2 diabetes (T2DM), the Zucker diabetic fatty rat (ZDF), the population of endocrine L......-cells and the gut morphology were quantified. The number of Lcells was 4.8 million in the normal rat and the L-cells were found to double in number in the diabetic ZDF rat model. Second, the L-cell population, gut morphology and endocrine cell gene expression were examined in a rodent model of Roux-en-Y gastric...

  14. [Bariatric surgery. Would you undergo surgery again?].

    Science.gov (United States)

    Albaina Landaluce, E; Díez Andrés, A; Navaridas Berganzo, A; Ruiz de Arcaute, I I

    2001-04-01

    The authors analyze the negative repercussions of morbid obesity; then they explain what baryatric surgery, a surgical technique employed with a high degree of success, consists of. They study the results, in terms of satisfaction, obtained from patients operated on in the Txagorritxu Hospital in Vitoria. The project on which this article is based was presented as a Main Project in a Course on Health Research Methodology, extension class section, "IDER", at the University of Alcalá and the University of Antioquia.

  15. Pediatric bariatric surgery: the clinical pathway.

    Science.gov (United States)

    Alqahtani, Aayed R; Elahmedi, Mohamed O

    2015-05-01

    Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution. Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only. Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients. Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.

  16. [Bariatric surgery in extremely obese children and adolescents].

    Science.gov (United States)

    Blüher, S; Till, H; Kiess, W

    2011-05-01

    The management of childhood obesity is a clinical dilemma. Validated and evidence-based intervention programs are still missing for this age group, and pediatricians increasingly see children with morbid obesity and with obesity-related comorbidities. For those extremely obese patients who failed to respond to the classical therapeutic approaches, bariatric surgery is a therapeutic option. Although available data for bariatric surgery in childhood and adolescence is limited to date, significant postoperative reduction in BMI and an evident improvement of preoperatively existing metabolic and cardiovascular comorbidities and psychosocial well-being have been reported. The indication for bariatric surgery in adolescents follows strict criteria and should be proposed within an interdisciplinary team in specialized centers, including a clinical ethics committee. This review discusses the present guidelines for bariatric surgery in childhood and adolescence as well as available follow-up data for both adults and pediatric patients.

  17. Monitoring of Diabetic Retinopathy in relation to Bariatric Surgery

    DEFF Research Database (Denmark)

    Brynskov, Troels; Laugesen, Caroline Schmidt; Svenningsen, Annette Lykke

    2016-01-01

    BACKGROUND: To investigate the need for closer perioperative monitoring of diabetic retinopathy in patients with type 2 diabetes undergoing bariatric surgery. METHODS: Prospective observational clinical study of 56 patients with type 2 diabetes undergoing bariatric surgery. The patients were...... examined with 7-field fundus images and optical coherence tomography scans 2 weeks before and 1, 3, 6 and 12 months after bariatric surgery. Worsening was defined as a two-step change in the Wisconsin Epidemiologic Study of Diabetic Retinopathy scale or appearance or worsening of macular edema...... preoperatively where HbA1c was 6.4 ± 1.9 %. CONCLUSIONS: Diabetic retinopathy was clinically stable after bariatric surgery, and none of the observed changes would have resulted in a changed screening interval at our center. This supports adherence to regular diabetic retinopathy screening guidelines following...

  18. Influence of obesity and bariatric surgery on gastric cancer

    National Research Council Canada - National Science Library

    Anna Carolina Batista Dantas Marco Aurelio Santo Roberto de Cleva Rubens Antbnio Aissar Sallum Ivan Cecconello

    2016-01-01

    Esophageal and gastric cancer (GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population...

  19. [Beginnings of bariatric and metabolic surgery in Spain].

    Science.gov (United States)

    Baltasar, Aniceto; Domínguez-Adame, Eduardo

    2013-01-01

    When bariatric and metabolic surgery initially began in Spain, it was a subject of debate, due to not knowing exactly who were the first surgeons to perform it. A study has revealed the authors of the first interventions.

  20. Metabolic Bone Disease in the Bariatric Surgery Patient

    Directory of Open Access Journals (Sweden)

    Susan E. Williams

    2011-01-01

    Full Text Available Bariatric surgery has proven to be a life-saving measure for some, but for others it has precipitated a plethora of metabolic complications ranging from mild to life-threatening, sometimes to the point of requiring surgical revision. Obesity was previously thought to be bone protective, but this is indeed not the case. Morbidly obese individuals are at risk for metabolic bone disease (MBD due to chronic vitamin D deficiency, inadequate calcium intake, sedentary lifestyle, chronic dieting, underlying chronic diseases, and the use of certain medications used to treat those diseases. After bariatric surgery, the risk for bone-related problems is even greater, owing to severely restricted intake, malabsorption, poor compliance with prescribed supplements, and dramatic weight loss. Patients presenting for bariatric surgery should be evaluated for MBD and receive appropriate presurgical interventions. Furthermore, every patient who has undergone bariatric surgery should receive meticulous lifetime monitoring, as the risk for developing MBD remains ever present.

  1. Bariatric Surgery in Type 1 Diabetes Mellitus: A Systematic Review.

    Science.gov (United States)

    Mahawar, Kamal K; De Alwis, Nimantha; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Small, Peter K

    2016-01-01

    Bariatric surgery is recognised as an effective treatment strategy for obese patients with type 2 diabetes mellitus. An increasing number of patients with type 1 diabetes mellitus also suffer with obesity and obesity-associated comorbidities but the role of bariatric and metabolic surgery in this group of patients is unclear. This systematic review investigates published English language scientific literature to understand the results of bariatric surgery in obese patients with type 1 diabetes mellitus. We found that these patients can experience significant weight loss and comorbidity resolution with bariatric surgery. Though most patients also see a decline in total insulin requirement, glycaemic control remains difficult. Most of the patients reported in literature have undergone gastric bypass but data is insufficient to recommend any particular procedure.

  2. Examination of bariatric surgery Facebook support groups: a content analysis.

    Science.gov (United States)

    Koball, Afton M; Jester, Dylan J; Domoff, Sarah E; Kallies, Kara J; Grothe, Karen B; Kothari, Shanu N

    2017-08-01

    Support following bariatric surgery is vital to ensure long-term postoperative success. Many individuals undergoing bariatric surgery are turning to online modalities, especially the popular social media platform Facebook, to access support groups and pages. Despite evidence suggesting that the majority of patients considering bariatric surgery are utilizing online groups, little is known about the actual content of these groups. The purpose of the present study was to conduct a content analysis of bariatric surgery support groups and pages on Facebook. Online via Facebook, independent academic medical center, United States. Data from bariatric surgery-related Facebook support groups and pages were extracted over a 1-month period in 2016. Salient content themes (e.g., progress posts, depression content, eating behaviors) were coded reliably (all κ> .70). More than 6,800 posts and replies were coded. Results indicated that seeking recommendations (11%), providing information or recommendations (53%), commenting on changes since surgery (19%), and lending support to other members (32%) were the most common types of posts. Content surrounding anxiety, eating behaviors, depression, body image, weight bias, and alcohol was found less frequently. Online bariatric surgery groups can be used to receive support, celebrate physical and emotional accomplishments, provide anecdotal accounts of the "bariatric lifestyle" for preoperative patients, and comment on challenges with mental health and experiences of weight bias. Providers should become acquainted with the content commonly found in online groups and exercise caution in recommending these platforms to information-seeking patients. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  3. Bariatric surgery: cost-effectiveness and budget impact.

    Science.gov (United States)

    Terranova, Lorenzo; Busetto, Luca; Vestri, Annarita; Zappa, Marco Antonio

    2012-04-01

    Bariatric surgery is to date the most effective treatment for morbid obesity and it has been proven to reduce obesity-related comorbidities and total mortality. As any medical treatment, bariatric surgery is costly and doubts about its affordability have been raised. On the other hand, bariatric surgery may reduce the direct and indirect costs of obesity and related comorbidities. The appreciation of the final balance between financial investments and savings is critical from a health economic perspective. In this paper, we try to provide a brief updated review of the most recent studies on the cost-efficacy of bariatric surgery, with particular emphasis on budget analysis. A brief overview of the economic costs of obesity will also be provided. The epidemic of obesity may cause a significant reduction in life expectancy and overwhelming direct and indirect costs for citizens and societies. Cost-efficacy analyses included in this review consistently demonstrated that the additional years of lives gained through bariatric surgery may be obtained at a reasonable and affordable cost. In groups of patients with very high obesity-related health costs, like patients with type 2 diabetes, the use of bariatric surgery required an initial economic investment, but may save money in a relatively short period of time.

  4. Mandatory weight loss during the wait for bariatric surgery.

    Science.gov (United States)

    Glenn, Nicole M; Raine, Kim D; Spence, John C

    2015-01-01

    Mandatory presurgical, behavior-induced weight loss, although not standard, is a relatively common practice among bariatric surgical clinics. We explore the patient's experience of this practice using phenomenology. We gathered experiential accounts from 7 individuals waiting to have the procedure at a large publically funded clinic in western Canada. In writing this article, we focused on four phenomenological themes: "just nod your head and carry on"-silencing through the ideal; waiting and weighing-promoting weight consciousness to the weight conscious; paying for surgical approval through weight loss; and presurgical weight loss and questioning the need for weight loss surgery altogether. We contrast the experiential findings with the clinical literature to question the impact and possible (unintended or unexpected) effects the practice might have, particularly on patients' lives. We situate this article within a larger discussion about the possible contribution of experiential knowledge to clinical guidelines, practices, and pedagogies. © The Author(s) 2014.

  5. Configuring bariatric bodies: exploring obesity surgery beyond the hospital

    Directory of Open Access Journals (Sweden)

    Jordi Sanz

    2006-11-01

    Full Text Available Bariatric surgery (surgery for obesity is, in many cases, the last resort for the clinically overweight. Drawing on ethnographic materials in a unit of morbid obesity, this article explores how "bariatric bodies" are configured so that bariatric surgery is a sustainable solution beyond the operation theatre. However, what medicine calls ?side-effects?, are, in terms of body configuration, a new set of semiotic-material relationships which start, but do not end, in the operating theatre. The bariatric digestive system might not necessarily fit with the set of relations with which it has to deal on leaving the hospital: the person will have to cope with eating very little, and with being able to ingest only a very limited amount of nutrients.

  6. Prevention of venous thromboembolism in patients undergoing bariatric surgery.

    Science.gov (United States)

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented.

  7. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Science.gov (United States)

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. PMID:26316771

  8. Depo-Provera (depot medroxyprogesterone acetate use after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Lam C

    2016-09-01

    Full Text Available Clarissa Lam,1 Amitasrigowri S Murthy2,3 1New York University School of Medicine, 2Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York University School of Medicine, 3New York University Langone Medical Center, New York, NY, USA Abstract: In the US, obesity rates are increasing greatly. The Centers for Disease Control and Prevention estimates that 68.5% of Americans, including 63.9% of adult women older than 20 years, are overweight (body mass index between 25 kg/m2 and 29.9 kg/m2 or obese (body mass index >30 kg/m2. In light of this, it is not surprising that the rates of bariatric surgery have also been increasing. When considering the metabolic changes associated with both bariatric surgery and contraceptive use, in combination with the unique medical considerations of obese women, it is indisputable that clear guidelines are needed when counseling obese patients of reproductive age after bariatric surgery. In this literature review, we focus on depot medroxyprogesterone acetate (DMPA and the implications of its use in obese women, preweight and postweight loss following bariatric surgery. Both DMPA use and bariatric surgery are known to cause bone loss, but it is still unclear whether there is an additive effect of the two factors on bone loss and whether either of these factors directly leads to an increased risk of bone fracture. The current consensus guidelines do not impose a restriction on the use of DMPA after bariatric surgery. DMPA use is associated with weight gain, and it is unclear whether weight loss blunting occurs with the use of DMPA after bariatric surgery. Prior studies had demonstrated an association with weight gain in adolescents, and therefore, those prescribing DMPA use after bariatric surgery in adolescents should proceed with caution. Adult women do not have a similar response to the use of DMPA. DMPA use has rarely been associated with increased risk of venous thromboembolism (VTE. The

  9. Attitudes towards bariatric surgery in the general public.

    Science.gov (United States)

    Sikorski, Claudia; Luppa, Melanie; Dame, Katrin; Brähler, Elmar; Schütz, Tatjana; Shang, Edward; König, Hans-Helmut; Riedel-Heller, Steffi G

    2013-03-01

    Prevalence rates of obesity are still rising. Weight loss surgery (WLS) is the most invasive but also most effective treatment option when behavioral modification has failed. Research indicates that health care professionals hold ambivalent views on bariatric surgery, while views of the general public have not yet been investigated. In a German representative sample of n = 3,003 respondents in a computer-assisted telephone interview, n = 1,008 persons were interviewed on their views of the effectiveness of bariatric surgery and other interventions for obesity. Also, willingness to recommend a treatment was assessed. Lifestyle-based interventions were viewed as most effective in terms of weight loss. About 50 % of the population stated that WLS is "very effective" while still a quarter of respondents did not ascribe effectiveness to WLS. Higher age was associated with lower expectations of effectiveness while higher stigmatizing attitudes and genetic attributes for obesity were associated with higher expectations of effectiveness. Seventy-two percent would not recommend WLS or undergo it, if applicable, themselves. Higher educated respondents and those that viewed WLS as effective were more likely to recommend WLS. The German general public seems to be rather cautious regarding bariatric surgery. It may be assumed that false beliefs on the effectiveness and risk patterns of bariatric surgery are still very common, despite rising surgery numbers. Our results further emphasize the need for providing evidence-based information on bariatric surgery to the general public.

  10. Cause of death in patients awaiting bariatric surgery.

    Science.gov (United States)

    Lakoff, Joshua M; Ellsmere, James; Ransom, Tom

    2015-02-01

    Obesity is associated with increased mortality. Bariatric surgery is becoming an important treatment modality for obesity, with an associated reduction in mortality. There are few data available on the incidence and cause of death in referred patients while they are waiting for bariatric surgery. We retrospectively examined all cases of death in patients who were referred for bariatric surgery assessment but who had not yet undergone bariatric surgery at a tertiary care centre in Halifax, Nova Scotia. The wait list comprised patients referred for surgery between March 2008 and May 2013. All cases of death were reviewed to determine age, sex, time of referral, time spent on the wait list, cause of death, comorbidities and body mass index (BMI). Of the 1399 patients referred, 22 (1.57%) died before receiving surgery. The mean age of these patients was 62.7 (range of 32-70) years. The average time from referral to death was 21.6 months, and the average BMI was 51.5. The most frequent cause of death was cancer, followed by cardiac and infectious causes. This study provides useful information about mortality and causes of death among patients awaiting bariatric surgery at our centre. Our results will help guide the development of a judicious system for triage in light of long wait times.

  11. Bariatric surgery, bone loss, obesity and possible mechanisms.

    Science.gov (United States)

    Brzozowska, M M; Sainsbury, A; Eisman, J A; Baldock, P A; Center, J R

    2013-01-01

    Bariatric surgery remains the most effective treatment for severely obese patients. However, the potential long-term effects of bariatric surgical procedures on health, including bone health, are only partially understood. The goal of this review was to present data on the impact of bariatric surgery on bone metabolism and to analyse possible reasons for the loss of bone mass that frequently occurs after bariatric surgery. Such factors include nutritional deficiencies, rapid weight loss per se, effects of fat-derived adipokines and gut-derived appetite-regulatory hormones. However, the relative roles of these factors in skeletal regulation and the mechanisms by which they work are not yet fully defined. Our review was focussed on the complex relationship between body weight, fat mass and bone mass, as well as peripheral and central mediators potentially involved in the dual regulation of both energy and bone homeostasis. We also review the data on the inverse relationship between central obesity, bone marrow fat and osteoporosis. As the number of bariatric operations increases, it is imperative to recognize mechanisms responsible for bariatric surgery-induced bone loss, with careful monitoring of bone health including long-term fracture incidence in patients undergoing these procedures. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.

  12. Enhanced recovery after bariatric surgery – a modern approach

    Directory of Open Access Journals (Sweden)

    Bekkhan Bayalovich Khatsiev

    2014-06-01

    Full Text Available Guidelines for enhanced recovery after surgery (ERAS are widely used and their efficiency was clearly demonstrated by numerous studies. Number of publications on this topic in bariatric surgery is significantly lower compared with other fields of surgery. However, the data accumulated allow to compose recommendations based on studies with high level of evidence. Authors review existing methods of enhanced recovery in their implementation into bariatric surgery. Enhanced recovery methods can be used to optimize all stages of perioperative care and include data on preoperative preparation, maintenance of electrolyte balance, prevention of postoperative nausea and vomiting, sufficient analgesia and safe discharge form hospital. Suggested guidelines for bariatric surgery are implied to be used by a multidisciplinary team.

  13. Bariatric Surgery and Urinary Stone Disease

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    Cevahir Ozer

    2016-07-01

    Full Text Available Obesity is a major public health problem and has been suggested to play a role in the etiology of urinary tract stone disease. Furthermore, the increasingly widespread use of surgery in the treatment of obesity also is related with urinary stone disease. In daily practice, patients to whom obesity surgery has been planned or who have undergone obesity surgery are seen more frequently. This review aims to highlight the urological evaluation and management of this patient group.

  14. A psychiatric perspective view of bariatric surgery patients

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    Isabel Brandão

    2015-10-01

    Full Text Available Abstract Background Bariatric surgery is the only procedure that has significant results in weight loss and improvements in medical comorbidities in morbid obese patients. Severely obese patients are also associated with a higher prevalence of psychiatric disorders and poor quality of life. Objective To evaluate specific areas of psychopathology in individuals undergoing bariatric surgery. Methods A review of the literature was conducted from January 2002 to March 2014 by researching PubMed database using the following query: “morbid AND obesity AND bariatric AND surgery AND (psychiatry OR psychology”. Results Overall improvements in eating behaviors, mood disorders and body image are reported after bariatric surgery, and the mechanism is not enlightened. Risk of suicide and consumption of substances of abuse, especially alcohol, after gastric bypass surgery are problems that clinicians must be aware. Discussion Bariatric patients should be monitored after surgery to identify who did not show the expected benefits postoperatively and the ones who develop psychiatric symptoms after an initial positive response.

  15. Techniques, assessment, and effectiveness of bariatric surgery in combating obesity

    Directory of Open Access Journals (Sweden)

    Dimitrios K Papamargaritis

    2010-10-01

    Full Text Available Dimitrios K Papamargaritis, Dimitrios J Pournaras, Carel W Le RouxImperial Weight Centre, Imperial College London, London, UKAbstract: Obesity is an epidemic disease, and its prevalence is predicted to rise in the future. Many health and social comorbidities, such as cardiovascular disease, type 2 diabetes mellitus, cancer, nonalcoholic fatty liver disease, arthritis, infertility, eating disorders, unemployment, and low quality of life, have been associated with obesity. Nowadays, bariatric surgery is the only effective treatment for severe obesity. An increasing body of literature demonstrates significant remission of obesity-related comorbidities and an increase in life expectancy after surgical treatment. Unfortunately, serious complications can appear after surgery, and the careful preoperative assessment of patients is necessary to estimate the indications and contraindications of bariatric surgery. Recent studies report the lower complication and mortality rates when bariatric procedures are performed in high-volume centers. The purpose of this review is to describe the techniques of the currently used surgical procedures and the clinical effectiveness of bariatric surgery. Additionally, the possible complications and mortality rates after bariatric surgery are discussed.Keywords: obesity, surgery, assessment, clinical effectiveness, complications

  16. Male fertility, obesity, and bariatric surgery.

    Science.gov (United States)

    Reis, Leonardo Oliveira; Dias, Fernando Goulart Fernandes

    2012-08-01

    Obesity has become a new worldwide health problem with significant impact not only on cardiovascular diseases but also on many other related disorders, highlighting infertility. Obesity may adversely affect male reproduction by endocrinologic, thermal, genetic, and sexual mechanisms. There is good evidence that obesity can be associated with reduced sperm concentrations, but studies about sperm motility, morphology, and DNA fragmentation have been less numerous and more conflicting. Although weight loss is the cornerstone of the treatment of obesity-related infertility, with promising results in restoring fertility and normal hormonal profiles, bariatric surgery impact on male fertility is still unclear and until now there is not enough data to support the informed consent in this scenario. Physicians are encouraged to highlight possible positive and/or negative impacts concerning male capacity of fertilization when informing patients. A balanced judgment and a personalized case-by-case management with patient involvement in decisions are fundamental in this setting and indication of cryopreservation of semen samples should be considered in selected circumstances. Well-structured trials controlled for confounders including female factors and based on solid outcomes (ie, birth rates) must urgently come up to clarify this emerging scenario.

  17. Bariatric surgery, gut morphology and enteroendocrine cells

    DEFF Research Database (Denmark)

    Hansen, Carl Frederik

    Considering that obesity and diabetes are some of the most important health problems in the world today, a lot studies have investigated the powerful effects of bariatric surgery on weight loss and diabetes remission during the past decade. An increased release of gut hormones is believed to cont...... 40 hormones. In this PhD study, gut morphology and the population of endocrine cells have been examined in three rodent animal models using stereological techniques. First, in a rodent model of type-2 diabetes (T2DM), the Zucker diabetic fatty rat (ZDF), the population of endocrine L......-cells and the gut morphology were quantified. The number of Lcells was 4.8 million in the normal rat and the L-cells were found to double in number in the diabetic ZDF rat model. Second, the L-cell population, gut morphology and endocrine cell gene expression were examined in a rodent model of Roux-en-Y gastric...... bypass (RYGB). In all regions of the gastrointestinal tract the mucosa showed extensive proliferation. The number of L-cells was increased to more than double and the L-cells in the common channel showed increased expression of mRNA coding for L-cell hormones, suggesting increased activity of these cells...

  18. Mandatory Risk Assessment Reduces Venous Thromboembolism in Bariatric Surgery Patients.

    Science.gov (United States)

    Nimeri, Abdelrahman A; Bautista, Jejomar; Ibrahim, Maha; Philip, Ruby; Al Shaban, Talat; Maasher, Ahmed; Altinoz, Ajda

    2017-08-23

    Bariatric surgery patients are at high risk for venous thromboembolism (VTE), and chemoprophylaxis is recommended. Sheikh Khalifa Medical City (SKMC) is an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) member since 2009. We report the rates of VTE in bariatric surgery patients from 2010 to 2016 compared to ACS NSQIP bariatric surgery programs before and after switching from heparin to low molecular weight heparin (LMWH), initiating mandatory risk assessment using Caprini scoring for VTE and adopting an aggressive strategy for high-risk patients regarding dosage of LMWH and chemoprophylaxis after discharge. During the study period, there were 1152 cases (laparoscopic Roux-en-Y gastric bypass (LRYGB) 625 and laparoscopic sleeve gastrectomy (LSG) 527) at Bariatric & Metabolic Institute (BMI) Abu Dhabi compared to 65,693 cases (LRYGB 32,130 and LSG 33,563) at ACS NSQIP bariatric surgery programs. VTE rates remained stable at ACS NSQIP bariatric surgery programs from 2010 to 2016 (0.45, 0.45, 0.45, 0.25, 0.35, 0.3, and 0.3%). In contrast, VTE rates at BMI Abu Dhabi decreased from 2.2% in 2011 to 0.35% after we adopted an aggressive strategy to VTE without an increase in bleeding complications. LRYGB patients with VTE had higher OR time, leak, collection, and mortality at ACS NSQIP hospitals compared to those at BMI Abu Dhabi. In contrast, rates were similar in LSG patients with VTE. Changing our approach to VTE management led our VTE rates to decrease and become like those of ACS NSQIP bariatric surgery patients in LSG and LRYGB.

  19. Review of contemporary role of robotics in bariatric surgery.

    Science.gov (United States)

    Bindal, Vivek; Bhatia, Parveen; Dudeja, Usha; Kalhan, Sudhir; Khetan, Mukund; John, Suviraj; Wadhera, Sushant

    2015-01-01

    With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP) is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery.

  20. Review of contemporary role of robotics in bariatric surgery

    Directory of Open Access Journals (Sweden)

    Vivek Bindal

    2015-01-01

    Full Text Available With the rise in a number of bariatric procedures, surgeons are facing more complex and technically demanding surgical situations. Robotic digital platforms potentially provide a solution to better address these challenges. This review examines the published literature on the outcomes and complications of bariatric surgery using a robotic platform. Use of robotics to perform adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass (RYGB, biliopancreatic diversion with duodenal switch and revisional bariatric procedures (RBP is assessed. A search on PubMed was performed for the most relevant articles in robotic bariatric surgery. A total of 23 articles was selected and reviewed in this article. The review showed that the use of robotics led to similar or lower complication rate in bariatric surgery when compared with laparoscopy. Two studies found a significantly lower leak rate for robotic gastric bypass when compared to laparoscopic method. The learning curve for RYGB seems to be shorter for robotic technique. Three studies revealed a significantly shorter operative time, while four studies found a longer operative time for robotic technique of gastric bypass. As for the outcomes of RBP, one study found a lower complication rate in robotic arm versus laparoscopic and open arms. Most authors stated that the use of robotics provides superior visualisation, more degrees of freedom and better ergonomics. The application of robotics in bariatric surgery seems to be a safe and feasible option. Use of robotics may provide specific advantages in some situations, and overcome limitations of laparoscopic surgery. Large and well-designed randomised clinical trials with long follow-up are needed to further define the role of digital platforms in bariatric surgery.

  1. Elective surgery to save my life: rethinking the "choice" in bariatric surgery.

    Science.gov (United States)

    Trainer, Sarah; Benjamin, Tonya

    2017-04-01

    The aim of this study was to explicate the processes by which a patient's choice to undergo bariatric surgery is made to feel like a medical necessity, to explore the ways widespread societal stigmatization of weight and bariatric surgery shapes patient and provider discourse about surgery and to discuss patient rationalizations of the choice to have surgery. Severe obesity is currently highly stigmatized. Bariatric surgery has become an increasingly used option for individuals seeking to lose drastic amounts of weight. The surgery itself, however, remains stigmatized across many diverse settings. This research design is centred on an ethnographic study of bariatric surgery patients who undergo surgery at a particular bariatric clinic in the American Southwest. Data collection included repeated ethnographic interviews with 35 individuals enrolled in the bariatric programme over the past 5 years. The interviews were supplemented by extensive participant observation, starting in 2014 to date. Thematic analysis of fieldnotes and transcribed interviews followed. People who have bariatric surgery for weight-loss may trade one type of stigma for another. Thus, individuals who qualify for bariatric surgery based on weight alone may be reluctant to explore the surgery as a viable option. This research also shows that younger women are more likely to face the effects of weight-related stigma, which has an impact on their motivations for undergoing bariatric surgery. Stigma - both weight-related and surgery-related - needs to be addressed at a larger level, in terms of policy and in clinical bariatric programmes. © 2016 John Wiley & Sons Ltd.

  2. Influence of Bariatric Surgery on Remission of Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Paweł Nalepa

    2011-12-01

    Full Text Available The plague of obesity afflicts an increasing group of people. Moreover type 2 diabetes, which is the most serious illness accompanying excessive weight, is becoming more and more common. Traditional methods of obesity treatment, such as diet and physical exercise, fail. This applies especially to people with class III obesity. The only successful way of treating obesity in their case is bariatric surgery. There are three types of bariatric surgery: restrictive procedures (reducing stomach volume, malabsorptive procedures, and mixed procedures, which combine both methods. In spite of the risk connected with the surgery and complications after it, bariatric procedures are advised to patients with class III obesity and class II with an accompanying illness which increases the probability of death. It has been proved that bariatric surgery not only eliminates obesity but also very frequently (in 90�0of cases leads to the remission of type 2 diabetes. Moreover, the remission occurs very fast – it takes place a long time before the patients reduce their weight, even within a few days after surgery. Detailed studies have shown that the remission of diabetes is caused mostly by the change of the gastro-intestinal hormones’ profile, resulting from the surgery. These hormones include GLP-1, GIP, peptide YY, ghrelin and oxyntomodulin. Additionally, the change of the amount of adipose tissue after the surgery influences the level of adipokines, i.e. the hormones of the adipose tissue, among which the most important are leptin, adiponectin and resistin. Thus, bariatric surgery not only changes the shape of the gastrointestinal tract but it also modulates the hormonal activity. Bariatric surgery is considered as therapy not only for the obese but also for diabetic patients.

  3. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Carlene Johnson Stoklossa

    2013-01-01

    Full Text Available Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.

  4. The effect of the Ontario Bariatric Network on health services utilization after bariatric surgery: a retrospective cohort study

    Science.gov (United States)

    Elnahas, Ahmad; Jackson, Timothy D.; Okrainec, Allan; Austin, Peter C.; Bell, Chaim M.; Urbach, David R.

    2016-01-01

    Background: In 2009, the Ontario Bariatric Network was established to address the exploding demand by Ontario residents for bariatric surgery services outside Canada. We compared the use of postoperative hospital services between out-of-country surgery recipients and patients within the Ontario Bariatric Network. Methods: We conducted a population-based, comparative study using administrative data held at the Institute for Clinical Evaluative Sciences. We included Ontario residents who underwent bariatric surgery between 2007 and 2012 either outside the country or at one of the Ontario Bariatric Network's designated centres of excellence. The primary outcome was use of hospital services in Ontario within 1 year after surgery. Results: A total of 4852 patients received bariatric surgery out of country, and 5179 patients underwent surgery through the Ontario Bariatric Network. After adjustment, surgery at a network centre was associated with a significantly lower utilization rate of postoperative hospital services than surgery out of country (rate ratio 0.90, 95% confidence interval [CI] 0.84 to 0.97). No statistically significant differences were found with respect to time in critical care or mortality. However, the physician assessment and reoperation rates were significantly higher among patients who received surgery at a network centre than among those who had bariatric surgery out of country (rate ratio 4.10, 95% CI 3.69 to 4.56, and rate ratio 1.84, 95% CI 1.34 to 2.53, respectively). Interpretation: The implementation of a comprehensive, multidisciplinary provincial program to replace outsourcing of bariatric surgical services was associated with less use of postoperative hospital services by Ontario residents undergoing bariatric surgery. Future research should include an economic evaluation to determine the costs and benefits of the Ontario Bariatric Network. PMID:27730113

  5. Bariatric surgery in elderly patients: a systematic review.

    Science.gov (United States)

    Giordano, Salvatore; Victorzon, Mikael

    2015-01-01

    Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (%) with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I (2) test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone.

  6. Energetic adaptations persist after bariatric surgery in severely obese adolescents

    Science.gov (United States)

    Energetic adaptations induced by bariatric surgery have not been studied in adolescents or for extended periods postsurgery. Energetic, metabolic, and neuroendocrine responses to Roux-en-Y gastric bypass (RYGB) surgery were investigated in extremely obese adolescents. At baseline and at 1.5, 6, and...

  7. Bariatric surgery implementation trends in the USA from 2002 to 2012.

    Science.gov (United States)

    Johnson, Emily E; Simpson, Annie N; Harvey, Jillian B; Simpson, Kit N

    2016-02-20

    Many beneficial health care interventions are either not put into practice or fail to diffuse over time due to complex contextual factors that affect implementation and diffusion. Bariatric surgery is an example of an effective intervention that recently experienced a plateau and decrease in rates, with minimal documented justification for this trend. While there are conceptual models that provide frameworks of general innovation implementation and diffusion, few studies have tested these models with data to measure the relative effects of factors that affect diffusion of specific health care interventions. A literature review identified factors associated with implementation and diffusion of health care innovations. These factors were utilized to construct a conceptual model of diffusion to explain changes in bariatric surgery over time. Six data sources were used to construct measures of the study population and factors in the model that may affect diffusion of surgery. The population included obese and morbidly obese patients from 2002 to 2012 who had bariatric surgery in 15 states. Multivariable models were used to identify environmental, population, and medical practice factors that facilitated or impeded diffusion of bariatric surgery over time. It was found that while bariatric surgery rates increased over time, the speed of growth in surgeries, or diffusion, slowed. Higher cumulative number of surgeries and higher proportion of the state population in age group 50-59 slowed surgery growth, but presence of Medicare centers of excellence increased the speed of surgery diffusion. Over time, the factors affecting the diffusion of bariatric surgery fluctuated, indicating that diffusion is affected by temporal and cumulative effects. The primary driver of diffusion of bariatric surgery was the extent of centers of excellence presence in a state. Higher cumulative surgery rates and higher proportions of older populations in a state slowed diffusion. Surprisingly

  8. Need for Intensive Nutrition Care After Bariatric Surgery.

    Science.gov (United States)

    Bétry, Cécile; Disse, Emmanuel; Chambrier, Cécile; Barnoud, Didier; Gelas, Patrick; Baubet, Sandrine; Laville, Martine; Pelascini, Elise; Robert, Maud

    2017-02-01

    Severe nutrition complications after bariatric surgery remain poorly described. The aim of this case series was to identify specific factors associated with nutrition complications after bariatric surgery and to characterize their nutrition disorders. We retrospectively reviewed all people referred to the clinical nutrition intensive care unit of our university hospital after bariatric surgery from January 2013 to June 2015. Twelve persons who required artificial nutrition supplies (ie, enteral nutrition or parenteral nutrition) were identified. Seven persons underwent a "one-anastomosis gastric bypass" (OAGB) or "mini gastric bypass," 2 underwent a Roux-en-Y gastric bypass, 2 had a sleeve gastrectomy, and 1 had an adjustable gastric band. This case series suggests that OAGB could overexpose subjects to severe nutrition complications requiring intensive nutrition care and therefore cannot be considered a "mini" bariatric surgery. Even if OAGB is often considered a simplified surgical technique, it obviously requires as the other standard bariatric procedures a close follow-up by experimented teams aware of its specific complications.

  9. Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity.

    Science.gov (United States)

    Klebanoff, Matthew J; Chhatwal, Jagpreet; Nudel, Jacob D; Corey, Kathleen E; Kaplan, Lee M; Hur, Chin

    2017-02-01

    Severe obesity affects 4% to 6% of US youth and is increasing in prevalence. Bariatric surgery for the treatment of adolescents with severe obesity is becoming more common, but data on cost-effectiveness are limited. To assess the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study. A state-transition model was constructed to compare 2 strategies: no surgery and bariatric surgery. In the no surgery strategy, patients remained at their initial body mass index (calculated as weight in kilograms divided by height in meters squared) over time. In the bariatric surgery strategy, patients were subjected to risks of perioperative mortality and complications as well as initial morbidity but also experienced longer-term quality-of-life improvements associated with weight loss. Cohort demographic information-of the 228 patients included, the mean (SD) age was 17 (1.6) years, the mean (range) body mass index was 53 (34-88), and 171 (75.0%) were female-surgery-related outcomes, and base case time horizon (3 years) were based on data from the Teen-Longitudinal Assessment of Bariatric Surgery study. One-way and probabilistic sensitivity analyses were performed. Quality-adjusted life-years (QALYs), total costs (in US dollars adjusted to 2015-year values using the Consumer Price Index), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness. After 3 years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of $30 747, yielding an unfavorable ICER of $154 684 per QALY. When the clinical study results were extrapolated to 4 years, the ICER decreased to $114 078 per QALY and became cost-effective by 5 years with an ICER of $91 032 per QALY. Outcomes were robust in most 1-way and probabilistic sensitivity analyses. Bariatric surgery incurs

  10. Empowerment and bariatric surgery: negotiations of credibility and control.

    Science.gov (United States)

    Knutsen, Ingrid Ruud; Terragni, Laura; Foss, Christina

    2013-01-01

    Today obesity is understood as a chronic illness. Programs developed to deal with obesity often build on an explicit aim to "empower" patients to take increased responsibility for their health, in line with contemporary neoliberal discourses. There is little empirically based knowledge about this so-called empowering process. In this article we focus on how an empowering program for patients diagnosed as morbidly obese worked on individuals' identity. The program encompassed a course in lifestyle change, bariatric surgery, and aftercare. We conducted qualitative interviews with 9 individuals at different stages of their treatment process and applied discourse analysis to interpret their constructions and negotiations as they progressed through the program. We found that dimensions of control and credibility framed the respondents' identity work. Based on the findings we suggest that contemporary discourses of empowerment as practice might leave the participants "trapped" within the ambivalence of freedom and control.

  11. [Strategy and critical analysis of bariatric surgery].

    Science.gov (United States)

    Houben, J J; Barea, M; Maroquin, L; Isabo, O; Desmarets, A

    2007-09-01

    Bariatric surgery has considerably developed during the last 20 years in Belgium. The increase of prevalence of the morbid obesity and the development of multiple surgical procedures widened the spectrum of treatment. If a rigorous selection and a multidisciplinary approach of the patients are inescapable, the various decision-making algorithms plunge the practitioner into a certain confusion. The purpose of this paper is to clarify the advantages and the inconveniences of the different surgical treatments in light of the evolution of the principles and the objective results of the literature. Among the techniques proven and validated in the long run, one can mention the Silastic Ring Vertical Gastroplasty according to Mac Lean by minilaparotomy, the laparoscopic adjustable ring and the more recent gastric by pass. The evaluation of laparoscopic sleeve gastrectomy, and of duodenal switch is on course. The bilio-pancreatic by-pass according to Scopinaro remains strongly controversed. A meta-analysis of the literature confirms the success of the gastric bypass. Regarding to the long term follow-up, the adjustable gastric banding deceives. The sleeve gastrectomy should be analyzed in the long term. The preliminary results of a epidemiologic and financial study within a private hospital of Brussels reveals that the cost effective ratio is in favor the Silastic Ring Vertical Gastroplasty and the laparoscopic adjustable banding, as well in terms of public health support than the charge for the private insurance and the patient. The projection beyond 5 years reverses the tendency to plead in favor of the gastric by-pass. First with the hit-parade of comfort, food diversification, tolerance, gastro-esophageal reflux, and undoubtedly of the rate of recurrence, it supplants the others techniques for sweet eaters. The volume eaters can profit from a sleeve gastrectomy which undoubtedly supplants the Silastic Ring Vertical Gastroplasty responsible for late annular stenoses and

  12. Personal Descriptions of Life Before and After Bariatric Surgery From Overweight or Obese Men.

    Science.gov (United States)

    Edward, Karen-Leigh; Hii, Michael W; Giandinoto, Jo-Ann; Hennessy, Julie; Thompson, Lisa

    2016-02-04

    Bariatric surgery is now a common weight loss solution for morbidly obese men where meaningful weight reduction and improvements in quality of life have been identified postsurgery. As the majority of surgical candidates are female, there exists a paucity of literature relating to the experience of males undergoing bariatric surgery. In this study, a qualitative descriptive-exploratory design was used to explore body image descriptions, adaptation of a new lifestyle, new boundaries postsurgery, and any barriers seeking consultation for surgery. Six males who had undergone bariatric surgery were recruited in Australia. Data were collected and analyzed using NVivo between May and October 2014. The themes emerging from the data included living in an obese body, life before surgery, decision making for surgery, and life after surgery. The participants collectively reported that life before surgery was challenging. They described the changes the surgery had made in their lives including positive changes to their health, body image, social lives, and self-esteem. Some participants preferred not to tell others their intentions for surgery due to perceived stigma. The men in this study also described a lack of information available to them depicting male perspectives, a possible barrier for men seeking weight loss surgery options. Implications for practice highlighted in these results relate to a greater need for accessible information specific to men based on real-life experiences.

  13. NSAID Use after Bariatric Surgery: a Randomized Controlled Intervention Study.

    Science.gov (United States)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N

    2016-12-01

    Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID use in patients who underwent bariatric surgery, and to determine the use of PPIs in patients who use NSAIDs after bariatric surgery. A randomized controlled intervention study in patients after bariatric surgery. Patients were randomized to an intervention or a control group. The intervention consisted of sending a letter to patients and their general practitioners on the risks of use of NSAIDs after bariatric surgery and the importance of avoiding NSAID use. The control group received care-as-usual. Dispensing data of NSAIDs and PPIs were collected from patients' pharmacies: from a period of 6 months before and from 3 until 9 months after the intervention. Two hundred forty-eight patients were included (intervention group: 124; control group: 124). The number of users of NSAIDs decreased from 22 to 18 % in the intervention group and increased from 20 to 21 % in the control group (NS). The use of a PPI with an NSAID rose from 52 to 55 % in the intervention group, and from 52 to 69 % in the control group (NS). Informing patients and their general practitioners by letter, in addition to care-as-usual, is not an effective intervention to reduce the use of NSAIDs after bariatric surgery (trial number NTR3665).

  14. INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY.

    Science.gov (United States)

    Vidal, Eduardo Arevalo; Rendon, Francisco Abarca; Zambrano, Trino Andrade; García, Yudoco Andrade; Viteri, Mario Ferrin; Campos, Josemberg Marins; Ramos, Manoela Galvão; Ramos, Almino Cardoso

    Intestinal malrotation is a rare congenital anomaly. In adults is very difficult to recognize due to the lack of symptoms. Diagnosis is usually incidental during surgical procedures or at autopsy. To review the occurrence and recognition of uneventful intestinal malrotation discovered during regular cases of bariatric surgeries. Were retrospectively reviewed the medical registry of 20,000 cases undergoing bariatric surgery, from January 2002 to January 2016, looking for the occurrence of intestinal malrotation and consequences in the intraoperative technique and immediate evolution of the patients. Five cases (0,025%) of intestinal malrotation were found. All of them were males, aging 45, 49, 37,52 and 39 years; BMI 35, 42, 49, 47 and 52 kg/m2, all of them with a past medical history of morbid obesity. The patient with BMI 35 kg/m2 suffered from type 2 diabetes also. All procedures were completed by laparoscopic approach, with no conversions. In one patient was not possible to move the jejunum to the upper abdomen in order to establish the gastrojejunostomy and a sleeve gastrectomy was performed. In another patient was not possible to fully recognize the anatomy due to bowel adhesions and a single anastomosis gastric bypass was preferred. No leaks or bleeding were identified. There were no perioperative complications. All patients were discharged 72 h after the procedure and no immediate 30-day complications were reported. Patients with malrotation can successfully undergo laparoscopic bariatric surgery. May be necessary changes in the surgical original strategy regarding the malrotation. Surgeons must check full abdominal anatomical condition prior to start the division of the stomach. Má-rotação intestinal é rara anomalia congênita em adultos de difícil reconhecimento devido à falta de sintomas. O diagnóstico é feito geralmente incidentalmente durante procedimentos cirúrgicos ou durante autópsia. Verificar a ocorrência e reconhecimento não eventual

  15. Remission of Type 2 Diabetes Mellitus in Patients After Different Types of Bariatric Surgery : A Population-Based Cohort Study in the United Kingdom

    NARCIS (Netherlands)

    Yska, Jan Peter; van Roon, Eric N; de Boer, Anthonius; Leufkens, Hubert G M; Wilffert, Bob; de Heide, Loek J M; de Vries, Frank; Lalmohamed, Arief

    2015-01-01

    Importance: To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. Objective: To assess the effect of different types of bariatric surgery in patients with T

  16. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery : A population-based cohort study in the United Kingdom

    NARCIS (Netherlands)

    Yska, Jan Peter; Van Roon, Eric N.; De Boer, Anthonius; Leufkens, Hubert G M; Wilffert, Bob; De Heide, Loek J M; De Vries, Frank; Lalmohamed, Arief

    2015-01-01

    IMPORTANCE: To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. OBJECTIVE: To assess the effect of different types of bariatric surgery in patients with T

  17. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery : A population-based cohort study in the United Kingdom

    NARCIS (Netherlands)

    Yska, Jan Peter; Van Roon, Eric N.; De Boer, Anthonius; Leufkens, Hubert G M; Wilffert, Bob; De Heide, Loek J M; De Vries, Frank; Lalmohamed, Arief

    2015-01-01

    IMPORTANCE: To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. OBJECTIVE: To assess the effect of different types of bariatric surgery in patients with

  18. Remission of Type 2 Diabetes Mellitus in Patients After Different Types of Bariatric Surgery : A Population-Based Cohort Study in the United Kingdom

    NARCIS (Netherlands)

    Yska, Jan Peter; van Roon, Eric N; de Boer, Anthonius|info:eu-repo/dai/nl/075097346; Leufkens, Hubert G M|info:eu-repo/dai/nl/075255049; Wilffert, Bob; de Heide, Loek J M; de Vries, Frank|info:eu-repo/dai/nl/303546670; Lalmohamed, Arief|info:eu-repo/dai/nl/357580680

    2015-01-01

    Importance: To our knowledge, an observational study on the remission of type 2 diabetes mellitus (T2DM) after different types of bariatric surgery based on data from general practice has not been carried out. Objective: To assess the effect of different types of bariatric surgery in patients with

  19. Primary care physician decision making regarding referral for bariatric surgery

    DEFF Research Database (Denmark)

    Stolberg, Charlotte Røn; Hepp, Nicola; Juhl, Anna Julie Aavild

    2017-01-01

    : Primary care physicians in Denmark. Methods: A total of 300 Danish PCPs were invited to participate in a questionnaire survey regarding experiences with bariatric surgery, reservations about bariatric surgery, attitudes to specific patient cases, and the future treatment of severe obesity. Most questions...... required a response on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree) and frequency distributions were calculated. Results: 133 completed questionnaires (44%) were returned. Most physicians found that they had good knowledge about the national...

  20. Early metabolic improvement following bariatric surgery in morbidly obese adolescents.

    Science.gov (United States)

    Teeple, E A; Teich, S; Schuster, D P; Michalsky, M P

    2012-01-01

    Bariatric surgery results in durable weight loss and improved comorbidities. The objectives of this study were to examine the efficacy of gastric bypass in reducing comorbid burden and improving metabolic status among morbidly obese adolescents. The medical records of 15 gastric bypass patients were retrospectively reviewed. Changes in metabolic markers were determined at baseline, 1 and 2 years post-operatively. Comparative analysis demonstrated significant improvement in weight, BMI, insulin, HbA1C, C-peptide, %B, %S, IR, cholesterol, percentile cholesterol, TG, percentile TG, HDL, percentile HDL, LDL, percentile LDL, and VLDL. Results support bariatric surgery as a treatment for morbidly obese adolescents with comorbidities.

  1. Can bariatric surgery be done as an outpatient procedure?

    Science.gov (United States)

    McCarty, Todd M

    2006-01-01

    It has become increasing clear that some types of bariatric surgery can be performed as outpatient operations. This is currently limited to lap-band, lap-RYGB, and some lap-revision operations, but may soon be applicable to other bariatric procedures. In fact, most lap-band procedures are currently performed in ambulatory surgical centers that often lack the capacity for an overnight stay. Lap-RYGB has been recently reported with 23-hour outpatient admission requiring an overnight stay. Careful patient selection, surgeon experience, and integrating the appropriate perioperative care components are associated with clinical success. Surgeon recognition of these possibilities and patient demand are already pushing this care across the nation. Only time will tell how many other bariatric operations will be performed as outpatient procedures, but if the past is any indication of the future, this trend should continue to increase. The question thus is not whether bariatric surgery can be done as an outpatient procedure, but rather by whom and in what setting can patient outcome be optimized. In the end, rhetoric is rhetoric and data are data, and we should let documented patient outcome, the crown jewel of bariatric surgery, guide the future.

  2. Preventing surgical site infections after bariatric surgery: value of perioperative antibiotic regimens

    Science.gov (United States)

    Chopra, Teena; Zhao, Jing J; Alangaden, George; Wood, Michael H; Kaye, Keith S

    2010-01-01

    Bariatric surgery for obesity has emerged as an effective and commonly used treatment modality. This paper reviews the surgical site infections (SSIs) that occur post bariatric surgery and SSI prevention. The benefit of bariatric surgery resulting in profound weight loss brings with it consequences in the form of postoperative complications that can have profound effects on morbidity and mortality in these patients. This paper sets out to define different types of SSIs that occur following bariatric surgery and to discuss existing literature on the critical aspects of SSI prevention and the appropriate use of surgical antimicrobial prophylaxis for bariatric surgery. PMID:20545596

  3. NHS litigation in bariatric surgery over a ten year period.

    Science.gov (United States)

    Ratnasingham, Kumaran; Knight, James; Liu, Mamie; Karatsai, Eleni; Humadi, Samer; Irukulla, Shashi

    2017-04-01

    Negligence claims in the UK NHS has increased over the last 30 years. The aim of this present study was determine the number of claims and the cost of litigation in Bariatric Surgery and compare it to similar other specialties. Data was received from NHS Litigation Authority (NHSLA) in response to Freedom of Information data request. There was a total of 7 claims, of which 4 were successful. The total pay out sum was £210,000 in 10 years. This is a very low amount compared to other surgical specialties. This low level of litigation probably indicates that the current bariatric surgical services in the NHS are delivering safe care with good patient satisfaction. This needs to be carefully considered prior to changing the payment tariffs for bariatric surgery. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Bariatric surgery in Asia in the last 5 years (2005-2009).

    Science.gov (United States)

    Lomanto, Davide; Lee, Wei-Jei; Goel, Rajat; Lee, Jeannette Jen-Mai; Shabbir, Asim; So, Jimmy B Y; Huang, Chih-Kun; Chowbey, Pradeep; Lakdawala, Muffazal; Sutedja, Barlian; Wong, Simon K H; Kitano, Seigo; Chin, Kin-Fah; Fah, Chin Kin; Dineros, Hildegardes C; Wong, Andrew; Cheng, Anton; Pasupathy, Shanker; Lee, Sang Kuon; Pongchairerks, Paisal; Giang, Tran Binh

    2012-03-01

    Obesity is a major public health concern around the world, including Asia. Bariatric surgery has grown in popularity to combat this rising trend. An e-mail questionnaire survey was sent to all the representative Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS) members of 12 leading Asian countries to provide bariatric surgery data for the last 5 years (2005-2009). The data provided by representative members were discussed at the 6th International APMBSS Congress held at Singapore between 21st and 23rd October 2010. Eleven nations except China responded. Between 2005 and 2009, a total of 6,598 bariatric procedures were performed on 2,445 men and 4,153 women with a mean age of 35.5 years (range, 18-69years) and mean BMI of 44.27 kg/m(2) (range, 31.4-73 kg/m(2)) by 155 practicing surgeons. Almost all of the operations were performed laparoscopically (99.8%). For combined years 2005-2009, the four most commonly performed procedures were laparoscopic adjustable gastric banding (LAGB, 35.9%), laparoscopic standard Roux-en-Y gastric bypass (LRYGB, 24.3%), laparoscopic sleeve gastrectomy (LSG, 19.5%), and laparoscopic mini gastric bypass (15.4%). Comparing the 5-year trend from 2004 to 2009, the absolute numbers of bariatric surgery procedures in Asia increased from 381 to 2,091, an increase of 5.5 times. LSG increased from 1% to 24.8% and LRYGB from 12% to 27.7%, a relative increase of 24.8 and 2.3 times, whereas LAGB and mini gastric bypass decreased from 44.6% to 35.6% and 41.7% to 6.7%, respectively. The absolute growth rate of bariatric surgery in Asia over the last 5 years was 449%.

  5. Bariatric surgery in individuals with liver cirrhosis: A narrative review

    Directory of Open Access Journals (Sweden)

    Everton Cazzo

    Full Text Available Summary Introduction: Bariatric surgery has become the gold standard treatment for morbid obesity, but there is no consensus regarding its safety and efficacy among individuals with chronic liver diseases. Objective: To critically evaluate the existing evidence on literature about bariatric surgery in individuals with liver cirrhosis. Method: Narrative review performed by means of an online search in the MEDLINE and LILACS databases. Results: Bariatric surgery is safe and effective in individuals with chronic liver disease without clinical decompensation or significant portal hypertension. Individuals with severe liver function impairment present significantly higher surgical morbidity and mortality. Among candidates to liver transplantation, surgery may be performed before, after and even during transplantation, and there is a predominant trend to perform it after. Vertical sleeve gastrectomy seems to be the most adequate technique in this group of subjects. Conclusion: Bariatric surgery is safe and effective in individuals with compensated cirrhosis without significant portal hypertension, but presents higher morbidity. Among candidates to liver transplantation and/or individuals with severe portal hypertension, morbidity and mortality are significantly higher.

  6. Socially desirable responding by bariatric surgery candidates during psychological assessment.

    Science.gov (United States)

    Ambwani, Suman; Boeka, Abbe G; Brown, Joshua D; Byrne, T Karl; Budak, Amanda R; Sarwer, David B; Fabricatore, Anthony N; Morey, Leslie C; O'Neil, Patrick M

    2013-01-01

    Most bariatric surgery programs in the United States require preoperative psychological evaluations for candidates for surgery. Among those who perform these evaluations is concern that many patients engage in "impression management" or minimizing the symptoms of distress to receive a recommendation to proceed with surgery from the mental health professional. We sought to assess the prevalence of socially desirable responding and its associations with measures of psychological functioning among bariatric surgery candidates at 2 academic medical centers in the United States. The participants were male (n = 66) and female (n = 293) bariatric surgery candidates who presented for psychological evaluation. The participants completed 2 measures of socially desirable response styles (Marlowe-Crowne Social Desirability Scale and Personality Assessment Inventory Positive Impression Management scale) and standardized measures of anxiety, depression, and alcohol-related problems. The participants exhibited elevated scores on the social desirability indicators, with 33.3-39.8% scoring above the recommended cut-score on the Personality Assessment Inventory Positive Impression Management scale and 62.3-67% scoring 1 standard deviation above the standardization mean on the Marlowe-Crowne Social Desirability Scale. Scores on the Marlowe-Crowne Social Desirability Scale and Personality Assessment Inventory Positive Impression Management scale correlated inversely with the clinical measures of anxiety and depression, and the high/low scorers on the social desirability indices exhibited significant differences in anxiety and depression. Thus, elevated scores on the social desirability indices were associated with underreporting of certain clinical symptoms. A substantial proportion of bariatric surgery candidates appear to present themselves in an overly favorable light during the psychological evaluation. This response style is associated with less reporting of psychological

  7. Influence of bariatric surgery on the use and pharmacokinetics of some major drug classes.

    Science.gov (United States)

    Yska, Jan Peter; van der Linde, Susanne; Tapper, Véronique V; Apers, Jan A; Emous, Marloes; Totté, Erik R; Wilffert, Bob; van Roon, Eric N

    2013-06-01

    The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes to be searched for were antidepressants, antidiabetics, statins, antihypertensive agents, corticosteroids, oral contraceptives, and thyroid drugs. A reduction in the use of medication by patients after bariatric surgery has been reported for various drug classes. Very few studies have been published on the influence of bariatric surgery on the pharmacokinetics of drugs. After bariatric surgery, theoretically, reduced drug absorption may occur. Correct dosing and choosing the right dosage form for drugs used by patients after bariatric surgery are necessary for optimal pharmacotherapy. Therefore, more clinical studies are needed on the influence of bariatric surgery on the pharmacokinetics of major drugs.

  8. Bariatric surgery and nonalcoholic fatty liver disease.

    Science.gov (United States)

    Bower, Guy; Athanasiou, Thanos; Isla, Alberto M; Harling, Leanne; Li, Jia V; Holmes, Elaine; Efthimiou, Evangelos; Darzi, Ara; Ashrafian, Hutan

    2015-07-01

    The rising prevalence of nonalcoholic fatty liver disease (NAFLD) is associated with the increasing global pandemic of obesity. These conditions cluster with type II diabetes mellitus and the metabolic syndrome to result in obesity-associated liver disease. The benefits of bariatric procedures on diabetes and the metabolic syndrome have been recognized for some time, and there is now mounting evidence to suggest that bariatric procedures improve liver histology and contribute to the beneficial resolution of NAFLD in obese patients. These beneficial effects derive from a number of weight-dependent and weight-independent mechanisms including surgical BRAVE actions (bile flow changes, restriction of stomach size, anatomical gastrointestinal rearrangement, vagal manipulation, enteric hormonal modulation) and subsequent effects such as reduced lipid intake, adipocytokine secretion, modulation of gut flora, improvements in insulin resistance and reduced inflammation. Here, we review the clinical investigations on bariatric procedures for NAFLD, in addition to the mounting mechanistic data supporting these findings. Elucidating the mechanisms by which bariatric procedures may resolve NAFLD can help enhance surgical approaches for metabolic hepatic dysfunction and also contribute toward developing the next generation of therapies aimed at reducing the burden of obesity-associated liver disease.

  9. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Science.gov (United States)

    Cerci, M.; Bellini, M. I.; Russo, F.; Benavoli, D.; Capperucci, M.; Gaspari, A. L.; Gentileschi, P.

    2013-01-01

    Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86%) discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87%) showed remission and 2 (13%) improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients. PMID:24454338

  10. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Directory of Open Access Journals (Sweden)

    M. Cerci

    2013-01-01

    Full Text Available Introduction. Moderate obesity (BMI 30–35 kg/m2 affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM (56%, gastric bypass was performed; in cases with hypertension (64% and obstructive sleep apnea (OSA (12%, sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86% discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87% showed remission and 2 (13% improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients.

  11. NSAID Use after Bariatric Surgery : a Randomized Controlled Intervention Study

    NARCIS (Netherlands)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N.

    2016-01-01

    Background Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. Aim To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID

  12. NSAID Use after Bariatric Surgery : a Randomized Controlled Intervention Study

    NARCIS (Netherlands)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N.

    2016-01-01

    Background Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. Aim To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID

  13. Clinical Challenges in Upper Gastrointestinal Malignancies after Bariatric Surgery

    NARCIS (Netherlands)

    W.H.W. Tse (Win Hou W); H.M. Kroon (Herman); J.J.B. van Lanschot (Jan)

    2017-01-01

    textabstractBackground/Aims: The incidence of morbid obesity has exponentially increased over the last decades. Bariatric surgery (BS) has been proven effective in inducing weight loss and resolving comorbidities associated with morbid obesity. However, BS can also lead to major diagnostic and

  14. Candidates for Bariatric Surgery: Morbidly Obese Patients with Pulmonary Dysfunction

    Directory of Open Access Journals (Sweden)

    Yu-Feng Wei

    2012-01-01

    Full Text Available Obesity is a well-known major risk factor of cardiovascular disease and is associated with various comorbidities. The impact of obesity on pulmonary function remains unclear. Reductions in chest wall compliance and respiratory muscle strength due to a high percent body fat and localized fat distribution contributes to impaired pulmonary function and the occurrence of adverse respiratory symptoms. Dietary modifications and pharmaceutical agents are not effective in the long-term treatment of obesity. Treatment of morbidly obese patients using bariatric surgery has increased each year, especially after the introduction of video laparoscopic techniques. Effective weight loss after bariatric surgery may improve cardiovascular disease risk factors, including diabetes, hypertension, dyslipidemia, atherosclerosis, inflammation, chronic kidney disease, obstructive sleep apnea, and obesity hypoventilation syndrome. Bariatric surgery has also been associated with significantly improved respiratory symptoms and pulmonary function. We currently present a review of principal studies that evaluated the effects of obesity on pulmonary function and the identification of anthropometric factors of obesity that correspond to the reversal of respiratory symptoms and impaired pulmonary function after bariatric surgery.

  15. The impact of bariatric surgery on obesity-related infertility and in vitro fertilization outcomes.

    Science.gov (United States)

    Tan, Orkun; Carr, Bruce R

    2012-12-01

    Obesity-related infertility is one of the most common problems of reproductive-age obese women who desire childbearing. The various types of bariatric surgeries have proved effective in controlling excessive weight gain, improving fertility, and preventing certain maternal and fetal complications in these women. This article summarizes the current evidence regarding the impact of bariatric surgery on obesity-related infertility and in vitro fertilization (IVF) outcomes. We have also attempted to draw conclusions about maternal and fetal risks and the benefits of bariatric surgery. Laparoscopic adjustable gastric banding and Roux-en-Y procedures are the two most commonly performed bariatric surgeries. Bariatric surgery was believed to improve menstrual irregularity and increase ovulation rate in anovulatory obese women, which lead to increased pregnancy rates. Although there are data in the literature suggesting the improvement of both the ovulatory function and the spontaneous pregnancy rates in obese women who lost weight after bariatric surgery, most of these are case-control studies with a small number of patients. The data are insufficient to determine an ideal time interval for pregnancy after bariatric surgery; however, the general consensus is that pregnancy should be delayed 12 to 18 months after bariatric surgery to avoid nutritional deficiencies. Few data exist regarding IVF success rates in women who have undergone bariatric surgery. One pairwise study discussed five patients who underwent bariatric surgery followed by IVF that resulted in three term pregnancies in three patients after the first IVF cycle. Many studies reported reductions in obesity-related pregnancy complications such as gestational diabetes and hypertensive disorders after bariatric surgery. Although data are inconsistent, some studies reported increased rate of preterm delivery and small for gestational age infants after bariatric surgery. Pregnancies after bariatric surgery may be

  16. FROM COMPLEX EVOLVING TO SIMPLE: CURRENT REVISIONAL AND ENDOSCOPIC PROCEDURES FOLLOWING BARIATRIC SURGERY

    Science.gov (United States)

    ZORRON, Ricardo; GALVÃO-NETO, Manoel Passos; CAMPOS, Josemberg; BRANCO, Alcides José; SAMPAIO, José; JUNGHANS, Tido; BOTHE, Claudia; BENZING, Christian; KRENZIEN, Felix

    2016-01-01

    ABSTRACT Background: Roux-en-Y gastric bypass (RYGB) is a standard therapy in bariatric surgery. Sleeve gastrectomy and gastric banding, although with good results in the literature, are showing higher rates of treatment failure to reduce obesity-associated morbidity and body weight. Other problems after bariatric may occur, as band erosion, gastroesophageal reflux disease and might be refractory to medication. Therefore, a laparoscopic conversion to a RYGB can be an effective alternative, as long as specific indications for revision are fulfilled. Objective: The objective of this study was to analyse own and literature data on revisional bariatric procedures to evaluate best alternatives to current practice. Methods: Institutional experience and systematic review from the literature on revisional bariatric surgery. Results: Endoscopic procedures are recently applied to ameliorate failure and complications of bariatric procedures. Therapy failure following RYGB occurs in up to 20%. Transoral outlet reduction is currently an alternative method to reduce the gastrojejunal anastomosis. The diameter and volume of sleeve gastrectomy can enlarge as well, which can be reduced by endoscopic full-thickness sutures longitudinally. Dumping syndrome and severe hypoglycemic episodes (neuroglycopenia) can be present in patients following RYGB. The hypoglycemic episodes have to be evaluated and usually can be treated conventionally. To avoid partial pancreatectomy or conversion to normal anatomy, a new laparoscopic approach with remnant gastric resection and jejunal interposition can be applied in non-responders alternatively. Hypoglycemic episodes are ameliorated while weight loss is sustained. Conclusion: Revisional and endoscopic procedures following bariatric surgery in patients with collateral symptomatic or treatment failure can be applied. Conventional non-surgical approaches should have been applied intensively before a revisional surgery will be indicated. Former complex

  17. Targeting the gut to treat obesity and its metabolic comorbidities: focus on bariatric surgery - view from the chair.

    Science.gov (United States)

    Carpentier, A C

    2016-12-01

    Over the past decade, bariatric surgery emerged as the most effective treatment modality for obesity and its complications, especially type 2 diabetes. Initially introduced on the basis of their capacity to restrict food intake and/or induce dietary fat malabsorption, the current bariatric surgery procedures result in many more physiological changes that may also partly explain their potent and sustained anti-obesity and anti-diabetic effects. In the session 2 of the 17th International Symposium of the Université Laval Research Chair in Obesity, outstanding speakers have provided insight into novel clinical and pathophysiological aspects in bariatric surgery. Dr Blandine Laferrère discussed the growing body of evidence implicating incretin hormones in the anti-diabetic effects of bariatric surgery and Dr Hans-Rudolf Berthoud explored emerging evidence suggesting that bariatric surgery may reset the defended body mass set point. As data are rapidly accruing about the beneficial effects of bariatric surgery, these procedures not only take a greater place in clinical practice, but they also offer outstanding occasions to peek into the intricate and complex links between diet and gastrointestinal track, and obesity and its complications.

  18. Causes and outcomes of revisional bariatric surgery: initial experience at a single center

    OpenAIRE

    2014-01-01

    Purpose Bariatric surgery has become more prevalent owing to the worldwide obesity epidemic. With the growing number of bariatric procedures performed annually, the requirement for revisional and secondary operations is increasing accordingly. This study aimed to evaluate the initial experience of revisional bariatric surgery at a single specialized center. Methods A retrospective review of the prospectively established database identified all patients who underwent revisional bariatric surge...

  19. Treatment of Obesity: Weight Loss and Bariatric Surgery

    Science.gov (United States)

    Wolfe, Bruce M.; Kvach, Elizaveta; Eckel, Robert H.

    2016-01-01

    This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD) as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by non-surgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the co-morbidities, quality of life and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes, inflammation, obstructive sleep apnea and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors following weight loss, it is reasonable to expect a reduction of CVD events and related mortality following weight loss in populations with obesity. The quality of the current evidence is reviewed and future research opportunities and summaries are stated. PMID:27230645

  20. Benefits of Bariatric Surgery and Perioperative Surgical Safety

    Directory of Open Access Journals (Sweden)

    Ji Chung Tham

    2015-11-01

    Full Text Available Obesity is a worldwide problem with numerous associated health problems. The number of patients eligible for surgery outnumber surgical capacity and so patients need to be prioritised based on their obesity- related health burden and comorbidities. Weight loss as a result of bariatric surgery is significant and maintained in the long term. In addition to weight loss, patient health improves in terms of metabolic, macrovascular, and microvascular disease. As a result, quality of life is better, along with psychosocial wellbeing. Bariatric surgery is associated with a relatively low number of complications and appears to result in a reduction in mortality risk due to the resolution of comorbidities. Hence, surgery can now be routinely considered as an adjunct to medical therapy in the management of obesity.

  1. Does pregnancy influence long-term results of bariatric surgery?

    Science.gov (United States)

    Quyên Pham, Thu; Pigeyre, Marie; Caiazzo, Robert; Verkindt, Hélène; Deruelle, Philippe; Pattou, François

    2015-01-01

    Bariatric surgery is performed mostly on obese women of reproductive age. Many authors have studied pregnancy outcomes after bariatric surgery. Only a small number of studies have analyzed the impact of maternity on the results of bariatric surgery. To study the effect of pregnancy on long-term outcomes of bariatric surgery. Lille University Hospital. A retrospective study was conducted on 591 women aged 18 to 42 years who had undergone laparoscopic adjustable gastric band (LAGB) surgery or laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery between 1996 and 2012. A comparison of the results after a 5-year follow-up was performed between patients who became pregnant after their bariatric surgery (pregnant group, n = 84) and postoperative nonpregnant women (nonpregnant group, n = 507). At the 5-year visit, 84.8% patients were seen. The preoperative body mass index (BMI) was the same in the 2 groups (pregnant group: 47.8±6.9 kg/m(2); nonpregnant group: 47.5±7.2 kg/m(2); P = .755). The percentage of excess weight loss (%EWL) was lower in the pregnant group at 2 years (pregnant group = 45.9±24.6%; nonpregnant group = 56.9±28.6%, P = .002) but was similar at 5 years (47.7±27.7% versus 49.9±28.9%, P = .644). The decrease in co-morbidities was similar after 5 years. The gestational weight gain (GWG) was higher when the band was deflated during pregnancy (GWG =+12.7±10.5 kg) compared to the band without fluid removal (GWG =+4.9±7 kg) or laparoscopic Roux-en-Y gastric bypass (GWG =+4.4±1.1 kg) (Pbariatric surgery slows down postoperative weight loss but does not affect weight results at 5-year follow-up. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. Endoscopic management of post-bariatric surgery complications.

    Science.gov (United States)

    Boules, Mena; Chang, Julietta; Haskins, Ivy N; Sharma, Gautam; Froylich, Dvir; El-Hayek, Kevin; Rodriguez, John; Kroh, Matthew

    2016-09-16

    Understanding the technical constructs of bariatric surgery is important to the treating endoscopist to maximize effective endoluminal therapy. Post-operative complication rates vary widely based on the complication of interest, and have been reported to be as high as 68% following adjustable gastric banding. Similarly, there is a wide range of presenting symptoms for post-operative bariatric complications, including abdominal pain, nausea and vomiting, dysphagia, gastrointestinal hemorrhage, and weight regain, all of which may provoke an endoscopic assessment. Bleeding and anastomotic leak are considered to be early ( 30 d) complications. Treatment of complications in the immediate post-operative period may require unique considerations. Endoluminal therapies serve as adjuncts to surgical and radiographic procedures. This review aims to summarize the spectrum and efficacy of endoscopic management of post-operative bariatric complications.

  3. [Bariatric and plastic surgery in obese adolescents: an alternative treatment].

    Science.gov (United States)

    Dubern, Béatrice; Tounian, Patrice

    2014-06-01

    The increased frequency of extreme forms of obesity in adolescents and the disappointing results of conventional treatments are now leading pediatricians to consider bariatric or cosmetic surgery as the only real long-term effective therapeutic alternative. The two main techniques currently used for bariatric surgery in adolescents are gastric bypass and adjustable gastric banding. Whatever the technique, weight loss is significant with improvement of comorbidities and quality of life. In addition, the complications are identical to those in adults and equally frequent. However, because of the particularities of this age, caution is still required. Adolescence is indeed characterized by specific nutritional needs, but also changes in body image in which surgery could have a negative effect. Currently, all obese teenagers making a request for bariatric surgery should have a comprehensive assessment with global care for at least 6 months. The indication is then discussed on a case-by-case basis by multidisciplinary teams and experts. To date, the type of surgery (gastric banding, gastric sleeve, or bypass) is still widely discussed. Based on experience with adults, we believe that gastric sleeve and bypass should be preferred. In addition, obesity in adolescents almost always involves psychosocial consequences, while somatic complications are rare. Thus, the care of adipo- or gynecomastia, abdominal fat excess, and concealed penis is essential and therefore justifies cosmetic surgery.

  4. The Impact of Bariatric Surgery on Psychological Health

    Directory of Open Access Journals (Sweden)

    Jeremy F. Kubik

    2013-01-01

    Full Text Available Obesity is associated with a relatively high prevalence of psychopathological conditions, which may have a significant negative impact on the quality of life. Bariatric surgery is an effective intervention in the morbidly obese to achieve marked weight loss and improve physical comorbidities, yet its impact on psychological health has yet to be determined. A review of the literature identified a trend suggesting improvements in psychological health after bariatric surgery. Majority of mental health gain is likely attributed to weight loss and resultant gains in body image, self-esteem, and self-concept; however, other important factors contributing to postoperative mental health include a patient’s sense of taking control of his/her life and support from health care staff. Preoperative psychological health also plays an important role. In addition, the literature suggests similar benefit in the obese pediatric population. However, not all patients report psychological benefits after bariatric surgery. Some patients continue to struggle with weight loss, maintenance and regain, and resulting body image dissatisfaction. Severe preoperative psychopathology and patient expectation that life will dramatically change after surgery can also negatively impact psychological health after surgery. The health care team must address these issues in the perioperative period to maximize mental health gains after surgery.

  5. Medical management of patients after bariatric surgery: Principles and guidelines

    Science.gov (United States)

    Elrazek, Abd Elrazek Mohammad Ali Abd; Elbanna, Abduh Elsayed Mohamed; Bilasy, Shymaa E

    2014-01-01

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review. PMID:25429323

  6. Management of late postoperative complications of bariatric surgery.

    Science.gov (United States)

    Hamdan, K; Somers, S; Chand, M

    2011-10-01

    The prevalence of obesity is increasing worldwide and the past decade has witnessed an exponential rise in the number of bariatric operations performed. As a consequence, an increasing number of patients are presenting to non-specialist units with complications following bariatric procedures. This article outlines the management of the most common late postoperative complications that are likely to present to the general surgeon. A search was conducted for late postoperative complications after bariatric surgery using PubMed, Embase, OVID and Google search engines, and combinations of the terms bariatric surgery, gastric bypass, gastric banding or sleeve gastrectomy, and late or delayed complications. Only studies with follow-up longer than 6 months were included. The most common long-term complications after gastric banding include band slippage and erosion. Deflation or removal of the band is often required. Internal hernia, adhesions and anastomotic stenosis are common causes of intestinal obstruction after gastric bypass surgery. Hepatobiliary complications pose a particular challenge because of the altered anatomy. Functional disorders such as reflux and dumping, and nutritional deficiencies are common and should be differentiated from conditions that require urgent investigations and timely surgical intervention. The immediate management of bariatric patients presenting with complications outside the immediate postoperative period requires adherence to basic surgical principles. Accurate diagnosis often relies on high-quality contrast and cross-sectional imaging, and effective surgical intervention necessitates a broad understanding of the altered anatomy, advanced surgical skills and liaison with specialists in the field when necessary. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  7. Medical management of patients after bariatric surgery: Principles and guidelines

    Institute of Scientific and Technical Information of China (English)

    Abd; Elrazek; Mohammad; Ali; Abd; Elrazek; Abduh; Elsayed; Mohamed; Elbanna; Shymaa; E; Bilasy

    2014-01-01

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index(BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients(BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  8. Medical management of patients after bariatric surgery: Principles and guidelines.

    Science.gov (United States)

    Elrazek, Abd Elrazek Mohammad Ali Abd; Elbanna, Abduh Elsayed Mohamed; Bilasy, Shymaa E

    2014-11-27

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m(2)) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m(2) and those with BMI > 35 kg/m(2) with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  9. Complications of pre-operative anorexia nervosa in bariatric surgery.

    Science.gov (United States)

    Shear, Matthew; DeFilippis, Ersilia M

    2015-01-01

    It is important to recognise that patients who seek weight loss surgery may have a history of restrictive eating or anorexia nervosa. The following case report describes a woman with a history of anorexia nervosa who underwent Roux-en-Y gastric bypass surgery. Her eating disorder symptoms subsequently reappeared and were largely resistant to treatment. To the best of our knowledge, this is the first case report of a bariatric surgery patient with a prior history of anorexia nervosa. Further research is required to determine how best to select patients for weight loss surgery.

  10. Recent advances in bariatric/metabolic surgery: appraisal of clinical evidence

    OpenAIRE

    2014-01-01

    Abstract Obesity and associated type 2 diabetes mellitus (T2DM) are becoming a serious medical issue worldwide. Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese patients. Increasing data indicates bariatric surgery as metabolic surgery is an effective and novel therapy for not well controlled obese T2DM patients. The review of recent developments in bariatric/metabolic surgery covers 4 major fields. 1) Improvement of safety: recen...

  11. Post-operative bariatric surgery complications: Deficiency of nutrients

    Directory of Open Access Journals (Sweden)

    Syed Abdul Majid Mufaqam1, Soni Dhwani Satishkumar2, Patel Palak Arvindkumar2

    2013-08-01

    Full Text Available Since more than half of the population in America falls under the category of obesity, scientists have discovered a surgical technique to reduce the weight of the obese patients. Bariatric surgery or gastric bypass surgery is a procedure that has been successful in reducing the weight for obese people. This technique requires a permanent gastric bypass (Roux-en-Y where part of the stomach and duodenum is removed. Since the size of the stomach is reduced to 20% of its original size along with the removal of duodenum – this may lead to improper absorption of several vitamins and minerals. This review showed that several vitamins and mineral deficiencies are observed in patients, post-operative bariatric surgery. Thiamin, folate, and B12 deficiencies were most commonly observed, and Vitamin A, D, C and B6 deficiencies were also seen in some cases. Iron and calcium deficiencies were also reported by some of the studies.

  12. [Evolution of low back pain after bariatric surgery].

    Science.gov (United States)

    Koulischer, S; Cadière, B; Cadière, G-B; Fabeck, L

    2015-01-01

    Although frequently called to mind by physicians, the relationship between overweight and low back pain is poorly understood and remains controversial. The present study aims to evaluate the evolution of low back pain in 65 patients planned for a bariatric surgery. The patients were enrolled prospectively. 54 patients (80%) could be evaluated 5 months after the procedure, and 47 patients (72%) were evaluated 22 months after surgery. Mean weight loss was 19 ± 9 kg (P statistically significant improvement of the NRS, Oswestry and SF-36 scores. This study suggests that low back pain might be reduced following bariatric surgery. However, the lack of dose-response effect is against a causal relationship between low back pain and obesity. Larger randomised controls are needed to determine a causal relationship.

  13. Peripheral polyneuropathy after bariatric surgery for morbid obesity

    Directory of Open Access Journals (Sweden)

    I-Ching Lin

    2011-01-01

    Full Text Available A patient with peripheral polyneuropathy after bariatric surgery for morbid obesity is reported. She suffered from frequent episodes of vomiting and abdominal pain after surgery. Muscle weakness in her lower limbs developed 5 months later and she experienced difficulty in walking and standing. Wrist drop, foot drop, and marked distal limb muscle atrophy were found bilaterally. Electromyography showed the presence of sensorimotor axonal polyneuropathy. Nutritional deficiencies may play an important role in pathogenesis. This uncommon neurological complication might be due to rapid weight loss and vitamin deficiency. Physicians who take care for patients after bariatric surgery should have a high index of awareness for the neurologic complications, and routine vitamin supplementation might be useful for these patients.

  14. Bariatric Endocrinology: Principles of Medical Practice

    Directory of Open Access Journals (Sweden)

    J. Michael Gonzalez-Campoy

    2014-01-01

    Full Text Available Obesity, is a chronic, biological, preventable, and treatable disease. The accumulation of fat mass causes physical changes (adiposity, metabolic and hormonal changes due to adipose tissue dysfunction (adiposopathy, and psychological changes. Bariatric endocrinology was conceived from the need to address the neuro-endocrinological derangements that are associated with adiposopathy, and from the need to broaden the scope of the management of its complications. In addition to the well-established metabolic complications of overweight and obesity, adiposopathy leads to hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, dysregulation of gut peptides including GLP-1 and ghrelin, the development of an inflammatory milieu, and the strong risk of vascular disease. Therapy for adiposopathy hinges on effectively lowering the ratio of orexigenic to anorexigenic signals reaching the the hypothalamus and other relevant brain regions, favoring a lower caloric intake. Adiposopathy, overweight and obesity should be treated indefinitely with the specific aims to reduce fat mass for the adiposity complications, and to normalize adipose tissue function for the adiposopathic complications. This paper defines the principles of medical practice in bariatric endocrinology—the treatment of overweight and obesity as means to treat adiposopathy and its accompanying metabolic and hormonal derangements.

  15. Adolescent Bariatric Surgery Program Characteristics: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study Experience

    Science.gov (United States)

    Michalsky, M.P.; Inge, T.H.; Teich, S.; Eneli, I.; Miller, R.; Brandt, M.L.; Helmrath, M.; Harmon, C.M.; Zeller, M.H.; Jenkins, T.M.; Courcoulas, A.; Buncher, C.R.

    2013-01-01

    Background The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Methods Data were obtained from the Teen-LABS database and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. Results All centers had extensive multidisciplinary involvement in the assessment, preoperative education and post-operative management of adolescents undergoing WLS. Eligibility criteria, pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. Conclusions The composition of clinical team and institutional resources are consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS. PMID:24491361

  16. Adolescent bariatric surgery program characteristics: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experience.

    Science.gov (United States)

    Michalsky, Marc P; Inge, Thomas H; Teich, Steven; Eneli, Ihuoma; Miller, Rosemary; Brandt, Mary L; Helmrath, Michael; Harmon, Carroll M; Zeller, Meg H; Jenkins, Todd M; Courcoulas, Anita; Buncher, Ralph C

    2014-02-01

    The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Data were obtained from the Teen-LABS database, and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. All centers had extensive multidisciplinary involvement in the assessment, pre-operative education, and post-operative management of adolescents undergoing WLS. Eligibility criteria and pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well-developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. The composition of clinical team and institutional resources is consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS. © 2013 Published by Elsevier Inc.

  17. Recent advances in bariatric/metabolic surgery: appraisal of clinical evidence.

    Science.gov (United States)

    Lee, Wei-Jei; Almulaifi, Abdullah

    2015-04-01

    Obesity and associated type 2 diabetes mellitus (T2DM) are becoming a serious medical issue worldwide. Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese patients. Increasing data indicates bariatric surgery as metabolic surgery is an effective and novel therapy for not well controlled obese T2DM patients. The review of recent developments in bariatric/metabolic surgery covers 4 major fields. 1) Improvement of safety: recent advances in laparoscopic/metabolic surgery has made this minimal invasive surgery more than ten times safer than a decade ago. The safety profile of laparoscopic/metabolic surgery is compatible with that of laparoscopic cholecystectomy now. 2) New bariatric/metabolic surgery: laparoscopic sleeve gastrectomy (LSG) is becoming the leading bariatric surgery because of its simplicity and efficacy. Other new procedures, such as gastric plication, banded plication, single anastomosis (mini) gastric bypass and Duodeno-jejunal bypass with sleeve gastrectomy have all been accepted as treatment modalities for bariatric/metabolic surgery. 3) Mechanism of bariatric/metabolic surgery: Restriction is the most important mechanism for bariatric surgery. Weight regain after bariatric surgery is usually associated with loss of restriction. Recent studies demonstrated that gut hormone, microbiota and bile acid changes after bariatric surgery may play an important role in durable weight loss as well as in T2DM remission. However, weight loss is still the cornerstone of T2DM remission after metabolic surgery. 4) PATIENT SELECTION: patients who may benefit most from bariatric surgery was found to be patients with insulin resistance. For Asian T2DM patients, the indication of metabolic surgery has been set to those with not well controlled (HbA1c > 7.5%) disease and with their BMI > 27.5 Kg/m(2). A novel diabetes surgical score, ABCD score, is a simple system for predicting the success of surgical therapy

  18. Emergency endoscopy for gastrointestinal bleeding after bariatric surgery. Therapeutic algorithm.

    Science.gov (United States)

    García-García, María Luisa; Martín-Lorenzo, Juan Gervasio; Torralba-Martínez, José Antonio; Lirón-Ruiz, Ramón; Miguel Perelló, Joana; Flores Pastor, Benito; Pérez Cuadrado, Enrique; Aguayo Albasini, José Luis

    2015-02-01

    Gastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2-4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm. From January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy. Twenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1(st)-6(th) postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15-20 days after surgery. All other patients were managed non-operatively. Conservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow- up is very important for early detention and treatment of this complication. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Economic considerations for bariatric surgery and morbid obesity.

    Science.gov (United States)

    Frezza, Eldo E; Wacthell, Mitchell; Ewing, Bradley

    2009-01-01

    The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years.

  20. Bile Acids, FXR, and Metabolic Effects of Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Olivier F. Noel

    2016-01-01

    Full Text Available Overweight and obesity represent major risk factors for diabetes and related metabolic diseases. Obesity is associated with a chronic and progressive inflammatory response leading to the development of insulin resistance and type 2 diabetes (T2D mellitus, although the precise mechanism mediating this inflammatory process remains poorly understood. The most effective intervention for the treatment of obesity, bariatric surgery, leads to glucose normalization and remission of T2D. Recent work in both clinical studies and animal models supports bile acids (BAs as key mediators of these effects. BAs are involved in lipid and glucose homeostasis primarily via the farnesoid X receptor (FXR transcription factor. BAs are also involved in regulating genes involved in inflammation, obesity, and lipid metabolism. Here, we review the novel role of BAs in bariatric surgery and the intersection between BAs and immune, obesity, weight loss, and lipid metabolism genes.

  1. Mechanisms of weight loss and improved metabolism following bariatric surgery.

    Science.gov (United States)

    Mulla, Christopher M; Middelbeek, Roeland J W; Patti, Mary-Elizabeth

    2017-09-03

    Bariatric surgery is increasingly recognized as one of the most effective interventions to help patients achieve significant and sustained weight loss, as well as improved metabolic and overall health. Unfortunately, the cellular and physiological mechanisms by which bariatric surgery achieves weight loss have not been fully elucidated, yet are critical to understanding the central role of the intestinal tract in whole-body metabolism and to developing novel strategies for the treatment of obesity. In this review, we provide an overview of potential mechanisms contributing to weight loss, including effects on regulation of energy balance and both central and peripheral nervous system regulation of appetite and metabolism. Moreover, we highlight the importance of the gastrointestinal tract, including alterations in bile acid physiology, secretion of intestinally derived hormones, and the microbiome, as a potent mediator of improved metabolism in postbariatric patients. © 2017 New York Academy of Sciences.

  2. Economic considerations for bariatric surgery and morbid obesity

    Science.gov (United States)

    Frezza, Eldo E; Wacthell, Mitchell; Ewing, Bradley

    2009-01-01

    The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years. PMID:21935309

  3. THE ALCOHOL CONSUMPTION IS AMENDED AFTER BARIATRIC SURGERY? AN INTEGRATIVE REVIEW

    OpenAIRE

    GREGORIO,Valeria Duarte; LUCCHESE, Roselma; Vera,Ivânia; SILVA, Graciele C.; SILVA, Andrecia; MORAES, Rayrane Clarah Chaveiro

    2016-01-01

    ABSTRACT Background Bariatric surgery has been an alternative when conservative methods of weight loss fail. Patients undergoing bariatric surgery have an increased risk of up to 6.5% of problems related to alcohol Objective: Integrative review out to analyze the change of alcohol consumption in this public Method: Database was accessed from June of 2015 to January of 2016 by searching "bariatric surgery" AND "alcoholism", and their Portuguese equivalents. ScienceDirect, PubMed, Lilacs and...

  4. EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPY IN PATIENTS UNDERGOING BARIATRIC SURGERY

    OpenAIRE

    2015-01-01

    Background: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients. Aim: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control gr...

  5. [Bariatric surgery in the treatment of severe obesity].

    Science.gov (United States)

    Dhahri, Abdennaceur; Qassemyar, Quentin; Verhaeghe, Pierre; Desailloud-Godard, Rachel; Badaoui, Rachid; Regimbeau, Jean-Marc

    2009-11-20

    Over the past ten years, the treatment of severe obesity has radically changed through the benefits of bariatric surgery not only on weight loss significant and lasting, but also on reducing mortality, correction of metabolic disorders, reduction of cardiovascular risk and improving the quality of life. Its indication should be multidisciplinary. Laparoscopy has become the rule, reducing the postoperative morbimortality. Four types of intervention are regularly performed in France. We report their principle, their results and major complications.

  6. Peroneal palsy after bariatric surgery: is nerve decompresion always necessary?

    Directory of Open Access Journals (Sweden)

    Ana M. Ramos-Leví

    2013-08-01

    Full Text Available We present two patients who underwent successful bariatric surgery and developed peroneal nerve palsy six months after the procedure. This is an unusual complication which determines a significant functional limitation, mainly because of foot drop, and its presence may be a hallmark of excessive and rapid weight loss. We discuss possible pathogenic mechanisms and therapeutic options, and we emphasize the important role of an adequate nutritional management, in order to avoid the need for a surgical nerve decompression.

  7. Psychological Assessment of the Patient Undergoing Bariatric Surgery

    OpenAIRE

    Snyder, Allison G.

    2009-01-01

    The purpose of this article is to provide an overview of the critical domains assessed during the psychological evaluation of candidates for bariatric surgery. Although no formal standard exists in the literature, there is growing recognition of the important elements to be addressed and the appropriate means for collecting the necessary data to determine psychological readiness for these procedures. Information regarding the components of the clinical interview and the specific measures used...

  8. Economic considerations for bariatric surgery and morbid obesity

    Directory of Open Access Journals (Sweden)

    Eldo E Frezza

    2009-12-01

    Full Text Available Eldo E Frezza, Mitchell Wacthell1, Bradley Ewing21Center for Metabolic Disease and Texas Tech University, Department of Pathology, 2Rawls Business School, Texas Tech University, Lubbock, TX, USAAbstract: The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years.Keywords: bariatric surgery, morbid obesity, economics

  9. Pregnancy outcomes in women with bariatric surgery as compared with morbidly obese women.

    Science.gov (United States)

    Abenhaim, Haim A; Alrowaily, Nouf; Czuzoj-Shulman, Nicholas; Spence, Andrea R; Klam, Stephanie L

    2016-11-01

    Pregnancies among morbidly obese women are associated with serious adverse maternal and neonatal outcomes. Our study objective is to evaluate the effect of bariatric surgery on obstetrical outcomes. We carried out a retrospective cohort study using the healthcare cost and utilization project - Nationwide Inpatient Sample from 2003 to 2011 comparing outcome of births among women who had undergone bariatric surgery with births among women with morbid obesity. Logistic regression was used to estimate the adjusted effect of bariatric surgery on maternal and newborn outcomes. There were 8 475 831 births during the study period (221 580 (2.6%) in morbidly obese women and 9587 (0.1%) in women with bariatric surgery). Women with bariatric surgery were more likely to be Caucasian and ≥35 years old as compared with morbidly obese women. As compared with women with morbid obesity, women with bariatric surgery had lower rates of hypertensive disorders, premature rupture of membrane, chorioamnionitis, cesarean delivery, instrumental delivery, postpartum hemorrhage, and postpartum infection. Induction of labor, postpartum blood transfusions, venous thromboembolisms, and intrauterine fetal growth restriction were more common in the bariatric surgery group. There were no differences observed in preterm births, fetal deaths, or reported congenital anomalies. In general, women who undergo bariatric surgery have improved pregnancy outcomes as compared with morbidly obese women. However, the bariatric surgery group was more likely to have venous thromboembolisms, to require a blood transfusion, to have their labor induced and to experience fetal growth restriction.

  10. Risk of Abdominal Surgery in Pregnancy Among Women Who Have Undergone Bariatric Surgery.

    Science.gov (United States)

    Stuart, Andrea; Källen, Karin

    2017-05-01

    To compare the rates of abdominal surgery during pregnancy among women with previous bariatric surgery (women in the case group) and women with first-trimester body mass index (BMI) greater than 35 and no previous bariatric surgery (women in the control group). We conducted a national cohort study, merging data from the Swedish Medical Birth Registry and the Swedish National Patient Registry, comparing women who had bariatric surgery from 1987 to 2011 with women in a control group with first-trimester BMI greater than 35 who had not had bariatric surgery. Primary outcome variables were diagnosis and surgical procedure codes grouped as five outcome categories: 1) intestinal obstruction, 2) gallbladder disease, 3) appendicitis, 4) hernia, and 5) diagnostic laparoscopy or laparotomy without the presence of a diagnosis or surgical code for outcomes in outcome categories 1-4. Odds ratios were computed using multivariate linear regression analysis for each separate pregnancy. For all pregnancies in a given woman, general estimating equations with robust variance estimation were used. Adjustment was made for smoking, year of delivery, maternal age, and previous abdominal surgery. During the first pregnancy after bariatric surgery, the rate of surgery for intestinal obstruction was 1.5% (39/2,543; 95% confidence interval [CI] 1.1-2.0%) in women in the case group compared with 0.02% (4/21,909; 95% CI 0.0-0.04%) among women in the control group (adjusted odds ratio [OR] 34.3, 95% CI 11.9-98.7). Similarly, the rate of diagnostic laparoscopy or laparotomy was 1.5% (37/2,542; 95% CI 1.0-1.9%) among women in the case group compared with 0.1% (18/21,909; 95% CI 0.0-0.1%) among women in the control group (adjusted OR 11.3, 95% CI 6.9-18.5). Bariatric surgery is associated with an increased risk of abdominal surgery during pregnancy.

  11. Graze eating among bariatric surgery candidates: prevalence and psychosocial correlates.

    Science.gov (United States)

    Goodpaster, Kasey P S; Marek, Ryan J; Lavery, Megan E; Ashton, Kathleen; Merrell Rish, Julie; Heinberg, Leslie J

    2016-06-01

    Graze eating is defined as repetitive, unplanned eating of small amounts of food throughout the day. Little consensuses exist regarding whether graze eating, like binge eating disorder (BED), is characterized by feelings of loss of control (LOC). Furthermore, little is known about how patients who graze eat with and without LOC differ psychologically. The present study seeks to better characterize graze eating by examining differences between graze eating with LOC (+LOC) and without LOC (-LOC) among presurgical bariatric patients. A large, Midwestern academic medical center. The sample consisted of 288 adult bariatric surgery candidates (mean age 45.8, standard deviation [SD] 12.57) who underwent a presurgical psychological evaluation. Graze eating, BED, and other mental health diagnoses were evaluated using a semistructured interview. Participants were also administered the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and binge eating scale (BES). Data were collected using a retrospective chart review. Among the 33% (n = 95) of the sample who reported preoperative graze eating, 32% (n = 30) also endorsed LOC. Graze eating, particularly with LOC, was associated with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) diagnoses of anxiety disorders and BED, and multiple measures of internalizing dysfunction on the MMPI-2-RF. Bariatric surgery candidates who graze eat experience a greater degree of overall distress and psychopathology including anxiety and depression. The minority who experience grazing+LOC appear to have even greater risk of psychopathology. Moreover, there appears to be significant overlap with BED. Future research should explore whether these 2 maladaptive eating patterns benefit from similar treatment. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. Laparoscopic bariatric surgery for the treatment of severe hypertriglyceridemia.

    Science.gov (United States)

    Hsu, Sung-Yu; Lee, Wei-Jei; Chong, Keong; Ser, Kong-Han; Tsou, Jun-Jiun

    2015-04-01

    It is well established that severe hypertriglyceridemia can lead to pancreatitis. At present, medical treatment for patients with severe hypertriglyceridemia and repeat pancreatitis attacks is not adequate. The aim of this study was to assess the effectiveness of laparoscopic bariatric surgery in these patients. A review of 20 morbidly obese patients with severe hypertriglyceridemia (a triglyceride level of >1000 mg/dL) who received laparoscopic bariatric surgery was performed. The study population comprised 14 males and six females, with an average age of 35.0 years (range 24-52 years), and the mean body mass index was 38.2 kg/m(2) (range 25-53 kg/m(2)). The preoperative mean plasma triglyceride level was 1782.7 mg/dL (range 1043-3884 mg/dL). Four patients had a history of hypertriglyceridemic pancreatitis and 13 patients had associated diabetes. Of the 20 patients, 17 (85%) received gastric bypass, whereas three (15%) received restrictive-type surgery. Laparoscopic access was used in all of the patients. Hypertriglyceridemia in morbidly obese patients was more commonly associated with male sex and a poorly controlled diabetic state. The mean weight reduction was 25.5% 1 year after surgery, with a marked improvement in diabetes management. As early as 1 month following surgery, the plasma mean triglyceride levels had decreased to 254 mg/dL (range 153-519 mg/dL), and this was further reduced to mean levels of 192 mg/dL (range 73-385 mg/dL) 1 year after surgery. One patient developed acute pancreatitis during the perioperative period, but none of the patients suffered an episode of pancreatitis in the follow-up period (from 6 months to 13 years). Bariatric surgery can be successfully used as a metabolic surgery in severe hypertriglyceridemia patients at risk of acute pancreatitis. However, control of triglyceride levels prior to bariatric surgery is indicated. Copyright © 2014. Published by Elsevier Taiwan.

  13. Preoperative predictors of weight loss following bariatric surgery: systematic review.

    Science.gov (United States)

    Livhits, Masha; Mercado, Cheryl; Yermilov, Irina; Parikh, Janak A; Dutson, Erik; Mehran, Amir; Ko, Clifford Y; Gibbons, Melinda Maggard

    2012-01-01

    Obesity affects 32% of adults in the USA. Surgery generates substantial weight loss, but 20-30% fails to achieve successful weight loss. Our objective was to identify preoperative psychosocial factors associated with weight loss following bariatric surgery. We performed a literature search of PubMed® and the Cochrane Database of Reviews of Effectiveness between 1988 and April 2010. Articles were screened for bariatric surgery and weight loss if they included a preoperative predictor of weight loss: body mass index (BMI), preoperative weight loss, eating disorders, or psychiatric disorder/substance abuse. One thousand seven titles were reviewed, 534 articles screened, and 115 included in the review. Factors that may be positively associated with weight loss after surgery include mandatory preoperative weight loss (7 of 14 studies with positive association). Factors that may be negatively associated with weight loss include preoperative BMI (37 out of 62 studies with negative association), super-obesity (24 out of 33 studies), and personality disorders (7 out of 14 studies). Meta-analysis revealed a decrease of 10.1% excess weight loss (EWL) for super-obese patients (95% confidence interval (CI) [3.7-16.5%]), though there was significant heterogeneity in the meta-analysis, and an increase of 5.9% EWL for patients with binge eating at 12 months after surgery (95% CI [1.9-9.8%]). Further studies are necessary to investigate whether preoperative factors can predict a clinically meaningful difference in weight loss after bariatric surgery. The identification of predictive factors may improve patient selection and help develop interventions targeting specific needs of patients.

  14. From bariatric to metabolic surgery: Looking for a "disease modifier" surgery for type 2 diabetes.

    Science.gov (United States)

    Cordera, Renzo; Adami, Gian Franco

    2016-01-25

    In this review the recent evolution of the comprehension of clinical and metabolic consequences of bariatric surgery is depicted. At the beginning bariatric surgery aim was a significant and durable weight loss. Later on, it became evident that bariatric surgery was associated with metabolic changes, activated by unknown pathways, partially or totally independent of weight loss. Paradigm of this "metabolic" surgery is its effects on type 2 diabetes mellitus (T2DM). In morbid obese subjects it was observed a dramatic metabolic response leading to decrease blood glucose, till diabetes remission, before the achievement of clinically significant weight loss, opening the avenue to search for putative anti-diabetic "intestinal" factors. Both proximal duodenal (still unknown) and distal (GLP1) signals have been suggested as hormonal effectors of surgery on blood glucose decrease. Despite these findings T2DM remission was never considered a primary indication for bariatric surgery but only a secondary one. Recently T2DM remission in obese subjects with body mass index (BMI) greater than 35 has become a primary aim for surgery. This change supports the idea that "metabolic surgery" definition could more appropriate than bariatric, allowing to explore the possibility that metabolic surgery could represent a "disease modifier" for T2DM. Therefore, several patients have undergone surgery with a primary aim of a definitive cure of T2DM and today this surgery can be proposed as an alternative therapy. How much surgery can be considered truly metabolic is still unknown. To be truly "metabolic" it should be demonstrated that surgery could cause T2DM remission not only in subjects with BMI > 35 but also with BMI < 35 or even < 30. Available evidence on this topic is discussed in this mini-review.

  15. Interest in bariatric surgery among obese patients with obstructive sleep apnea.

    Science.gov (United States)

    Dudley, Katherine A; Tavakkoli, Ali; Andrews, Robert A; Seiger, Ashley N; Bakker, Jessie P; Patel, Sanjay R

    2015-01-01

    Standard obstructive sleep apnea (OSA) therapies are poorly tolerated. Bariatric surgery is a potential alternative but the level of interest in this intervention among OSA patients is unknown. Determine the proportion of OSA patients who would be interested in bariatric surgery. Sleep clinics, United States. Consecutive adult patients with untreated severe OSA and a body mass index of 35-45 kg/m(2) were approached. Patients at low perioperative risk and no urgent indication for OSA treatment were invited to a separate informational visit about bariatric surgery as primary treatment for OSA. Of 767 eligible patients, 230 (30.0%) were not at low perioperative risk, 49 (6.4%) had drowsy driving, and 16 (2.1%) had no insurance coverage for bariatric surgery. Of the remaining 482 patients, over one third (35.5%) were interested in bariatric surgery. Surgical interest was 47.2% in women versus 27.6% in men (Pbariatric surgery interest. Nearly two thirds of obese patients with severe OSA are good candidates for bariatric surgery. Among candidates, over one third are interested in this treatment. Interest rates are highest among women and diabetics, indicating that metabolic improvements continue to be a major driver of surgery even in patients with severe OSA. Given patient interest, the role of bariatric surgery should be routinely discussed with obese OSA patients. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  16. Systematic review of obesity surgery mortality risk score--preoperative risk stratification in bariatric surgery.

    Science.gov (United States)

    Thomas, Harun; Agrawal, Sanjay

    2012-07-01

    Bariatric surgery is the best long term treatment for morbid obesity. However, it carries risks of considerable morbidity and potential mortality. There is no published review on pre-operative identification of high-risk patients in bariatric surgery. This systematic review analyses obesity surgery mortality risk score (OS-MRS) as a tool for pre-operative prediction of mortality risk in bariatric surgery. Medline and Embase was systematically searched using the medical subjects headings (MeSH) terms 'bariatric surgery' and 'mortality' with further free text search and cross references. Studies that described OS-MRS to predict mortality risk after bariatric surgery were included in this review. Six studies evaluated 9,382 patients to assess the validity of OS-MRS to predict the mortality risk after bariatric surgery. Patient's age ranged from 19 to 67 years, and the body mass index ranged from 30 to 84. There were 83 deaths among the 9,382 patients (0.88 %) with individual studies reporting a mortality range from 0 % to 1.49 %. There were 13 deaths among 4,912 (0.26 %) class A patients, 55 deaths among 4,124 (1.33 %) class B patients and 15 deaths among 346 (4.34 %) class C patients. Mortality in classes A, B and C was significantly different from each of the other two classes (P < 0.05, χ(2)). This systematic review confirms that OS-MRS stratifies the mortality risk in the three-risk classification subgroups of patients. The OS-MRS can be used for pre-operative identification of high-risk patients undergoing primary Roux-en-Y gastric bypass surgery.

  17. Complications of bariatric surgery: Presentation and emergency management.

    Science.gov (United States)

    Kassir, Radwan; Debs, Tarek; Blanc, Pierre; Gugenheim, Jean; Ben Amor, Imed; Boutet, Claire; Tiffet, Olivier

    2016-03-01

    The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  18. Medication and nutritional supplement use before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Charline Fernanda Backes

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: Bariatric surgery has been an effective alternative treatment for morbid obesity and has resulted in decreased mortality, better control over comorbidities and reduced use of drugs. The objective of this study was to analyze the impact of bariatric surgery on medication drug and nutritional supplement use. DESIGN AND SETTING: Longitudinal study of before-and-after type, on 69 morbidly obese patients in a public hospital in Porto Alegre. METHODS: Through interviews, the presence of comorbidities and use of drugs with and without prescription were evaluated. RESULTS: Among the 69 patients interviewed, 85.5% had comorbidities in the preoperative period, with an average of 2.3 (± 1.5 per patient. The main comorbidities reported were hypertension, diabetes and dyslipidemia. 84.1% of the patients were using prescribed drugs in the preoperative period. The mean drug use per patient was 4.8, which decreased to 4.4 after the procedure. The surgery enabled significant reduction in use of most antidiabetic (84%, antilipemic (77% and antihypertensive drugs (49.5%. On the other hand, there was a significant increase in use of multivitamins and drugs for disorders of the gastrointestinal tract. The dosages of most of the drugs that continued to be prescribed after surgery were decreased, but not significantly. CONCLUSION: After bariatric surgery, there were increases in the use of vitamins, gastric antisecretory drugs and antianemic drugs. Nevertheless, there was an overall reduction in drug use during this period, caused by suspension of drugs or dose reduction.

  19. Bariatric surgery: a viable treatment option for patients with severe mental illness.

    Science.gov (United States)

    Shelby, Sarah R; Labott, Susan; Stout, Rebecca A

    2015-01-01

    Although bariatric surgery has become a recognized treatment for obesity, its utility among patients with severe psychiatric disorders has not been extensively studied. A few studies have reported similar weight loss outcomes in these patients, but psychiatric status after bariatric surgery has been studied only minimally, and it is unknown if exacerbation of the mental illness affects weight loss. The aim of this study was to shed greater light on the issue of serious mental illness and bariatric surgery. Specifically, do patients with a diagnosis of schizophrenia, bipolar I, and bipolar II have poorer weight loss outcomes postbariatric surgery than the general bariatric surgery population? Also, do patients with these diagnoses experience an exacerbation of psychiatric symptoms after bariatric surgery, and if so, is the exacerbation of these disorders linked to poorer weight loss results? Midwest university medical center. A medical record review of approximately 1500 bariatric patients in a Midwest university medical center was conducted to identify those patients with diagnoses of schizophrenia, bipolar I, and bipolar II. Information was gathered on bariatric surgery outcomes and changes in psychiatric status postsurgery. Eighteen patients were identified as undergoing bariatric surgery and having a diagnosis of schizophrenia, bipolar I, or bipolar II. Weight loss in this group was significant and comparable to expected outcomes of absolute weight lost, changes in body mass index, and percentage excess weight loss for patients in the typical bariatric population. Postsurgery psychiatric status was known on 10 patients. All 10 patients experienced some exacerbation of psychiatric problems yet weight loss outcomes were still as expected. Bariatric surgery is a viable obesity treatment option for patients with schizophrenia, bipolar I, and bipolar II disorders. Symptom exacerbations occurred postsurgery, although it is not clear if these were due to the surgery or

  20. The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery.

    Science.gov (United States)

    Khanbhai, M; Dubb, S; Patel, K; Ahmed, A; Richards, T

    2015-01-01

    As bariatric surgery rates continue to climb, anaemia will become an increasing concern. We assessed the prevalence of anaemia and length of hospital stay in patients undergoing bariatric surgery. Prospective data (anaemia [haemoglobin bariatric surgery. Results from a prospective database of 1530 patients undergoing elective general surgery were used as a baseline. Fifty-seven patients (14%) were anaemic pre-operatively, of which 98% were females. Median MCV (fL) and overall median ferritin (μg/L) was lower in anaemic patients (83 vs. 86, p=0.001) and (28 vs. 61, psurgery patients, prevalence of anaemia was similar (14% vs. 16%) but absolute iron deficiency was more common in those undergoing bariatric surgery; microcytosis pbariatric surgery. In bariatric patients with anaemia there was an overall increased length of hospital stay. Copyright © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

  1. Food quality in the late postoperative period of bariatric surgery: an evaluation using the bariatric food pyramid.

    Science.gov (United States)

    Soares, Fernando Lucas; Bissoni de Sousa, Larissa; Corradi-Perini, Carla; Ramos da Cruz, Magda Rosa; Nunes, Mario Gilberto Jesus; Branco-Filho, Alcides José

    2014-09-01

    Bariatric surgery is an effective intervention in the treatment of obesity, but lifestyle and diet should be monitored after this procedure to ensure success. The Bariatric Food Pyramid was created basing on long-term nutritional care that proposes a standard of healthy living and eating habits considering gastric capacity and specific nutritional needs. The purpose of the current study is to evaluate the life habits and diet quality of patients who have undergone bariatric surgery (who have been recovering for at least 6 months) based on the specific food pyramid. Retrospective data analysis was performed using medical records of patients who had been followed for at least 6 months after bariatric surgery. The following data were collected from patient records: age, gender, education level (years), BMI (preoperative and postoperative), percentage of excess weight loss (EWL) relative to the time of surgery, frequency of physical activity, use of nutritional supplements, usual dietary intake history, and fluid intake. Results were analyzed using descriptive statistics. We evaluated 172 patient records. In this study, there was a low prevalence of physical activity, use of vitamin-mineral supplements, and water intake. There also was low consumption of protein, fruit, vegetables, and vegetable oils. In addition, intake of carbohydrates, sugars, and fats were higher than the recommendations established by the pyramid. The results indicate that patients who have undergone bariatric surgery have an inadequate diet according to food evaluation with the specific pyramid. In the long term, this may lead to weight gain and vitamin and mineral deficiencies.

  2. Baropodometric analyses of patients before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ivan Leo Bacha

    2015-11-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the vertical component of the ground reaction force, plantar pressure, contact area of the feet and double-support time using static and dynamic (gait baropodometry before and after bariatric surgery. METHODS: Sixteen individuals with a body mass index of between 35 and 55 were evaluated before and after bariatric surgery. Thirteen patients (81.3% were female and three (18.8% male and their average age was 46±10 (21-60 years. An FSCAN system (version 3848 was used for baropodometric analyses (1 km/h and 3 km/h. The peak plantar pressure and ground reaction force were measured for the rear foot and forefoot. The double-support time and foot contact area were measured during gait. RESULTS: There were reductions in the ground reaction force in the forefoot and rear foot and in the foot contact area in all evaluations and of the double-support time at 3 km/h, as well as a significant reduction in the body mass index at six months post-surgery. The peak pressure did not vary at 1 km/h and at 3 km/h, reductions in peak pressure were observed in the left and right rear feet and left forefoot. CONCLUSIONS: Weight loss after bariatric surgery resulted in decreases in the ground reaction force and contact area of the foot. Plantar pressure was decreased at 3 km/h, especially in the forefoot. There was an increase in rhythm because of a reduction in the double-support time at 3 km/h.

  3. Bariatric surgery does not improve outcomes in patients undergoing primary total knee arthroplasty.

    Science.gov (United States)

    Martin, J R; Watts, C D; Taunton, M J

    2015-11-01

    Bariatric surgery has been advocated as a means of reducing body mass index (BMI) and the risks associated with total knee arthroplasty (TKA). However, this has not been proved clinically. In order to determine the impact of bariatric surgery on the outcome of TKA, we identified a cohort of 91 TKAs that were performed in patients who had undergone bariatric surgery (bariatric cohort). These were matched with two separate cohorts of patients who had not undergone bariatric surgery. One was matched 1:1 with those with a higher pre-bariatric BMI (high BMI group), and the other was matched 1:2 based on those with a lower pre-TKA BMI (low BMI group). In the bariatric group, the mean BMI before bariatric surgery was 51.1 kg/m(2) (37 to 72), which improved to 37.3 kg/m(2) (24 to 59) at the time of TKA. Patients in the bariatric group had a higher risk of, and worse survival free of, re-operation (hazard ratio (HR) 2.6; 95% confidence interval (CI) 1.2 to 6.2; p = 0.02) compared with the high BMI group. Furthermore, the bariatric group had a higher risk of, and worse survival free of re-operation (HR 2.4; 95% CI 1.2 to 3.3; p = 0.2) and revision (HR 2.2; 95% CI 1.1 to 6.5; p = 0.04) compared with the low BMI group. While bariatric surgery reduced the BMI in our patients, more analysis is needed before recommending bariatric surgery before TKA in obese patients.

  4. No more broken hearts: weight loss after bariatric surgery returns patients' postoperative risk to baseline following coronary surgery.

    Science.gov (United States)

    Baimas-George, Maria; Hennings, Dietric L; Al-Qurayshi, Zaid; Emad Kandil; DuCoin, Christopher

    2017-06-01

    The obesity epidemic is associated with a rise in coronary surgeries because obesity is a risk factor for coronary artery disease. Bariatric surgery is linked to improvement in cardiovascular co-morbidities and left ventricular function. No studies have investigated survival advantage in postoperative bariatric patients after coronary surgery. To determine if there is a benefit after coronary surgery in patients who have previously undergone bariatric surgery. National Inpatient Sample. We performed a retrospective, cross-sectional analysis of the National Inpatient Sample database from 2003 to 2010. We selected bariatric surgical patients who later underwent coronary surgery (n = 257). A comparison of postoperative complications and mortality after coronary surgery were compared with controls (n = 1442) using χ(2) tests, linear regression analysis, and multivariate logistical regression models. A subset population was identified as having undergone coronary surgery (n = 1699); of this population, 257 patients had previously undergone bariatric surgery. They were compared with 1442 controls. The majority was male (67.2%), white (82.6%), and treated in an urban environment (96.8%). Patients with bariatric surgery assumed the risk of postoperative complications after coronary surgery that was associated with their new body mass index (BMI) (BMI999.9, 95% CI .18 to>999.9, P = .07). Length of stay was significantly longer in postbariatric patients (BMIbariatric patients have a return to baseline risk of morbidity and mortality after coronary surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  5. Aspects of Exercise before or after Bariatric Surgery: A Systematic Review

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    Sjaak Pouwels

    2015-04-01

    Full Text Available Background: Bariatric surgery has a considerable effect on weight loss. A positive relation of exercise and weight loss has been described before. However, the mode of exercise and its timing pre- or postoperatively or a combination remains unclear. Methods: A multi-database search was conducted. Identified articles were reviewed on description of exercise, timing around a bariatric intervention, and outcome. Methodological quality of the included studies was rated using the Physiotherapy Evidence Database scale. A Cohen's kappa score assessed the level of agreement. Outcome measurements were improvement of anthropometric and physical fitness variables, operation related complications, weight regain, and quality of life. Results: A total of 8 prospective studies were included. Four focused on training before and 4 on training after a bariatric procedure. Details of exercises varied from 45 min treadmill up to full descriptive programs. Supervision was frequently included. Significant improvement was encountered for biometric results physical fitness variables. Conclusion: In the majority of reports on exercising in a (future bariatric population, positive effects on anthropometrics, cardiovascular risk factors and physical fitness were described. However, the results were not unanimous, with a wide range of exercise programs and perioperative timing, therefore hampering adequate practical guidance.

  6. Confirmatory Factor Analysis of the Beck Depression Inventory-II in Bariatric Surgery Candidates

    Science.gov (United States)

    Hall, Brian J.; Hood, Megan M.; Nackers, Lisa M.; Azarbad, Leila; Ivan, Iulia; Corsica, Joyce

    2013-01-01

    Screening for depression is an integral part of psychological evaluations conducted prior to bariatric surgery. The Beck Depression Inventory-II (BDI-II) is the most commonly used measure of depression in these treatment evaluations. The reliability and validity of the BDI-II has not yet been evaluated within bariatric surgery-seeking samples,…

  7. Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes

    NARCIS (Netherlands)

    Yska, Jan Peter; van der Linde, Susanne; Tapper, Veronique V.; Apers, Jan A.; Emous, Marloes; Totte, Erik R.; Wilffert, Bob; van Roon, Eric N.

    2013-01-01

    The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes t

  8. Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes

    NARCIS (Netherlands)

    Yska, Jan Peter; van der Linde, Susanne; Tapper, Veronique V.; Apers, Jan A.; Emous, Marloes; Totte, Erik R.; Wilffert, Bob; van Roon, Eric N.

    The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes

  9. Confirmatory Factor Analysis of the Beck Depression Inventory-II in Bariatric Surgery Candidates

    Science.gov (United States)

    Hall, Brian J.; Hood, Megan M.; Nackers, Lisa M.; Azarbad, Leila; Ivan, Iulia; Corsica, Joyce

    2013-01-01

    Screening for depression is an integral part of psychological evaluations conducted prior to bariatric surgery. The Beck Depression Inventory-II (BDI-II) is the most commonly used measure of depression in these treatment evaluations. The reliability and validity of the BDI-II has not yet been evaluated within bariatric surgery-seeking samples,…

  10. Endoscopic Approach for Major Complications of Bariatric Surgery

    Science.gov (United States)

    Joo, Moon Kyung

    2017-01-01

    As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures. PMID:28008162

  11. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

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    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  12. FUNCTIONAL ASSESSMENT OF OLDER OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY

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    Denis PAJECKI

    2014-03-01

    Full Text Available Context Obesity in the elderly is associated with exacerbation of functional decline (dependency, that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years. Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72 and 75% were women. They had an average weight of 121.1 kg (72.7-204 and a mean BMI of 47.2 kg/m2 (35.8-68.9. 16 patients (40% have shown dependency for activities of daily living, 19 (47,5% for instrumental activities of daily living and 20 patients (50% had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression has shown

  13. A Cognitive-Behavioral Mindfulness Group Therapy Intervention for the Treatment of Binge Eating in Bariatric Surgery Patients

    Science.gov (United States)

    Leahey, Tricia M.; Crowther, Janis H.; Irwin, Sharon R.

    2008-01-01

    Binge eating is a negative indicator of post-surgical weight loss and health outcome in bariatric surgery patients (Hsu, Bentancourt, Sullivan, 1996). Cognitive-behavioral techniques and mindfulness-based practices have been shown to successfully treat binge eating (Agras, Telch, Arnow, Eldredge, & Marnell, 1997; Kristeller & Hallett, 1999). This…

  14. A Cognitive-Behavioral Mindfulness Group Therapy Intervention for the Treatment of Binge Eating in Bariatric Surgery Patients

    Science.gov (United States)

    Leahey, Tricia M.; Crowther, Janis H.; Irwin, Sharon R.

    2008-01-01

    Binge eating is a negative indicator of post-surgical weight loss and health outcome in bariatric surgery patients (Hsu, Bentancourt, Sullivan, 1996). Cognitive-behavioral techniques and mindfulness-based practices have been shown to successfully treat binge eating (Agras, Telch, Arnow, Eldredge, & Marnell, 1997; Kristeller & Hallett, 1999). This…

  15. Bariatric Surgery Prior to Total Knee Arthroplasty is Associated With Fewer Postoperative Complications.

    Science.gov (United States)

    Werner, Brian C; Kurkis, Gregory M; Gwathmey, F Winston; Browne, James A

    2015-09-01

    This study used a national database to compare 90-day postoperative complication rates between three groups of patients who underwent total knee arthroplasty (TKA): (1) non-obese patients (n=66,523), (2) morbidly obese patients who did not have bariatric surgery (n=11,294) and (3) morbidly obese patients who underwent bariatric surgery prior to TKA (n=219). Morbidly obese patients who underwent bariatric surgery prior to TKA had reduced rates of major (OR 0.45, P=0.001) and minor (OR 0.61, P=0.01) complications compared to morbidly obese patients who did not have bariatric surgery. Bariatric surgery prior to TKA appears to be associated with less risk of postoperative complications, although not to the same level as non-obese patients.

  16. Bariatric Surgery and Liver Cancer in a Consortium of Academic Medical Centers.

    Science.gov (United States)

    Yang, Baiyu; Yang, Hannah P; Ward, Kristy K; Sahasrabuddhe, Vikrant V; McGlynn, Katherine A

    2016-03-01

    Obesity is implicated as an important factor in the rising incidence of liver cancer in the USA. Bariatric surgery is increasingly used for treating morbid obesity and comorbidities. Using administrative data from UHC, a consortium of academic medical centers in the USA, we compared the prevalence of liver cancer among admissions with and without a history of bariatric surgery within a 3-year period. Admissions with a history of bariatric surgery had a 61 % lower prevalence of liver cancer compared to those without a history of bariatric surgery (prevalence ratio 0.39, 95 % confidence interval 0.35-0.44), and these inverse associations persisted within strata of sex, race, and ethnicity. This hospital administrative record-based analysis suggests that bariatric surgery could play a role in liver cancer prevention.

  17. Oral Anticoagulant Use After Bariatric Surgery: A Literature Review and Clinical Guidance.

    Science.gov (United States)

    Martin, Karlyn A; Lee, Craig R; Farrell, Timothy M; Moll, Stephan

    2017-05-01

    Bariatric surgery may alter the absorption, distribution, metabolism, or elimination (disposition) of orally administered drugs via changes to the gastrointestinal tract anatomy, body weight, and adipose tissue composition. As some patients who have undergone bariatric surgery will need therapeutic anticoagulation for various indications, appropriate knowledge is needed regarding anticoagulant drug disposition and resulting efficacy and safety in this population. We review general considerations about oral drug disposition in patients after bariatric surgery, as well as existing literature on oral anticoagulation after bariatric surgery. Overall, available evidence on therapeutic anticoagulation is very limited, and individual drug studies are necessary to learn how to safely and effectively use the direct oral anticoagulants. Given the sparsity of currently available data, it appears most prudent to use warfarin with international normalized ratio monitoring, and not direct oral anticoagulants, when full-dose anticoagulation is needed after bariatric surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Long-term follow-up after bariatric surgery in a national cohort.

    Science.gov (United States)

    Thereaux, J; Lesuffleur, T; Païta, M; Czernichow, S; Basdevant, A; Msika, S; Millat, B; Fagot-Campagna, A

    2017-09-01

    Lifelong medical follow-up is mandatory after bariatric surgery. The aim of this study was to assess the 5-year follow-up after bariatric surgery in a nationwide cohort of patients. All adult obese patients who had undergone primary bariatric surgery in 2009 in France were included. Data were extracted from the French national health insurance database. Medical follow-up (medical visits, micronutrient supplementation and blood tests) during the first 5 years after bariatric surgery was assessed, and compared with national and international guidelines. Some 16 620 patients were included in the study. The percentage of patients with at least one reimbursement for micronutrient supplements decreased between the first and fifth years for iron (from 27.7 to 24.5 per cent; P bariatric surgery is poor, especially for young men with poor early follow-up. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  19. Wishing for deburdening through a sustainable control after bariatric surgery

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    My Engström

    2011-02-01

    Full Text Available The aim of this study was an in-depth investigation of the change process experienced by patients undergoing bariatric surgery. A prospective interview study was performed prior to as well as 1 and 2 years after surgery. Data analyses of the transcribed interviews were performed by means of the Grounded Theory method. A core category was identified: Wishing for deburdening through a sustainable control over eating and weight, comprising three related categories: hoping for deburdening and control through surgery, feeling deburdened and practising control through physical restriction, and feeling deburdened and trying to maintain control by own willpower. Before surgery, the participants experienced little or no control in relation to food and eating and hoped that the bariatric procedure would be the first brick in the building of a foundation that would lead to control in this area. The control thus achieved in turn affected the participants’ relationship to themselves, their roles in society, and the family as well as to health care. One year after surgery they reported established routines regarding eating as well as higher self-esteem due to weight loss. In family and society they set limits and in relation to health care staff they felt their concern and reported satisfaction with the surgery. After 2 years, fear of weight gain resurfaced and their self-image was modified to be more realistic. They were no longer totally self-confident about their condition, but realised that maintaining control was a matter of struggle to obtaining a foundation of sustainable control. Between 1 and 2 years after surgery, the physical control mechanism over eating habits started to more or less fade for all participants. An implication is that when this occurs, health care professionals need to provide interventions that help to maintain the weight loss in order to achieve a good long-term outcome.

  20. [Nutritional implications of bariatric surgery on the gastrointestinal tract].

    Science.gov (United States)

    Rubio, M A; Moreno, C

    2007-05-01

    Anatomical change in the anatomy of the gastrointestinal tract after bariatric surgery leads to modification of dietary patterns that have to be adapted to new physiological conditions, either related with the volume of intakes or the characteristics of the macro- and micronutrients to be administered. Restrictive diet after bariatric surgery (basically gastric bypass and restrictive procedures) is done at several steps. The first phase after surgery consists in the administration of clear liquids for 2-3 days, followed by completely low-fat and high-protein content (> 50-60 g/day) liquid diet for 2-4 weeks, normally by means of formula-diets. Soft or grinded diet including very soft protein-rich foods, such as egg, low-calories cheese, and lean meats such as chicken, cow, pork, or fish (red meats are not so well tolerated) is recommended 2-4 weeks after hospital discharge. Normal diet may be started within 8 weeks from surgery or even later. It is important to incorporate hyperproteic foods with each meal, such egg whites, lean meats, cheese or milk. All these indications should be done under the supervision of an expert nutrition professional to always advise the patients and adapting the diet to some special situations (nausea/vomiting, constipation, diarrhea, dumping syndrome, dehydration, food intolerances, overfeeding, etc.). The most frequent vitamin and mineral deficiencies in the different types of surgeries are reviewed, with a special focus on iron, vitamin B12, calcium, and vitamin D metabolism. It should not be forgotten that the aim of obesity surgery is making the patient loose weight and thus post-surgery diet is designed to achieve that goal although without forgetting the essential role that nutritional education has on the learning of new dietary habits contributing to maintain that weight loss over time.

  1. Pursuing bariatric surgery in an urban area: Gender and racial disparities and risk for psychiatric symptoms.

    Science.gov (United States)

    Miller-Matero, Lisa Renee; Tobin, Erin T; Clark, Shannon; Eshelman, Anne; Genaw, Jeffrey

    2016-01-01

    Bariatric surgery is effective for weight loss; however, only a small percentage of those who qualify choose to pursue it. Additionally, although psychiatric symptoms appear to be common among candidates, the risk factors for symptoms are not known. Therefore, the purpose of this study was to examine the characteristics of those who are pursuing bariatric surgery in an urban area, whether demographic disparities continue to exist, and identify characteristics of those who may be at higher risk for experiencing psychiatric symptoms. There were 424 bariatric candidates who completed a required psychological evaluation prior to bariatric surgery. Bariatric surgery candidates tended to be middle-aged, Caucasian females, which was unexpected when compared to the rates of obesity among these groups. Therefore, it appears that there are disparities in who chooses to seek out bariatric surgery compared to those who may qualify due to their obesity status. Cultural factors may play a role in why males and African Americans seek out bariatric surgery less frequently. Psychiatric symptoms among candidates are also common, with depression symptoms increasing with age and BMI. Perhaps the compounding effects of medical comorbidities over time are contributing to greater depressive symptoms in the older patients. Findings from this study suggest that we may need to explore ways of encouraging younger patients, males, and ethnic minorities to pursue bariatric surgery to increase weight loss success and decrease medical comorbidities. Copyright © 2015 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

  2. Temperament and Personality in Bariatric Surgery-Resisting Temptations?

    Science.gov (United States)

    Claes, Laurence; Müller, Astrid

    2015-11-01

    Temperament and personality traits can serve as both risk factors as well as protective factors in the development of morbid obesity. In the present review, we present an overview of studies focusing on the relationship between temperament/personality and morbid obesity in pre-operative and postoperative bariatric surgery patients. We consider studies that focus on both a categorical and dimensional point of view on temperament/personality, as well as studies based on cross-sectional and longitudinal designs. Finally, we will integrate the research findings, discuss the implications for assessment and treatment and formulate suggestions for future research.

  3. Bariatric surgery - effects on obesity and related co-morbidities

    DEFF Research Database (Denmark)

    Svane, Maria Saur; Madsbad, Sten

    2014-01-01

    hormone responses, especially a 10-fold increase in glucagon-like peptide-1 (GLP-1), which improves insulin secretion. After gastric banding, the remission of diabetes depends more on weight loss. Bariatric surgery reduces cardiovascular risk factors including hypertension, lipid disturbances, non...... after RYGB and SG, where the mean weight loss is about 40 kg or 15 body mass index (BMI) units. Some of the benefits after RYGB and SG are independent of weight loss, and the remission of type 2 diabetes is observed a few days after the operation; this depends on changes in insulin sensitivity and gut...

  4. Effects of bariatric surgery on the body composition of adults

    Directory of Open Access Journals (Sweden)

    Tiago Wally Hartwig

    2013-09-01

    Full Text Available The most alarming cases are known as morbidly obese. An effective method to change the anthropometric characteristics of this population with excess body weight and high fat mass is bariatric surgery. The objective of this study was to analyze the body composition of morbidly obese patients undergoing bariatric surgery in the city of Pelotas, Southern Brazil. In a prospective cohort study, a group of morbidly obese patients was followed up 30 days before and 30 days after surgery. The sample consisted of 123 patients who underwent vertical banded Roux-en-Y gastroplasty between April 2003 and May 2010. Body composition (fat percentage was determined by bioelectrical impedance analysis. The mean age of the patients was 36.1 ± 8.8 years and mean body weight loss was 14.1 ± 6.0 kg (p<0.001. The mean reduction in body mass index (BMI was 5.2 ± 2.1 kg/m2 (p<0.001. Body fat percentage and fat mass were reduced by 2.8% (p<0.001 and 9.7 ± 4.9 kg (p<0.001, respectively. In addition, there was a reduction of 4.4 ± 3.4 kg (p<0.001 in lean mass. We concluded that the surgical procedure significantly reduced body weight, BMI, fat percentage and fat mass and is an alternative when conventional treatments appear ineffective.

  5. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care.

    Directory of Open Access Journals (Sweden)

    Ian J Douglas

    2015-12-01

    Full Text Available Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities.This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM, hypertension, angina, myocardial infarction (MI, stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88-5.08. Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo and sleeve gastrectomy (6.29 kg/mo were associated with greater initial weight reduction than gastric banding (2.77 kg/mo. Protective hazard ratios (HRs were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55-0.83; hypertension, 0.35 (95% CI 0.27-0.45; angina, 0.59 (95% CI 0.40-0.87;MI, 0.28 (95% CI 0.10-0.74; and obstructive sleep apnoea, 0.55 (95% CI 0.40-0.87. Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84-12.62, and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI

  6. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care

    Science.gov (United States)

    Douglas, Ian J.; Bhaskaran, Krishnan; Batterham, Rachel L.; Smeeth, Liam

    2015-01-01

    Background Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities. Methods and Findings This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88–5.08). Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55–0.83); hypertension, 0.35 (95% CI 0.27–0.45); angina, 0.59 (95% CI 0.40–0.87);MI, 0.28 (95% CI 0.10–0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40–0.87). Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84–12.62), and between bariatric surgery and the resolution of

  7. Current status of bariatric surgery in the treatment of type 2 diabetes.

    Science.gov (United States)

    Pinkney, J; Kerrigan, D

    2004-02-01

    Bariatric surgery (from the Greek words baros meaning 'weight' and iatrikos 'the art of healing') is a rapidly evolving branch of surgical science. The aim is to induce major weight loss in those whose obesity places them at high risk of serious health problems. In an attempt to balance the risks of surgery against the benefits of weight loss, bariatric operations are currently performed only in the morbidly obese, or those with a body mass index (BMI) > 35 kgm(-2) who already have developed comorbidity such as type 2 diabetes. Although weight loss is beneficial for obese patients with diabetes, current medical treatment for obesity is difficult. In contrast, observational studies show a major impact of bariatric surgery on diabetes, raising the question whether this approach should be used more widely to treat diabetes in obese patients? If bariatric surgery were shown to be the best way to treat diabetes in obese subjects the implications for health services would be wide-ranging. Bariatric surgery leads to withdrawal of diabetic treatment in about 60% or more of patients, and reductions of therapy for many others. Although data on bariatric surgery in subjects with diabetes are provocative, most studies have been uncontrolled or flawed in other ways. Most importantly, bariatric surgery has not yet been compared against standard medical treatment for diabetes in randomized controlled trials with diabetes-specific endpoints in all relevant patient groups. Potential indications for bariatric surgery are discussed, and the unanswered questions that need to be addressed by clinical trials are summarized. Although small numbers of patients may be interested in bariatric surgery for type 2 diabetes, current data are insufficient to endorse its wide scale use for this indication. Until essential studies are undertaken the role and economics of bariatric surgery in the diabetic clinic will remain uncertain.

  8. Significant Resolution of Female Sexual Dysfunction after Bariatric Surgery

    Science.gov (United States)

    Bond, Dale S.; Wing, Rena R.; Vithiananthan, Sivamainthan; Sax, Harry C.; Roye, G. Dean; Ryder, Beth A.; Pohl, Dieter; Giovanni, Jeannine

    2010-01-01

    Background We previously reported that the majority of women seeking bariatric surgery had female sexual dysfunction (FSD) as defined by the validated Female Sexual Function Index (FSFI). Objective The current study examined whether FSD resolves after bariatric surgery. Setting The Miriam Hospital, Providence RI, USA. Methods Fifty-four reportedly sexually active women (43.3±9.5 years) completed the FSFI pre- and 6-months post-operatively after a mean excess weight loss (%EWL) of 42.3% [Laparoscopic adjustable gastric banding (LAGB) n=38; %EWL=34.6±15.7; Roux-en-Y gastric bypass (RYGB) n=16; %EWL=60.0±21.2). The FSFI assesses sexual function across six domains with higher scores indicating better sexual function. Summing of these scores yields a FSFI-total score (range=2–36 with ≤26.55=FSD). Results Before surgery, 34 women (63%) had scores indicative of FSD. By 6-months after surgery, FSD had resolved in 23 of these 34 (68%) women, and only 1 woman developed FSD. In the entire sample, there were significant (p<0.05) improvements from pre- to post-surgery on all FSFI domains. FSFI-total scores improved after LAGB (24.2±5.9 to 29.1±4.1, p<0.001) and RYGB (23.7±7.7 to 30.0±4.7, p<0.001). In regression analyses, being married, younger age, and worse preoperative sexual function were related to greater sexual function improvements. Postoperatively, participants’ FSFI-total scores were indistinguishable from published normative controls (29.4±4.3 vs. 30.5±5.3, p=0.18). Conclusion FSD resolved in a large percentage of women. Sexual functioning in the entire sample improved to levels consistent with normative controls. This improvement in sexual function did not depend on surgery type or weight loss amount, and appears to be an additional benefit for women undergoing bariatric surgery. PMID:20678969

  9. The impact of bariatric surgery on quality of life: a systematic review and meta-analysis.

    Science.gov (United States)

    Lindekilde, N; Gladstone, B P; Lübeck, M; Nielsen, J; Clausen, L; Vach, W; Jones, A

    2015-08-01

    This study aims to review the obesity literature in order to assess the impact of bariatric surgery on quality of life and the between-study variation by examining the standardized mean magnitude of effect in change in the levels of quality of life. The following databases EMBASE, PubMed, PsycINFO, CINAHL, the Cochrane Library and Web of Science were systematically searched for studies examining change in quality of life in adults receiving bariatric surgery for obesity. Seventy-two studies were included with a total of 9,433 participants treated for obesity with bariatric surgery. The average impact of bariatric surgery on quality of life corresponded to an effect size of 0.88 (95% CI: 0.80-0.96), indicating that bariatric surgery has a significant positive influence on quality of life in general. The impact varied considerably across studies with bariatric surgery showing a significantly greater positive influence on physical quality of life compared to mental quality of life. Bariatric surgery is effective in improving quality of life, especially when looking at physical well-being. Greater focus on the psychological well-being of the person undergoing surgery for obesity may lead to a better post-surgery prognosis for more people.

  10. Pregnancy after bariatric surgery: improving outcomes for mother and child

    Directory of Open Access Journals (Sweden)

    González I

    2016-12-01

    Full Text Available Irene González,1 Albert Lecube,2 Miguel Ángel Rubio,3 Pedro Pablo García-Luna4 1Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Huelva, Huelva, Spain; 2Endocrinology and Nutrition Department, Arnau de Vilanova University Hospital, Lleida Biomedicine Research Institute (IRB-Lleida, CIBER in Diabetes and Associated Metabolic Disorders (CIBERDEM, Lleida University, Lleida, Spain; 3Endocrinology and Nutrition Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain; 4Endocrinology and Nutrition Department, Hospitales Universitarios Virgen del Rocío, Seville, Spain Abstract: The significant increase in the prevalence of obesity has led to an increase in the number of obese women who become pregnant. In this setting, in recent years, there has been an exponential rise in the number of bariatric procedures, with approximately half of them performed in women of childbearing age, and a remarkable surge in the number of women who become pregnant after having undergone bariatric surgery (BS. These procedures entail the risk of nutritional deficiencies, and nutrition is a crucial aspect during pregnancy. Therefore, knowledge and awareness of the consequences of these techniques on maternal and fetal outcomes is essential. Current evidence suggests a better overall obstetric outcome after BS, in comparison to morbid obese women managed conservatively, with a reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia, and congenital defects. However, the risk of potential maternal nutritional deficiencies and newborns small for gestational age cannot be overlooked. Results concerning the incidence of preterm delivery and the number of C-sections are less consistent. In this paper, we review the updated evidence regarding the impact of BS on pregnancy. Keywords: bariatric surgery, pregnancy, maternal and fetal outcomes, gestational diabetes mellitus, small for

  11. Bariatric surgery and diabetes remission: Who would have thought it?

    Directory of Open Access Journals (Sweden)

    Awadhesh Kumar Singh

    2015-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM and obesity are increasingly common and major global health problems. The Edmonton obesity staging system clearly pointed towards increased mortality proportionate to the severity of obesity. Obesity itself triggers insulin resistance and thereby poses the risk of T2DM. Both obesity and T2DM have been associated with higher morbidity and mortality and this calls for institution of effective therapies to deal with the rising trend of complications arising out of this dual menace. Although lifestyle changes form the cornerstone of therapy for both the ailments, sustained results from this modalities is far from satisfactory. While Look AHEAD (action for HEAalth in diabetes study showed significant weight loss, reduction in glycated hemoglobin and higher remission rate of T2DM at 1 st year following intensive lifestyle measures; recurrence and relapse rate bounced back in half of subjects at 4 years, thereby indicating that weight loss and glycemic control is difficult to maintain in the long term with lifestyle interventions. Same recurrence phenomenon was also observed with pharmacotherapy with rimonabant, sibutramine and orlistat. Bariatric surgery has been seen to associate with substantial and sustained weight loss in morbidly obese patients. Interestingly, bariatric surgeries also induce higher rates of short and long-term diabetes remission. Although the exact mechanism behinds this diabetes remission are not well understood; improved insulin action, beta-cell function and complex interplay of hormones in the entero-insular axis appears to play a major role. This article reviews the effectiveness of bariatric procedures on remission or improvement in diabetes and put a perspective on its implicated mechanisms.

  12. Bariatric Surgery Is Gaining Ground as Treatment of Obesity After Heart Transplantation: Report of Two Cases.

    Science.gov (United States)

    Tsamalaidze, Levan; Elli, Enrique F

    2017-08-22

    Experience with bariatric surgery in patients after orthotopic heart transplantation (OHT) is still limited. We performed a retrospective review of patients who underwent bariatric surgery after OHT from January 1, 2010 to December 31, 2016. Two post-OHT patients with BMI of 37.5 and 36.2 kg/m² underwent laparoscopic robotic-assisted Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, respectively. Quality of life substantially improved for both patients. Bariatric surgery is safe and feasible in OHT patients, despite numerous risk factors. Careful selection of patients is required with proper preoperative management and overall care. Due to the complexity of treatment and perioperative care in this specific population, these operations should be done in high-volume centers with multidisciplinary teams composed of bariatric, cardiac transplant surgeons and critical care physicians. Bariatric surgery can be highly effective for treatment of obesity after OHT.

  13. Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes

    Science.gov (United States)

    2013-01-01

    Obesity is recognized as a global health crisis. Bariatric surgery offers a treatment that can reduce weight, induce remission of obesity-related diseases, and improve the quality of life. In this article, we outline the different options in bariatric surgery and summarize the recommendations for selecting and assessing potential candidates before proceeding to surgery. We present current data on post-surgical outcomes and evaluate the psychosocial and economic effects of bariatric surgery. Finally, we evaluate the complication rates and present recommendations for post-operative care. PMID:23302153

  14. Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes

    Directory of Open Access Journals (Sweden)

    Neff KJ

    2013-01-01

    Full Text Available Abstract Obesity is recognized as a global health crisis. Bariatric surgery offers a treatment that can reduce weight, induce remission of obesity-related diseases, and improve the quality of life. In this article, we outline the different options in bariatric surgery and summarize the recommendations for selecting and assessing potential candidates before proceeding to surgery. We present current data on post-surgical outcomes and evaluate the psychosocial and economic effects of bariatric surgery. Finally, we evaluate the complication rates and present recommendations for post-operative care.

  15. A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration.

    Science.gov (United States)

    Funk, L M; Gunnar, W; Dominitz, J A; Eisenberg, D; Frayne, S; Maggard-Gibbons, M; Kalarchian, M A; Livingston, E; Sanchez, V; Smith, B R; Weidenbacher, H; Maciejewski, Matthew L

    2017-04-01

    In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.

  16. Food preferences and underlying mechanisms after bariatric surgery.

    Science.gov (United States)

    Behary, Preeshila; Miras, Alexander D

    2015-11-01

    Bariatric surgery leads to significant long-term weight loss, particularly Roux-en-Y gastric bypass (RYGB). The mechanisms underlying weight loss have not been fully uncovered. The aim of this review is to explore the changes in food preferences, as a novel mechanism contributing to weight loss, and also focus on the underlying processes modulating eating behaviour after bariatric surgery. Patients after gastric bypass are less hungry and prefer healthier food options. They develop an increased acuity to sweet taste, which is perceived as more intense. The appeal of sweet fatty food decreases, with functional MRI studies showing a corresponding reduction in activation of the brain reward centres to high-energy food cues. Patients experiencing post-ingestive symptoms with sweet and fatty food develop conditioned aversive behaviours towards the triggers. Gut hormones are elevated in RYGB and have the potential to influence the taste system and food hedonics. Current evidence supports a beneficial switch in food preferences after RYGB. Changes within the sensory and reward domain of taste and the development of post-ingestive symptoms appear to be implicated. Gut hormones may be the mediators of these alterations and therefore exploiting this property might prove beneficial for designing future obesity treatment.

  17. Bariatric surgery, lipoprotein metabolism and cardiovascular risk.

    Science.gov (United States)

    Tailleux, Anne; Rouskas, Konstantinos; Pattou, François; Staels, Bart

    2015-08-01

    To summarize recent epidemiological, preclinical and clinical studies on the effects of Roux-en-Y-gastric bypass (RYGBP) surgery on cardiovascular risk factors and the underlying mechanisms. Although RYGBP has mechanical effects on the gastrointestinal tract, the reduced gastric pouch and intestinal calorie absorption cannot fully explain the metabolic improvements. Obesity predisposes to cardiovascular risk factors such as dyslipidemia, type 2 diabetes, nonalcoholic fatty liver disease and hypertension. In contrast to the limited success of pharmacological and lifestyle interventions, RYGBP induces sustained weight loss, metabolic improvements and decreases morbidity/mortality. In line, RYGBP reduces cardiovascular risk factors. Although the mechanisms are not entirely understood, RYGBP induces complex changes in the gut affecting other organs through endocrine and metabolic signals from the intestine to all key metabolic organs, which can link RYGBP and decreased cardiovascular risk. Here, we discuss the roles of changes in lipid absorption and metabolism, bile acid metabolism, gut hormones and the microbiote as potential mechanisms in the decreased cardiovascular risk and metabolic improvement after RYGBP.

  18. Relevance of Adipose Tissue Stiffness Evaluated by Transient Elastography (AdipoScan™) in Morbidly Obese Patients before Bariatric Surgery

    Science.gov (United States)

    Sasso, Magali; Abdennour, Meriem; Liu, Yuejun; Hazrak, Hecham; Aron-Wisnewsky, Judith; Bouillot, Jean-Luc; Le Naour, Gilles; Bedossa, Pierre; Torjman, Joan; Clément, Karine; Miette, Véronique

    Subcutaneous adipose tissue (scAT) in human obesity undergoes severe alteration such as fibrosis which is related to metabolic alterations and to less efficiency in losing weight after bariatric surgery. There is currently no non-invasive tool to assess fibrosis in scAT. Vibration Controlled Transient Elastography (VCTE) using FibroScan® is widely used to assess liver fibrosis in clinical practice. A novel device named AdipoScan™ which is based on VCTE has been developed by Echosens (Paris) so as to assess scAT. The objective of this study is to show the first AdipoScan clinical results. AdipoScan™ was assessed in vivo on 73 morbidly obese patients candidate for bariatric surgery who were enrolled in the Pitié Salpêtrière hospital. scAT shear wave speed measured by AdipoScan™ is significantly associated with scAT fibrosis, gender, hypertension status, total body fat mass assessed by DXA, hypertension status, glycemic, lipid, hepatic parameters and adiponectin. Results suggest that scAT evaluation before bariatric surgery can be useful in clinical practice since it is related to scAT fibrosis -who plays in role in weight loss resistance after bariatric surgery- and to obesity induced co-morbidities such as diabetes, hypertension liver dysfunction.

  19. Bariatric surgery interest around the world: what Google Trends can teach us.

    Science.gov (United States)

    Linkov, Faina; Bovbjerg, Dana H; Freese, Kyle E; Ramanathan, Ramesh; Eid, George Michel; Gourash, William

    2014-01-01

    Bariatric surgery may prove an effective weight loss option for those struggling with severe obesity, but it is difficult to determine levels of interest in such procedures at the population level through traditional approaches. Analysis of Google Trend information may give providers and healthcare systems useful information regarding Internet users' interest in bariatric procedures. The objective of this study was to gather Google Trend information on worldwide Internet searches for "bariatric surgery", "gastric bypass", "gastric sleeve", "gastric plication", and "lap band" from 2004-2012 and to explore temporal relationships with relevant media events, economic variations, and policy modifications. Data were collected using Google Trends. Trend analyses were performed using Microsoft Excel Version 14.3.5 and Minitab V.16.0. Trend analyses showed that total search volume for the term "bariatric surgery" has declined roughly 25% since January 2004, although interest increased approximately 5% from 2011 to 2012. Interest in lap band procedures declined 30% over the past 5 years, while "gastric sleeve" has increased 15%. Spikes in search numbers show an association with events such as changing policy and insurance guidelines and media coverage for bariatric procedures. This report illustrates that variations in Internet search volume for terms related to bariatric surgery are multifactorial in origin. Although it is impossible to ascertain if reported Internet search volume is based on interest in potentially undergoing bariatric surgery or simply general interest, this analysis reveals that search volume appears to mirror real world events. Therefore, Google Trends could be a way to supplement understanding about interest in bariatric procedures. © 2013 American Society for Bariatric Surgery Published by American Society for Metabolic and Bariatric Surgery All rights reserved.

  20. Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis.

    Science.gov (United States)

    Li, Kun; Zou, Jianan; Ye, Zhibin; Di, Jianzhong; Han, Xiaodong; Zhang, Hongwei; Liu, Weijie; Ren, Qinggui; Zhang, Pin

    2016-01-01

    Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. The main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up. Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed.

  1. Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis

    Science.gov (United States)

    Ye, Zhibin; Di, Jianzhong; Han, Xiaodong; Zhang, Hongwei; Liu, Weijie; Ren, Qinggui; Zhang, Pin

    2016-01-01

    Background Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. Objective To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. Methods We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. Results 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. Limitations The main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up. Conclusions Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed. PMID:27701452

  2. Recent advances in bariatric/metabolic surgery: appraisal of clinical evidence

    Institute of Scientific and Technical Information of China (English)

    Wei-Jei Lee; Abdullah Almulaifi

    2015-01-01

    Obesity and associated type 2 diabetes mellitus (T2DM) are becoming a serious medical issue worldwide.Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese patients.Increasing data indicates bariatric surgery as metabolic surgery is an effective and novel therapy for not well controlled obese T2DM patients.The review of recent developments in bariatric/metabolic surgery covers 4 major fields.1) Improvement of safety:recent advances in laparoscopic/metabolic surgery has made this minimal invasive surgery more than ten times safer than a decade ago.The safety profile of laparoscopic/metabolic surgery is compatible with that of laparoscopic cholecystectomy now.2) New bariatric/metabolic surgery:laparoscopic sleeve gastrectomy (LSG) is becoming the leading bariatric surgery because of its simplicity and efficacy.Other new procedures,such as gastric plication,banded plication,single anastomosis (mini) gastric bypass and Duodeno-jejunal bypass with sleeve gastrectomy have all been accepted as treatment modalities for bariatric/metabolic surgery.3)Mechanism of bariatric/metabolic surgery:Restriction is the most important mechanism for bariatric surgery.Weight regain after bariatric surgery is usually associated with loss of restriction.Recent studies demonstrated that gut hormone,microbiota and bile acid changes after bariatric surgery may play an important role in durable weight loss as well as in T2DM remission.However,weight loss is still the cornerstone of T2DM remission after metabolic surgery.4) Patient selection:patients who may benefit most from bariatric surgery was found to be patients with insulin resistance.For Asian T2DM patients,the indication of metabolic surgery has been set to those with not well controlled (HbA1c > 7.5%) disease and with their BMI > 27.5 Kg/m2.A novel diabetes surgical score,ABCD score,is a simple system for predicting the success of surgical therapy for T2DM.

  3. Lipids and bariatric procedures part 1 of 2: Scientific statement from the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and Obesity Medicine Association: FULL REPORT.

    Science.gov (United States)

    Bays, Harold E; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl E; Kothari, Shanu; Azagury, Dan E; Morton, John; Nguyen, Ninh T; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

    2016-01-01

    Bariatric procedures often improve lipid levels in patients with obesity. This 2 part scientific statement examines the potential lipid benefits of bariatric procedures and represents the contributions from authors representing the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and the Obesity Medicine Association. The foundation for this scientific statement was based on published data through June 2015. Part 1 of this 2 part scientific statement provides an overview of: (1) adipose tissue, cholesterol metabolism, and lipids; (2) bariatric procedures, cholesterol metabolism, and lipids; (3) endocrine factors relevant to lipid influx, synthesis, metabolism, and efflux; (4) immune factors relevant to lipid influx, synthesis, metabolism, and efflux; (5) bariatric procedures, bile acid metabolism, and lipids; and (6) bariatric procedures, intestinal microbiota, and lipids, with specific emphasis on how the alterations in the microbiome by bariatric procedures influence obesity, bile acids, and inflammation, which in turn, may all affect lipid levels. Included in part 2 of this comprehensive scientific statement will be a review of (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease (CVD) risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on CVD; and finally, (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures. This document represents the full report of part 1.

  4. Lipids and bariatric procedures part 1 of 2: Scientific statement from the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and Obesity Medicine Association: EXECUTIVE SUMMARY.

    Science.gov (United States)

    Bays, Harold E; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl E; Kothari, Shanu; Azagury, Dan E; Morton, John; Nguyen, Ninh T; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

    2016-01-01

    Bariatric procedures often improve lipid levels in patients with obesity. This 2-part scientific statement examines the potential lipid benefits of bariatric procedures and represents contributions from authors representing the National Lipid Association, American Society for Metabolic and Bariatric Surgery, and the Obesity Medicine Association. The foundation for this scientific statement was based on data published through June 2015. Part 1 of this 2-part scientific statement provides an overview of: (1) adipose tissue, cholesterol metabolism, and lipids; (2) bariatric procedures, cholesterol metabolism, and lipids; (3) endocrine factors relevant to lipid influx, synthesis, metabolism, and efflux; (4) immune factors relevant to lipid influx, synthesis, metabolism, and efflux; (5) bariatric procedures, bile acid metabolism, and lipids; and (6) bariatric procedures, intestinal microbiota, and lipids, with specific emphasis on how the alterations in the microbiome by bariatric procedures influence obesity, bile acids, and inflammation, which in turn, may all affect lipid levels. Included in part 2 of this comprehensive scientific statement will be a review of: (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on cardiovascular disease; and finally (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures. This document represents the executive summary of part 1.

  5. The Effect of Bariatric Surgery on Diabetic Retinopathy: Good, Bad, or Both?

    Science.gov (United States)

    Gorman, Dora M.; le Roux, Carel W.

    2016-01-01

    Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.

  6. Krukenberg tumor after gastric bypass for morbid obesity. Bariatric surgery and gastric cancer.

    Science.gov (United States)

    Menéndez, Pablo; Villarejo, Pedro; Padilla, David

    2013-01-01

    Gastric bypass is one of the most frequently performed surgical procedures in bariatric surgery. A neoplasm within the gastric pouch is a somewhat infrequent complication but with important survival consequences. We present the case of a 51-year-old woman who developed an adenocarcinoma in the bypassed stomach three years after bariatric surgery; the tumour was incidentally discovered after gynaecological surgery for uterine myomas. Various diagnostic modalities for the excluded stomach were analysed.

  7. Krukenberg tumor after gastric bypass for morbid obesity: Bariatric surgery and gastric cancer

    Directory of Open Access Journals (Sweden)

    Pablo Menéndez

    2013-06-01

    Full Text Available Gastric by-pass is one of the most performed surgical procedure in bariatric surgery. Neoplasm within gastric remnant is a slightly frequent complication (only six cases have been described but with important survival consequences. We present a case of a patient who developed an adenocarcinoma in excluded stomach, after three years of bariatric surgery; the tumor was incidentally discovered after a gynecological surgery for uterine myomas. Different diagnostic modalities for the excluded stomach were analyzed.

  8. [Bariatric surgery is more efficient than medical treatment in achieving remission in diabetes mellitus type 2].

    Science.gov (United States)

    Klein, Mads; Rosenberg, Jacob; Gögenur, Ismail

    2013-04-01

    Observational studies have shown that bariatric surgery can lead to remission of diabetes mellitus type 2 (DMII), but randomized controlled trials have been lacking. Recently, randomized controlled trials comparing bariatric surgery with optimal medical treatment in patients suffering from poorly controlled DMII, have been performed. These trials show that bariatric surgery in general, and the malabsorptive procedures in particular, are more effective than medical treatment in achieving remission of DMII. These procedures should therefore be considered in the treatment of patients with DMII and obesity.

  9. The Impact of Bariatric Surgery on Type 2 Diabetes Mellitus and the Management of Hypoglycemic Events

    Science.gov (United States)

    Kassem, Mahmoud Attia Mohamed; Durda, Michael Andrew; Stoicea, Nicoleta; Cavus, Omer; Sahin, Levent; Rogers, Barbara

    2017-01-01

    Recent studies discussed the benefit of bariatric surgery on obese patients diagnosed with type 2 diabetes mellitus (T2DM). Several factors play an essential role in predicting the impact of bariatric surgery on T2DM, such as ABCD score (age, BMI, C-peptide, and duration of the disease), HbA1c, and fasting blood glucose, incretins [glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP)]. DiaRem score known to include factors such as age, HbA1c, medication, and insulin usage used to predict the remission of T2DM, but it has some limitations. An extensive literature search was conducted on PubMed and Google Scholar using keywords such as gastric bypass, T2DM, bariatric surgery, GLP-1, GIP, and post bariatric hypoglycemia. Restrictive-malabsorptive procedures are most effective in treating T2DM patients based on changes induced in appetite through regulation of gastrointestinal hormones, with decreased hunger and increased satiation. We provide a review of bariatric surgery influence on T2DM and management of post-intervention hypoglycemic events. Post-bariatric surgery hypoglycemia is a serious complication especially when patients develop life-threatening neuroglycopenia with loss of consciousness and seizure. The avoidance of this adverse event may be achieved by strict dietary modification including a restriction on carbohydrates as well as foods with high glycemic index. Further research will provide more information on post-bariatric surgery hyperinsulinemic hypoglycemia pathophysiology and management. PMID:28298900

  10. Pregnancy after bariatric surgery: improving outcomes for mother and child

    Science.gov (United States)

    González, Irene; Lecube, Albert; Rubio, Miguel Ángel; García-Luna, Pedro Pablo

    2016-01-01

    The significant increase in the prevalence of obesity has led to an increase in the number of obese women who become pregnant. In this setting, in recent years, there has been an exponential rise in the number of bariatric procedures, with approximately half of them performed in women of childbearing age, and a remarkable surge in the number of women who become pregnant after having undergone bariatric surgery (BS). These procedures entail the risk of nutritional deficiencies, and nutrition is a crucial aspect during pregnancy. Therefore, knowledge and awareness of the consequences of these techniques on maternal and fetal outcomes is essential. Current evidence suggests a better overall obstetric outcome after BS, in comparison to morbid obese women managed conservatively, with a reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia, and congenital defects. However, the risk of potential maternal nutritional deficiencies and newborns small for gestational age cannot be overlooked. Results concerning the incidence of preterm delivery and the number of C-sections are less consistent. In this paper, we review the updated evidence regarding the impact of BS on pregnancy. PMID:28008286

  11. Binge Eating Disorder and Medical Comorbidities in Bariatric Surgery Candidates

    Science.gov (United States)

    Mitchell, James E.; King, Wendy C.; Pories, Walter; Wolfe, Bruce; Flum, David R.; Spaniolas, Konstatinos; Bessler, Mark; Devlin, Michael; Marcus, Marsha D.; Kalarchian, Melissa; Engel, Scott; Khandelwal, Saurobh; Yanovski, Susan

    2016-01-01

    Objective To determine whether binge eating disorder (BED) status is associated with medical comorbidities in obese adults scheduled for bariatric surgery. Method The study utilized Longitudinal Assessment of Bariatric Surgery-2 data obtained from 6 clinical centers around the United States. This is a well-phenotyped cohort of individuals who were evaluated within 30 days prior to their scheduled surgery using standardized protocols. In the cohort, 350 participants were classified as having BED and 1875 as not having BED (non-BED). Multivariable logistic regression was used to determine whether BED status was independently related to medical comorbidities. As an exploratory analysis, significance was based on nominal P-values (p<.05). Holm-adjusted P-values were also reported. Results After adjusting for age, sex, education and body mass index, BED status was independently associated with 4 of 15 comorbidities (i.e., impaired glucose levels (odds ratio [OR]=1.45 (95%CI: 1.12–1.87), high triglycerides (OR=1.28 (95%CI: 1.002–1.63) and urinary incontinence (OR=1.30 (95%CI: 1.02,1.66) all being more common among the BED sample, and severe walking limitations being less common in the BED sample (OR=0.53 (95%CI: 0.29–0.96)). With further adjustment for psychiatric/emotional health indicators, BED status was independently associated with 3 comorbidities (impaired glucose levels (OR=1.36 (95%CI: 1.04–1.79), cardiovascular disease (OR=0.50 (95%CI: 0.30–0.86) and severe walking limitations (OR=0.38 (95%CI: 0.19–0.77)). However, Holm’s adjusted P-values for all variables were greater than .05. Discussion The results suggest the possibility of a contribution of BED to risk of specific medical comorbidities in severely obese adults. PMID:25778499

  12. Use of alcohol before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ana Carolina Ribeiro de Amorim

    Full Text Available OBJECTIVE: to assess alcohol intake in the bariatric surgery pre and postoperative periods. METHODS: Patients were interviewed atSurgery Clinic of the Hospital das Clínicas da Universidade Federal de Pernambuco - HC/UFPE (Brazil from July 2011 to March 2012. We analyzed socioeconomic, anthropometric and clinical variables. We used the Alcohol Use Disorders Identification Test (AUDIT C. RESULTS: One hundred nineteen patients were enrolled (mean age: 41.23+11.30 years, with a predominance of the female gender (83.2%, non-Caucasian race (55%, married individuals or in a stable union (65.5%, with a high school education (40.3%and active in the job market (37%. Weight and body mass index (BMI were 128.77+25.28Kg and 49.09+9.26Kg/m2,respectively in the preoperative period (class II obesity and 87.19+19.16Kg and 33.04+6.21Kg/m2, respectively in the postoperative period (class I obesity (p<0.001. Hypertension was the most frequent disease in the pre (66.6% and postoperative (36.5% periods. The prevalence of alcohol use was 26.6% in the preoperative period, of which 2.2% of high risk, and 35.1% in the postoperative period, of which 1.4% of probable dependence; this difference did not achieve statistical significance (p=0.337. CONCLUSION: The prevalence of abusive alcohol intake and/or probable dependence was low in both the pre and postoperative periods, with little evidence of risky consumption among the patients submitted to bariatric surgery.

  13. Recent advances in the modification of taste and food preferences following bariatric surgery.

    Science.gov (United States)

    Primeaux, Stefany D; de Silva, Taniya; Tzeng, Tony H; Chiang, Monica C; Hsia, Daniel S

    2016-06-01

    There is a large body of evidence indicating that bariatric surgery provides durable weight loss and health benefits to patients who are obese and have comorbidities such as type 2 diabetes (T2D). However, there are still many questions related to mechanisms of metabolic improvement, predictors of success/failure, and long term consequences, which need to be answered. More recently, there has been a particular interest in the modulation of taste and food preferences that occurs after bariatric surgery and how this affects weight loss in different individuals. Animal models as well as human studies have shed some light on the role of taste in changing food preferences and how these changes may affect weight loss after surgery. The goal of this review is to discuss the physiological and behavioral consequences of bariatric surgery as a treatment for obesity and T2D, with particular emphasis on recent studies describing bariatric surgery-induced modifications in taste perception and food preferences.

  14. Current status of bariatric surgery in Japan and effectiveness in obesity and diabetes.

    Science.gov (United States)

    Sasaki, Akira; Wakabayashi, Go; Yonei, Yoshikazu

    2014-01-01

    The rate of obesity in Japan, defined as having a body mass index (BMI) of 25 kg/m(2) or greater, is reportedly at 24 %, a lower level of severe obesity than in the EU and US. However, the incidence of obesity-related health problems is reportedly higher among Asians. Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery in Japan and accounted for 54 % of such surgeries in 2011; procedures such as laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass (LRYGB), practiced frequently worldwide, were uncommon. Possible reasons include concern over delayed postoperative discovery of gastric cancer in LRYGB, and rapid adoption of the comparatively simple LSG procedure. In type 2 diabetes mellitus (T2DM) patients, where continued pursuit of medical treatment is difficult and a potential exists for future deterioration of diabetes-complicated diseases, the criterion for surgical indication in the EU and US is a BMI of 30-35 kg/m(2), with priority given to BMI >35 kg/m(2). For Asian patients, the recommendation is to lower this indication criterion by 2.5 kg/m(2). Efficacy of metabolic surgery is anticipated particularly among T2DM patients with obesity complication, a short history of insulin treatment, and intact insulin secreting ability, and in these cases bariatric surgery should be contemplated.

  15. Eating Behavior and Eating Disorders in Adults Prior to Bariatric Surgery

    Science.gov (United States)

    Mitchell, James E.; King, Wendy C.; Courcoulas, Anita; Dakin, George; Elder, Katherine; Engel, Scott; Flum, David; Kalarchian, Melissa; Khandelwal, Saurabh; Pender, John; Pories, Walter; Wolfe, Bruce

    2014-01-01

    Objective To describe eating patterns, prevalence of problematic eating behaviors, and determine factors associated with binge eating disorder (BED), prior to bariatric surgery. Method Prior to surgery, 2,266 participants (median age 46 years; 78.6% female; 86.9% white; median body mass index 45.9 kg/m2) of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study completed eating behavior survey items in the self-administered LABS-2 Behavior form. Other measures included the Alcohol Use Disorder Identification Test, the LABS-2 Psychiatric and Emotional Test Survey, the Beck Depression Inventory, the Interpersonal Support Evaluation List-12, the Short Form-36 Health Survey and Impact of Weight Quality of Life-Lite Survey. Results The vast majority (92.1%) of participants reported eating dinner regularly, while just over half (54.0%) reported eating breakfast regularly. Half of the participants reported eating at least 4 meals/week at restaurants; two meals/week were fast food. Loss of control eating was reported by 43.4%, night eating syndrome by 17.7%; 15.7% satisfied criteria for binge eating disorder (BED), 2% for bulimia nervosa. Factors that independently increased the odds of BED were being a college graduate, eating more times per day, taking medication for psychiatric or emotional problems, and having symptoms of alcohol use disorder, lower self-esteem and greater depressive symptoms. Discussion Prior to undergoing bariatric surgery a substantial proportion of patients report problematic eating behaviors. Several factors associated with BED were identified, most suggesting other mental health problems, including higher levels of depressive symptomotology. The strengths of this study include the large sample size, the multi-center design and use of standardized assessment practices. PMID:24719222

  16. Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery

    Science.gov (United States)

    Cummings, David E; Cohen, Ricardo V

    2014-01-01

    Bariatric surgery use is largely governed worldwide by a 1991 National Institutes of Health consensus statement that advocates BMI as the primary operative criterion and restricts surgery to severely obese patients. These guidelines have been enormously valuable in standardising practice, thereby facilitating accumulation of a copious database of information regarding long-term surgical benefits and risks, from vast clinical experience and research. However, the National Institutes of Health recommendations had important limitations from the outset and are now gravely outdated. They do not account for remarkable advances in minimally invasive surgical techniques or the development of entirely new procedures. In the two decades since they were crafted, we have gained far greater understanding of the dramatic, weight-independent benefits of some operations on metabolic diseases, especially type 2 diabetes, and of the inadequacy of BMI as a primary criterion for surgical selection. Furthermore, there is now a substantial and rapidly burgeoning body of level-1 evidence from randomised trials comparing surgical versus non-surgical approaches to obesity, type 2 diabetes, and other metabolic diseases, including among only mildly obese or merely overweight patients. Herein, we present arguments to impel the development of new guidelines for the use of bariatric and so-called metabolic surgery to inform clinical practice and insurance compensation. PMID:24622721

  17. Does Certification as Bariatric Surgery Center and Volume Influence the Outcome in RYGB-Data Analysis of German Bariatric Surgery Registry.

    Science.gov (United States)

    Stroh, Christine; Köckerling, F; Lange, V; Wolff, S; Knoll, C; Bruns, C; Manger, Th

    2017-02-01

    To examine the association between the certification as bariatric surgery center and volume and patient outcome, data collected in the German Bariatric Surgery Registry were evaluated. All data were registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg. Data collection began in 2005 for all bariatric procedures in an online database. Participation in the quality assurance study is required for all certified bariatric surgery centers in Germany. Descriptive evaluation and matched pairs analysis were performed. Patients were matched via propensity score taking into account BMI, age, and incidence of comorbidities. During the period from 2005 to 2013, 3083 male and 10,639 female patients were operated on with the RYGB primary approach. In Centers of Competence (77.2 %) and non-accredited hospitals (76.3 %), the proportion of female patients was significantly lower than in Centers of Reference/Excellence (78.7 %; p = 0.002). The mean age in Centers of Reference/Excellence (41.2 years) was significantly lower than in Centers of Competence (43.2 years; p bariatric surgery centers with higher volume. The study supports the concept of certification. There are different factors which can and cannot be preoperatively modified and influence the perioperative outcome.

  18. [Preoperative fasting period of fluids in bariatric surgery].

    Science.gov (United States)

    Simon, P; Pietsch, U-C; Oesemann, R; Dietrich, A; Wrigge, H

    2017-07-01

    Aspiration of stomach content is a severe complication during general anaesthesia. The DGAI (German Society for Anesthesiology and Intensive Care Medicine) guidelines recommend a fasting period for liquids of 2 h, with a maximum of 400 ml. Preoperative fasting can affect the patients' recovery after surgery due to insulin resistance and higher protein catabolism as a response to surgical stress. The aim of the study was to compare a liberal fasting regimen consisting of up to 1000 ml of liquids until 2 h before surgery with the DGAI recommendation. The prospective observational clinical study was approved by the ethics committee of the University of Leipzig. In the liberal fasting group (Glib) patients undergoing bariatric surgery were asked to drink 1000 ml of tea up to 2 h before surgery. Patients assigned to the restrictive fasting group (Gres) who were undergoing nonbariatric abdominal surgery were asked to drink no more than 400 ml of water up to 2 h preoperatively. Right after anaesthesia induction and intubation a gastric tube was placed, gastric residual volume was measured and the pH level of gastric fluid was determined. Moreover, the occurrence of aspiration was monitored. In all, 98 patients with a body mass index (BMI) of Glib 51.1 kg/m(2) and Gres 26.5 kg/m(2) were identified. The preoperative fasting period of liquids was significantly different (Glib 170 min vs. Gres 700 min, p Gres 5 ml, p = 0.355). The pH of gastric fluid was nearly similar (Glib 4.0; Gres 3.0; p = 0.864). Aspiration did not occur in any patient. There is evidence suggesting that a liberal fluid fasting regimen (1000 ml of fluid) in the preoperative period is safe in patients undergoing bariatric surgery.

  19. [Criteria for selection of patients for bariatric surgery].

    Science.gov (United States)

    Hell, E; Miller, K

    2002-12-01

    Because of the high prevalence of co-morbid conditions and poor life expectancy a Body Mass Index (BMI) of 40 kg/m(2) or more is an indication for surgery in a fully informed, consenting adult in optimal medical condition to tolerate general anaesthesia. Patients with BMI of 35-40 kg/m(2) and the existence of one or more serious obesity-related conditions ameliorated by weight loss, such as hypertension, pulmonary insufficiency, non-insulin-dependent diabetes mellitus etc., are also candidates for surgical treatment. The bariatric surgeon should use these international criteria as guidelines only, not strict rules. Attempts on the part of internists and more frequently insurance carriers to require documented failure of previous non-operative treatment is not meaningful.

  20. Tissue-Specific Effects of Bariatric Surgery Including Mitochondrial Function

    Directory of Open Access Journals (Sweden)

    Simon N. Dankel

    2011-01-01

    Full Text Available A better understanding of the molecular links between obesity and disease is potentially of great benefit for society. In this paper we discuss proposed mechanisms whereby bariatric surgery improves metabolic health, including acute effects on glucose metabolism and long-term effects on metabolic tissues (adipose tissue, skeletal muscle, and liver and mitochondrial function. More short-term randomized controlled trials should be performed that include simultaneous measurement of metabolic parameters in different tissues, such as tissue gene expression, protein profile, and lipid content. By directly comparing different surgical procedures using a wider array of metabolic parameters, one may further unravel the mechanisms of aberrant metabolic regulation in obesity and related disorders.

  1. Psychological predictors of weight loss after bariatric surgery

    DEFF Research Database (Denmark)

    Wimmelmann, Cathrine Lawaetz; Dela, Flemming; Mortensen, Erik Lykke

    2014-01-01

    Background: Morbid obesity is the fastest growing BMI group in the U.S. and the prevalence of morbid obesity worldwide has never been higher. Bariatric surgery is the most effective treatment for severe forms of obesity especially with regardto a sustained long-term weight loss. Psychological...... factors are thought to play animportant role for maintaining the surgical weight loss. However, results from priorresearch examining preoperative psychological predictors of weight loss outcomeare inconsistent. The aim of this article was to review more recent literature onpsychological predictors...... studies published after 2003 were included.Results: 19 eligible studies were identified. Psychological predictors of surgicalweight loss investigated in the reviewed studies include cognitive function, per-sonality, psychiatric disorder, and eating behaviour....

  2. Remission of Ulcerated Necrobiosis Lipoidica Diabeticorum after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Suleyman Bozkurt

    2013-01-01

    Full Text Available A 32-year-old woman with type 2 diabetes mellitus suffering from morbid obesity with BMI 45,14 kg/m2 was operated on. Not only the type 2DM but also one of its complication known as necrobiosis lipoidica diabeticorum remitted postoperatively. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals but an epidemic that threatens global well-being. It causes or exacerbates many health problems, and in particular, it is associated with the type 2 diabetes. Necrobiosis lipoidica is a granulomatous skin disease of unknown etiology, associated mainly with diabetes mellitus. We presented in this paper a morbid obese case of necrobiosis lipoidica diabeticorum with dramatic good response to bariatric surgery.

  3. Physical Activity in Bariatric Surgery Patients: Does Temperament Matter?

    Science.gov (United States)

    Gruner-Labitzke, Kerstin; Claes, Laurence; Bartsch, Merle; Schulze, Mareike; Langenberg, Svenja; Köhler, Hinrich; Marschollek, Michael; de Zwaan, Martina; Müller, Astrid

    2017-07-01

    Our aim was to investigate if physical activity (PA) in bariatric surgery patients is related to temperament. Preoperative (n = 70) and post-operative (n = 73) patients were categorized as being physically 'active' versus 'inactive' on the basis of objective PA monitoring. Assessment included the behavioural inhibition system (BIS)/behavioural activation system (BAS) scales, the effortful control (EC) subscale of the Adult Temperament Questionnaire-Short Form, a numeric pain rating scale and measures for depressive and eating disorder symptoms. 'Active' did not differ from 'inactive' patients with regard to temperament (BIS, BAS, and EC). Regressions with PA grouping as dependent variable (adjusted for age, gender, body mass index (BMI), depressive or eating disorder symptoms, or pain intensity) indicated an association between lower BMI and more PA in the preoperative and the post-operative group. In the post-operative group, in addition to lower BMI, also lower age and higher BIS reactivity contributed to more PA. Furthermore, there was a significant interaction between BMI and BIS suggesting that low BMI was only associated with more PA in post-operative patients with high BIS. The results indicate that temperament per se does not contribute to the level of PA in bariatric surgery patients. However, in post-operative patients, lower BMI was associated with a higher likelihood of being physically active particularly in patients with anxious temperament. These preliminary findings need further investigation within longitudinal studies. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

  4. Operative Treatments for Reflux After Bariatric Surgery: Current and Emerging Management Options.

    Science.gov (United States)

    Treitl, Daniela; Nieber, Derek; Ben-David, Kfir

    2017-03-01

    Gastroesophageal reflux disease (GERD) is a common disorder that has a well-established connection with obesity. To ameliorate the morbidity associated with obesity, bariatric procedures have become an established pathway to accomplish sustained weight loss. In some procedures, such as with the Roux-en-Y gastric bypass surgery, weight loss is also accompanied by the resolution of GERD symptoms. However, other popular bariatric surgeries, such as the sleeve gastrectomy, have a controversial impact on their effect on reflux. Consequently, increased attention has been given to the development of strategies for the management of de novo or recurrent reflux after bariatric surgery. This article aims to discuss medical and surgical strategies for reflux after bariatric surgery, and their outcomes.

  5. Bariatric surgery and bone disease: from clinical perspective to molecular insights.

    Science.gov (United States)

    Folli, F; Sabowitz, B N; Schwesinger, W; Fanti, P; Guardado-Mendoza, R; Muscogiuri, G

    2012-11-01

    The use of bariatric surgery for the treatment of morbid obesity has increased annually for the last decade. Although many studies have demonstrated the efficacy and durability of bariatric surgery for weight loss, there are limited data regarding long-term side effects of these procedures. Recently, there has been an increased focus on the impact of bariatric surgery on bone metabolism. Bariatric surgery utilizes one or more of three mechanisms of action resulting in sustained weight loss. These include restriction (gastric banding, vertical banded gastroplasty and sleeve gastrectomy), malabsorption surgery with or without associated restriction (Roux en Y gastric bypass, duodenal switch, biliopancreatic diversion and jejunoileal bypass) and changes in gut-derived hormones that control energy metabolism also referred to as neuro-hormonal control of energy metabolism (Roux en Y gastric bypass, duodenal switch, biliopancreatic diversion, jejunoileal bypass, surgical procedures as above and gastric sleeve). Weight reduction has been associated with increased bone resorption but the mechanisms behind this have not yet been fully elucidated. Each of the mechanisms of action of bariatric surgery (restriction, malabsorption, neuro-hormonal control of energy metabolism) may uniquely affect bone resorption. In this paper we will review the current state of knowledge regarding the relationship between bariatric surgery and bone metabolism with emphasis on possible mechanisms of action such as malnutrition, hormonal interactions and mechanical unloading of the skeleton. Further, we suggest a future research agenda.

  6. The effect of bariatric surgery on gut hormones that alter appetite.

    Science.gov (United States)

    Pournaras, D-J; Le Roux, C-W

    2009-12-01

    Bariatric surgery is the only effective treatment for morbid obesity in the long term. Gut hormones are key players in the metabolic mechanisms causing obesity. Furthermore gut hormones are involved in the signalling process of hunger and satiety which leads to the control of nutrient intake. In this review, the role of these hormones as facilitators of appetite control after bariatric and metabolic surgery will be explored.

  7. ASSESSMENT OF THE QUALITY OF LIFE IN OBESE PATIENTS AND BARIATRIC SURGERY (IN SPANISH)

    OpenAIRE

    2015-01-01

    Introduction: Obesity is an important cause of morbi-morbidity and it is considered a public health problem. Currently, the bariatric surgery is one of the used strategies to reduce the obesity, nevertheless, there are little information about its impact on the quality of life related with the health (QLRH). The aim was to compare the quality of life of obese patients scheduled for bariatric surgery with previously intervened patients. Methods: Cross-sectional study carried ...

  8. Country of origin and bariatric surgery in Sweden during 2001-2010.

    Science.gov (United States)

    Memarian, Ensieh; Sundquist, Kristina; Calling, Susanna; Sundquist, Jan; Li, Xinjun

    2015-01-01

    The prevalence of obesity, as well as use of bariatric surgery, has increased worldwide. The aim of the present study was to investigate the potential differences in the use of bariatric surgery among Swedes and immigrants in Sweden and whether the hypothesized differences remain after adjustment for socioeconomic factors. A closed cohort of all individuals aged 20-64 years was followed during 2001-2010. Further analyses were performed in 2 periods separately (2001-2005 and 2006-2010). Age-standardized cumulative incidence rates (CR) of bariatric surgery were compared between Swedes and immigrants considering individual variables. Cox proportional hazards models were used in univariate and multivariate models for males and females. A total of 12,791 Swedes and 2060 immigrants underwent bariatric surgery. The lowest rates of bariatric surgery were found in immigrant men. The largest difference in CR between Swedes and immigrants was observed among low-income individuals (3.4 and 2.3 per 1000 individuals, respectively). Adjusted hazard ratios (HRs) were lower for all immigrants compared with Swedes in the second period. The highest HRs were observed among immigrants from Chile and Lebanon and the lowest among immigrants from Bosnia. Except for Nordic countries, immigrants from all other European countries had a lower HR compared with Swedes. Men in general and some immigrant groups had a lower HR of bariatric surgery. Moreover, the difference between Swedes and immigrants was more pronounced in individuals with low socioeconomic status (income). It is unclear if underlying barriers to receive bariatric surgery are due to patients' preferences/lack of knowledge or healthcare structures. Future studies are needed to examine potential causes behind these differences. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Major Increase in Microbiota-Dependent Proatherogenic Metabolite TMAO One Year After Bariatric Surgery.

    Science.gov (United States)

    Trøseid, Marius; Hov, Johannes R; Nestvold, Torunn Kristin; Thoresen, Hanne; Berge, Rolf K; Svardal, Asbjørn; Lappegård, Knut Tore

    2016-05-01

    Trimethylamine-N-oxide (TMAO) is formed in the liver from trimethylamine (TMA), a product exclusively generated by the gut microbiota from dietary phosphatidylcholine and carnitine. An alternative pathway of TMAO formation from carnitine is via the microbiota-dependent intermediate γ-butyrobetaine (γBB). Elevated TMAO levels are associated with cardiovascular disease (CVD), but little is known about TMAO in obesity. Given the proposed contribution of microbiota alterations in obesity and type 2 diabetes (T2D), we investigated the potential impact of obesity, lifestyle-induced weight loss, and bariatric surgery on plasma levels of TMAO, its microbiota-dependent intermediate γBB, and its diet-dependent precursors carnitine and choline. TMAO, γBB, carnitine, and choline were measured by high-performance liquid chromatography in 34 obese individuals (17 with and 17 without T2D) undergoing bariatric surgery and 17 controls. TMAO was not elevated in obese patients or reduced by lifestyle interventions but increased approximately twofold after bariatric surgery. Similar to TMAO, plasma levels of γBB were not influenced by lifestyle interventions but increased moderately after bariatric surgery. In contrast, carnitine and choline, which are abundant in nutrients, such as in red meat and eggs, and not microbiota dependent, were reduced after lifestyle interventions and rebounded after bariatric surgery. The major increase in TMAO after bariatric surgery was unexpected because high TMAO levels have been linked to CVD, whereas bariatric surgery is known to reduce CVD risk. Prospective studies of gut microbiota composition and related metabolites in relation to long-term cardiovascular risk after bariatric surgery are warranted.

  10. Metabolic bariatric surgery and type 2 diabetes mellitus: an endocrinologist's perspective

    Institute of Scientific and Technical Information of China (English)

    Sonali Ganguly; Hong Chang Tan; Phong Ching Lee; Kwang Wei Tham

    2015-01-01

    Traditional treatment of T2DM consisting of modification of diet,an exercise regimen,and pharmacotherapy has problems of poor lifestyle modifications and fail tend of treatment over time,now bariatric surgery is recommended for treatment of obese patients with T2DM because its great improvements on weight loss and metabolic.In this article,effects of bariatric surgery on diabetes and diabetes-related complications are reviewed.

  11. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

    Science.gov (United States)

    Wharton, S; Serodio, K J; Kuk, J L; Sivapalan, N; Craik, A; Aarts, M-A

    2016-04-01

    The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature.

  12. Self-determination and motivation for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Park, Juyeon

    2016-10-01

    This study examined how obese individuals acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one's motivation was internally regulated, related to one's personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient's pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients' motivation, further helping to improve their long-term quality of life post-surgery.

  13. The effects of bariatric surgeries on type 2 diabetes mellitus

    Science.gov (United States)

    Lerd Ng, Jia; Ortiz, Roberto; Hughes, Tyler; Abou Ghantous, Michel; Bouhali, Othmane; Arredouani, Abdelilah; Allen, Roland

    2012-10-01

    We consider a scientific mystery which is of central importance in treating the most rapidly emerging national and global health threat: type 2 diabetes mellitus. The mystery involves a surprising effect of certain bariatric surgeries, and specifically Roux-en-Y gastric bypass (RYGB), a procedure which bypasses most of the stomach and upper intestine. An unanticipated result is that RYGB is usually found to contribute within only a few days to glucose homeostasis. This means the surgery can immediately cure patients even before they start losing weight. We are investigating this wondrous biochemical response with a quantitative model which includes the most important mechanisms. One of the major contributors is glucagon-like peptide 1 (GLP-1), an incretin whose concentration is found to increase by a large amount right after the RYGB surgical procedure. However, our results, in conjunction with the experimental and medical data, indicate that other substances must also contribute. If these substances can be definitively identified, it may be possible to replace the surgery with pharmaceuticals as the preferred treatment for type 2 diabetes.

  14. Changes in Weight and Comorbidities among Adolescents Undergoing Bariatric Surgery: 1-Year Results from the Bariatric Outcomes Longitudinal Database

    Science.gov (United States)

    Messiah, Sarah E.; Lopez-Mitnik, Gabriela; Winegar, Deborah; Sherif, Bintu; Arheart, Kristopher L.; Reichard, Kirk W.; Michalsky, Marc P.; Lipshultz, Steven E.; Miller, Tracie L.; Livingstone, Alan S.; De La Cruz-Muñoz, Nestor

    2012-01-01

    Background Bariatric surgery is one of the few effective treatments for morbid obesity but the weight loss and other health related outcomes for this procedure in large, diverse adolescent patient populations are not well characterized. Objective To analyze the prospective Bariatric Outcomes Longitudinal Database (BOLD) to determine the weight loss and health related outcomes in adolescents. Setting BOLD data is collected from 423 surgeons at 360 facilities in the United States. Methods Main outcome measures included anthropometric and comorbidity status at baseline (n=890) and at 3 (n=786), 6 (n=541), and 12 (n=259) months after surgery. Adolescents (75% female; 68% non-Hispanic white, 14% Hispanic, 11% non-Hispanic black, and 6% other) age 11-to-19 years were included in the analyses. Results The overall one year mean weight loss for those who underwent gastric bypass surgery was more than twice that of those who underwent adjustable gastric band surgery (48.6 kg versus 20 kg, P<0.001). Similar results were found for all other anthropometric changes and comparisons over one year between surgery types (P<0.001). In general, gastric bypass patients reported more improvement versus adjustable gastric band patients in comorbidities one year after surgery. There were a total of 45 readmissions among gastric bypass patients and 10 among adjustable gastric band patients with 29 and 8 reoperations required, respectively. Conclusions Weight loss at 3-, 6-, and 12-months after surgery is approximately double in adolescent males and females who underwent gastric bypass surgery versus those who underwent adjustable gastric band surgery. Bariatric surgery can safely and substantially reduce weight and related comorbidities in morbidly obese adolescents for at least 1 year. PMID:22542199

  15. What is the role of bariatric surgery in the management of obesity?

    Science.gov (United States)

    Panteliou, E; Miras, A D

    2017-04-01

    Diet, exercise, cognitive behavioral therapy and pharmacotherapy are some of the means of assisting patients to lose weight, with bariatric surgery being the most effective. Over the last two decades, the increased awareness of the systemic benefits of bariatric surgery, as well as the improved safety and the wider use of the laparoscopic approach, has made bariatric surgery flourish. In the United Kingdom, the adjustable gastric band (10%), vertical sleeve gastrectomy (37%) and Roux-en-Y gastric bypass (45%) are the three most common procedures. Obesity-associated mortality and co-morbidities such as type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, renal dysfunction and depression improve significantly with bariatric surgery. The mechanisms of weight loss extend beyond restriction and malabsorption and include changes in hunger and satiety, food preferences, and possibly energy expenditure. Despite its safety and efficacy, bariatric surgery is underutilized as less than 1% of adults with obesity receive it. In view of the evolution of obesity into a global threat, access to bariatric surgery should be increased, whilst developing safer and less invasive weight loss treatments.

  16. Bariatric surgery and nonalcoholic fatty liver disease: current and potential future treatments

    Directory of Open Access Journals (Sweden)

    Akira eSasaki

    2014-10-01

    Full Text Available Nonalcoholic fatty liver disease (NAFLD and nonalcoholic steatohepatitis (NASH are increasingly common cause of chronic liver disease worldwide. The diagnosis of NASH is challenging as most affected patients are symptom-free and the role of routine screening is not clearly established. Most patients with severe obesity who undergo bariatric surgery have NAFLD, which is associated insulin resistance, type 2 diabetes mellitus (T2DM, hypertension, and obesity-related dyslipidemia. The effective treatment for NAFLD is weight reduction through lifestyle modifications, antiobesity medication, or bariatric surgery. Among these treatments, bariatric surgery is the most reliable method for achieving substantial, sustained weight loss. This procedure is safe when performed by a skilled surgeon, and the benefits include reduced weight, improved quality of life, decreased obesity-related comorbidities, and increased life expectancy. Further research is urgently needed to determine the best use of bariatric surgery with NAFLD patients at high risk of developing liver cirrhosis and its role in modulating complications of NAFLD, such as T2DM and cardiovascular disease. The current evidence suggests that bariatric surgery for patients with severe obesity decreases the grade of steatosis, hepatic inflammation, and fibrosis. However, further long-term studies are required to confirm the true effects before recommending bariatric surgery as a potential treatment for nonalcoholic steatohepatitis.

  17. Bariatric Surgery as a Bridge to Renal Transplantation in Patients with End-Stage Renal Disease.

    Science.gov (United States)

    Al-Bahri, Shadi; Fakhry, Tannous K; Gonzalvo, John Paul; Murr, Michel M

    2017-05-13

    Obesity is a relative contraindication to organ transplantation. Preliminary reports suggest that bariatric surgery may be used as a bridge to transplantation in patients who are not eligible for transplantation because of morbid obesity. The Bariatric Center at Tampa General Hospital, University of South Florida, Tampa, Florida. We reviewed the outcomes of 16 consecutive patients on hemodialysis for end-stage renal disease (ESRD) who underwent bariatric surgery from 1998 to 2016. Demographics, comorbidities, weight loss, as well as transplant status were reported. Data is mean ± SD. Six men and ten women aged 43-66 years (median = 54 years) underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 12), laparoscopic adjustable gastric banding (LAGB, n = 3), or laparoscopic sleeve gastrectomy (LSG, n = 1). Preoperative BMI was 48 ± 8 kg/m(2). Follow-up to date was 1-10 years (median = 2.8 years); postoperative BMI was 31 ± 7 kg/m(2); %EBWL was 62 ± 24. Four patients underwent renal transplantation (25%) between 2.5-5 years after bariatric surgery. Five patients are currently listed for transplantation. Five patients were not listed for transplantation due to persistent comorbidities; two of these patients died as a consequence of their comorbidities (12.5%) more than 1 year after bariatric surgery. Two patients were lost to follow-up (12.5%). Bariatric surgery is effective in patients with ESRD and improves access to renal transplantation. Bariatric surgery offers a safe approach to weight loss and improvement in comorbidities in the majority of patients. Referrals of transplant candidates with obesity for bariatric surgery should be considered early in the course of ESRD.

  18. Older adults fighting obesity with bariatric surgery: Benefits, side effects, and outcomes.

    Science.gov (United States)

    Marihart, Cindy L; Brunt, Ardith R; Geraci, Angela A

    2014-01-01

    The aging population is growing exponentially worldwide. Associated with this greater life expectancy is the increased burden of chronic health conditions, many of which are exacerbated by the continued rise in obesity. In the US, the prevalence of obesity in adults aged 60 years and older increased from 23.6% to 37% in 2010. This review examines bariatric surgery as a treatment option for obese adults > 60 years old. The most common types of weight-loss surgery are laparoscopic adjustable gastric banding, vertical sleeve gastrectomy, Roux-en-Y gastric bypass, and the duodenal switch. A comprehensive literature search found 349 articles that referred to bariatric surgery in older adults. Of these, 70 relevant articles on bariatric surgery for older adults were utilized for this article. Weight-loss surgery procedures were found to be equally safe for both older adults and their younger counterparts. Pre-surgical psychological assessment is critical for positive outcomes for older adults. Benefits of bariatric surgery include a decrease in comorbidities, chronic disease risk, and medication use coupled with improved mobility and quality of life outcomes. Side effects include surgical failure, changes in psychological status, and increased physical and mental stress. Bariatric surgery can offer patients an effective and long-lasting treatment for obesity and related diseases. There does not appear to be any one bariatric procedure that is recommended for older adults, so individual needs should be taken into consideration when exploring options. Costs range from US$17,000 for laparoscopic procedures to US$26,000 for open gastric surgeries. Estimated savings start accruing within 3 months of surgery making bariatric surgery a serious cost saving consideration.

  19. The effect of bariatric surgery on gastrointestinal and pancreatic peptide hormones.

    Science.gov (United States)

    Meek, Claire L; Lewis, Hannah B; Reimann, Frank; Gribble, Fiona M; Park, Adrian J

    2016-03-01

    Bariatric surgery for obesity has proved to be an extremely effective method of promoting long-term weight reduction with additional beneficial metabolic effects, such as improved glucose tolerance and remission of type 2 diabetes. A range of bariatric procedures are in common use, including gastric banding, sleeve gastrectomy and the Roux-en-Y gastric bypass. Although the mechanisms underlying the efficacy of bariatric surgery are unclear, gastrointestinal and pancreatic peptides are thought to play an important role. The aim of this review is to summarise the effects of different bariatric surgery procedures upon gastrointestinal and pancreatic peptides, including ghrelin, gastrin, cholecystokinin (CCK), glucose-dependent insulinotropic hormone (GIP), glucagon-like peptide 1 (GLP-1), peptide YY (PYY), oxyntomodulin, insulin, glucagon and somatostatin.

  20. Bariatric surgery for obesity and metabolic disorders: state of the art.

    Science.gov (United States)

    Nguyen, Ninh T; Varela, J Esteban

    2017-03-01

    Obesity is one of the most important public health conditions worldwide. Bariatric surgery for severe obesity is an effective treatment that results in the improvement and remission of many obesity-related comorbidities, as well as providing sustained weight loss and improvement in quality of life. Contemporary bariatric operations include Roux-en-Y gastric bypass, sleeve gastrectomy, adjustable gastric band and the duodenal switch. The vast majority of these procedures are now performed using laparoscopic technique, the main advantages of which include rapid recovery, the reduction of postoperative pain and the reduction of wound-related complications, compared with open surgery. Contemporary bariatric surgery is now safe, with a mortality of three in 1,000 patients; however, all bariatric operations are associated with their own unique short-term and long-term nutritional and procedural-related complications. Type 2 diabetes mellitus (T2DM) is the most studied metabolic disorder associated with obesity, with data demonstrating that improvement and remission of T2DM in patients with obesity is superior after bariatric surgery compared with conventional medical therapy. Bariatric surgery is now a part of some treatment algorithms for the medical management of patients with T2DM and severe obesity. New, minimally invasive and endoscopic devices for the treatment of obesity have now been approved in the USA, which will expand the treatment options for individuals with obesity.

  1. Bariatric Surgery as Potential Treatment for Nonalcoholic Fatty Liver Disease: A Future Treatment by Choice or by Chance?

    OpenAIRE

    2013-01-01

    Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD) which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through life style modifications, antiobesity medication, and bariatric surgery. Importantly, bariatric surgery is the best alternative option for weight reduction if lifestyle modifications and pharmacological therapy have not yielded long-term success. Bariatric surgery ...

  2. Psychological and health comorbidities before and after bariatric surgery: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Susana Sofia Pereira da Silva

    2013-12-01

    Full Text Available INTRODUCTION: Morbid obesity has multiple implications for psychological and physical health. Bariatric surgery has been selected as the treatment of choice for this chronic disease, despite the controversial impact of the surgery on psychosocial health. The objective of this study was to describe candidates for bariatric surgery and analyze changes in weight, psychopathology, personality, and health problems and complaints at 6- and 12- month follow-up assessments. METHODS: Thirty obese patients (20 women and 10 men with a mean age of 39.17±8.81 years were evaluated in different dimensions before surgery and 6 and 12 months after the procedure. RESULTS: Six and 12 months after bariatric surgery, patients reported significant weight loss and a significant reduction in the number of health problems and complaints. The rates of self-reported psychopathology were low before surgery, and there were no statistically significant changes over time. The conscientiousness, extraversion, and agreeableness dimensions increased, but neuroticism and openness remained unchanged. All changes had a medium effect size. CONCLUSIONS: Our results suggest that patients experience significant health improvements and some positive personality changes after bariatric surgery. Even though these findings underscore the role of bariatric surgery as a relevant treatment for morbid obesity, more in-depth longitudinal studies are needed to elucidate the evolution of patients after the procedure.

  3. Bariatric surgery in patients with bipolar spectrum disorders: Selection factors, postoperative visit attendance, and weight outcomes.

    Science.gov (United States)

    Friedman, Kelli E; Applegate, Katherine; Portenier, Dana; McVay, Megan A

    2017-04-01

    As many as 3% of bariatric surgery candidates are diagnosed with a bipolar spectrum disorder. 1) To describe differences between patients with bipolar spectrum disorders who are approved and not approved for surgery by the mental health evaluator and 2) to examine surgical outcomes of patients with bipolar spectrum disorders. Academic medical center, United States. A retrospective record review was conducted of consecutive patients who applied for bariatric surgery between 2004 and 2009. Patients diagnosed with bipolar spectrum disorders who were approved for surgery (n = 42) were compared with patients with a bipolar spectrum disorder who were not approved (n = 31) and to matched control surgical patients without a bipolar spectrum diagnosis (n = 29) on a variety of characteristics and surgical outcomes. Of bariatric surgery candidates diagnosed with a bipolar spectrum disorder who applied for surgery, 57% were approved by the psychologist and 48% ultimately had surgery. Patients with a bipolar spectrum disorder who were approved for surgery were less likely to have had a previous psychiatric hospitalization than those who were not approved for surgery. Bariatric surgery patients diagnosed with a bipolar spectrum disorder were less likely to attend follow-up care appointments 2 or more years postsurgery compared to matched patients without bipolar disorder. Among patients with available data, those with a bipolar spectrum disorder and matched patients had similar weight loss at 12 months (n = 21 for bipolar; n = 24 for matched controls) and at 2 or more years (mean = 51 mo; n = 11 for bipolar; n = 20 for matched controls). Patients diagnosed with a bipolar spectrum disorder have a high rate of delay/denial for bariatric surgery based on the psychosocial evaluation and are less likely to attend medical follow-up care 2 or more years postsurgery. Carefully screened patients with bipolar disorder who engage in long-term follow-up care may benefit from bariatric

  4. Bariatric Surgery as Potential Treatment for Nonalcoholic Fatty Liver Disease: A Future Treatment by Choice or by Chance?

    Directory of Open Access Journals (Sweden)

    Shuja Hafeez

    2013-01-01

    Full Text Available Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through life style modifications, antiobesity medication, and bariatric surgery. Importantly, bariatric surgery is the best alternative option for weight reduction if lifestyle modifications and pharmacological therapy have not yielded long-term success. Bariatric surgery is an effective treatment option for individuals who are grossly obese and associated with marked decrease in obesity-related morbidity and mortality. The most common performed bariatric surgery is Roux-en-Y gastric bypass (RYGB. The current evidence suggests that bariatric surgery in these patients will decrease the grade of steatosis, hepatic inflammation, and fibrosis. NAFLD per se is not an indication for bariatric surgery. Further research is urgently needed to determine (i the benefit of bariatric surgery in NAFLD patients at high risk of developing liver cirrhosis (ii the role of bariatric surgery in modulation of complications of NAFLD like diabetes and cardiovascular disease. The outcomes of the future research will determine whether bariatric surgery will be one of the recommended choice for treatment of the most progressive type of NAFLD.

  5. Bariatric surgery as potential treatment for nonalcoholic fatty liver disease: a future treatment by choice or by chance?

    Science.gov (United States)

    Hafeez, Shuja; Ahmed, Mohamed H

    2013-01-01

    Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD) which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through life style modifications, antiobesity medication, and bariatric surgery. Importantly, bariatric surgery is the best alternative option for weight reduction if lifestyle modifications and pharmacological therapy have not yielded long-term success. Bariatric surgery is an effective treatment option for individuals who are grossly obese and associated with marked decrease in obesity-related morbidity and mortality. The most common performed bariatric surgery is Roux-en-Y gastric bypass (RYGB). The current evidence suggests that bariatric surgery in these patients will decrease the grade of steatosis, hepatic inflammation, and fibrosis. NAFLD per se is not an indication for bariatric surgery. Further research is urgently needed to determine (i) the benefit of bariatric surgery in NAFLD patients at high risk of developing liver cirrhosis (ii) the role of bariatric surgery in modulation of complications of NAFLD like diabetes and cardiovascular disease. The outcomes of the future research will determine whether bariatric surgery will be one of the recommended choice for treatment of the most progressive type of NAFLD.

  6. Effect of Health Literacy on Help-seeking Behavior in Morbidly Obese Patients Agreeing to Bariatric Surgery.

    Science.gov (United States)

    Cayci, Haci Murat; Erdogdu, Umut Eren; Demirci, Hakan; Ardic, Aykut; Topak, Nevruz Yildirim; Taymur, İbrahim

    2017-08-18

    We aimed to evaluate the effect of health literacy on agreement for bariatric surgery among morbidly obese patients. The data of 242 morbidly obese patients (body mass index-BMI ≥ 40 kg/m(2)) were evaluated in a cross-sectional case-control pattern. The patients were classified into two groups as those who were attending the clinic for the purpose of receiving bariatric surgery (n = 138) and those who did not (n = 104). The Turkish version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47), consisting of 47 questions, was used for the health literacy evaluation. It was seen that patients who accepted bariatric surgery were younger and had higher weight and BMI values (p bariatric surgery and 26.04 (8.33:46.88) in the group who did not agree to bariatric surgery, and a statistically significant difference was determined between the two groups (p bariatric surgery and 45.2% of the group who did not (p  25-33) (respectively, 36.2%, 37.5%, p = 0.840). A sufficient level (> 33-42) and a perfect level were higher in the group who agreed to bariatric surgery (respectively, 42.8%, 18.1%, p bariatric surgery in morbidly obese patients. The higher the health literacy level, the more the agreement to bariatric surgery increased.

  7. Translating weight loss into agency: Men's experiences 5 years after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Eli Natvik

    2015-06-01

    Full Text Available Fewer men than women with severe obesity undergo bariatric surgery for weight loss, and knowledge about men's situation after surgery, beyond medical status, is lacking. Our aim was to explore men's experiences with life after bariatric surgery from a long-term perspective. We conducted in-depth interviews with 13 men, aged 28–60 years, between 5 and 7 years after surgery. The analysis was inspired by Giorgi's phenomenological method. We found that agency was pivotal for how the men understood themselves and their lives after surgery. Weight loss meant regaining opportunities for living and acting in unrestricted and independent daily lives, yet surgery remained a radical treatment with complex consequences. Turning to surgery had involved conceptualizing their own body size as illness, which the men had resisted doing for years. After surgery, the rapid and major weight loss and the feelings of being exhausted, weak, and helpless were intertwined. The profound intensity of the weight loss process took the men by surprise. Embodying weight loss and change involved an inevitable renegotiating of experiences connected to the large body. Having bariatric surgery was a long-term process that seemed unfinished 5 years after surgery. Restrictions and insecurity connected to health and illness persist, despite successful weight loss and embodied change. Bariatric surgery initiated a complex and long-lasting life-changing process, involving both increased capacity for agency and illness-like experiences.

  8. Recommendations for bariatric surgery in adolescents in Australia and New Zealand.

    Science.gov (United States)

    Baur, Louise A; Fitzgerald, Dominic A

    2010-12-01

    The prevalence of severe obesity and associated co-morbidities is increasing in adolescence. Although support for long-term whole-of-family lifestyle change is the mainstay of paediatric obesity treatment, there is increasing recognition of the place of other therapies,including bariatric surgery, in the management of severely obese adolescents. While there are rising numbers of reports of bariatric surgery in adolescents, there are as yet no Australian or New Zealand recommendations available to guide decisions as to which adolescents should receive such surgery and how they should best be managed. This paper presents a summary of the recommendations that are contained within the full position paper developed on behalf of the Royal Australasian College of Physicians Paediatric Policy and Advocacy Committee Working Party on Bariatric Surgery for Adolescents, working in conjunction with the Australia and New Zealand Association of Paediatric Surgeons and the Obesity Surgery Society of Australia and New Zealand.

  9. Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

    Science.gov (United States)

    de Zwaan, Martina; Georgiadou, Ekaterini; Stroh, Christine E.; Teufel, Martin; Köhler, Hinrich; Tengler, Maxi; Müller, Astrid

    2014-01-01

    Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). Results: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole. PMID:25477839

  10. Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

    Directory of Open Access Journals (Sweden)

    Martina eDe Zwaan

    2014-11-01

    Full Text Available Background: Massive weight loss (MWL following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image and physical functioning.Methods: In this cross-sectional study 3 groups were compared: 1 patients prior to bariatric surgery (n=79, 2 patients after bariatric surgery who had not undergone BCS (n=252, and 3 patients after bariatric surgery who underwent subsequent body contouring surgery (BCS (n=62. All participants completed self-report questionnaires assessing body image (MBSRQ, quality of life (IWQOL-Lite, symptoms of depression (PHQ-9 and anxiety (GAD-7.Results: Overall, 62 patients (19.2% reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%, thigh lifts (24.2%, and breast lifts (16.1%. Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients; however, there were fewer differences between patients with and without BCS. Patients after BCS reported better appearance evaluation, body area satisfaction, and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better appearance evaluation and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.

  11. Factors Leading to Self-Removal from the Bariatric Surgery Program After Attending the Orientation Session.

    Science.gov (United States)

    Yang, Kai; Zhang, Binghao; Kastanias, Patti; Wang, Wei; Okraniec, Allan; Sockalingam, Sanjeev

    2017-01-01

    Bariatric surgery orientation sessions are often the first point of contact and a recommended component of pre-bariatric surgery assessment. Self-removal rates after bariatric program orientation are as high as 25 % despite the proven efficacy of this procedure. The objective of this study was to identify factors contributing to patient self-removal after orientation using a mixed method approach. Patients who attended the Toronto Western Hospital Bariatric Surgery Program orientation between 2012 and 2013 and then self-removed from the program (N = 216) were included in the study. Subjects were interviewed via telephone using a semi-structured interview guide, generating both quantitative and qualitative data. Factors leading to discontinuation were rated on a five-point Likert scale. Qualitative data was analyzed using constant comparative methodology. The response rate was 59 % with a 40.7 % completion rate (N = 88). Concerns about potential surgical risks and complications and the ability to adapt to changes in eating and drinking post-operatively were identified as the top two factors for patients' self-removal from the program. Thematic analysis uncovered 11 major themes related to patient self-removal. Unexpected themes include perceived personal suitability for the surgery, family impact of surgery, miscommunication with the family physician, and fears related to the orientation information. This is one of the first studies examining barriers to bariatric surgery in the pre-operative setting and offers new insights into the reasons patients self-remove from bariatric surgery programs. This study may inform bariatric orientation program changes resulting in improved access to this effective surgical intervention.

  12. Postoperative Follow-up After Bariatric Surgery: Effect on Weight Loss.

    Science.gov (United States)

    Spaniolas, Konstantinos; Kasten, Kevin R; Celio, Adam; Burruss, Matthew B; Pories, Walter J

    2016-04-01

    While adherence to long-term follow-up after bariatric surgery is a mandate for center of excellence certification, the effect of attrition on weight loss is not well understood. The aim of this study was to assess the effect of postoperative follow-up on 12-month weight loss using the Bariatric Outcomes Longitudinal Database (BOLD) dataset. Patients with complete follow-up (3, 6, and 12 months) were compared to patients who had one or more prior missed visits. There were 51,081 patients with 12-month follow-up data available. After controlling for baseline characteristics, complete follow-up was independently associated with excess weight loss ≥50%, and total weight loss ≥30%. Adherence to postoperative follow-up is independently associated with improved 12-month weight loss after bariatric surgery. Bariatric programs should strive to achieve complete follow-up for all patients.

  13. PRE- AND POSTOPERATIVE IN BARIATRIC SURGERY: SOME BIOCHEMICAL CHANGES.

    Science.gov (United States)

    Tedesco, Amanda Kaseker; Biazotto, Rafaela; Gebara, Telma Souza E Silva; Cambi, Maria Paula Carlini; Baretta, Giorgio Alfredo Pedroso

    The bariatric surgery may cause some nutritional deficiencies. To compare the serum levels of biochemical markers, in iimmediate post-surgical patients who were submitted to bariatric surgery. Non-concurrent prospective cross-sectional study. The analysis investigated data in medical charts of pre-surgical and immediate post-surgical patients who were submitted to bariatric surgery, focusing total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C reactive protein, vitamin B12 levels, folic acid, homocysteine values, iron and serum calcium at the referred period. Twenty-nine patients of both genders were evaluated. It was observed weight loss from 108.53 kg to 78.69 kg after the procedure. The variable LDL-c had a significant difference, decreasing approximately 30.3 mg/dl after the surgery. The vitamin B12 serum average levels went from 341.9 pg/ml to 667.2 pg/ml. The triglycerides values were in a range of 129.6 mg/dl-173.3 mg/dl, and 81.9 mg/dl-105.3 mg/dl at the pre- and postoperative respectively. CRP levels fall demonstrated reduction of inflammatory activity. The variable homocysteine was tested in a paired manner and it did not show a significant changing before or after, although it showed a strong correlation with LDL cholesterol. Eligible patients to bariatric surgery frequently present pre-nutritional deficiencies, having increased post-surgical risks when they don´t follow an appropriate nutritional follow-up. A cirurgia bariátrica pode causar deficiências nutricionais. Comparar os níveis séricos bioquímicos de pacientes submetidos à cirurgia bariátrica no pré e pós-operatório precoce. Estudo transversal, retrospectivo não concorrente. A análise considerou a investigação de prontuários de pacientes submetidos à gastroplastia no período pré-operatório e pós-operatório precoce, analisando resultado bioquímicos de colesterol total, HDL colesterol, LDL colesterol, triglicérides, proteína C reativa, dosagens de vitamina

  14. Outcomes of Bariatric Surgery in Morbidly Obese Patients with Multiple Sclerosis

    Science.gov (United States)

    Jammoul, Adham; Aminian, Ali; Shimizu, Hideharu; Fisher, Carolyn J.; Schauer, Philip R.; Rae-Grant, Alexander; Brethauer, Stacy A.

    2017-01-01

    Obesity is common in patients with multiple sclerosis (MS); however, safety and efficacy of bariatric surgery in this population remain unclear. A database of 2,918 was retrospectively reviewed, yielding 22 (0.75%) severely obese patients with MS who underwent bariatric surgery. Sixteen surgical patients with complete follow-up data were matched to a nonsurgical control group of MS patients, based on age, BMI, MS subtype, and length of follow-up. MS relapse rates and trends in the timed twenty-five foot walk test (T25FW) were compared. In the surgical group (gastric bypass n = 19, sleeve gastrectomy n = 3), preoperative BMI was 46.5 ± 7.2 Kg/m2 and average excess weight was 60.4 kg. Follow-up data was collected at 59.0 ± 29.8 months. There were two major and four minor complications. Five patients required readmission and there were no mortalities. Percent excess weight loss was 75.5 ± 27.0%. In the 16 patients with follow-up data, patients who underwent bariatric surgery were significantly faster on the T25FW compared to the nonsurgical population. In conclusion, bariatric surgery is relatively safe and effective in achieving weight loss in patients with MS. In addition, surgery may help patients maintain ambulation. Findings support the need for further studies on bariatric surgery and disease-specific outcomes in this population. PMID:28299203

  15. Genetic modifiers of obesity and bariatric surgery outcomes.

    Science.gov (United States)

    Sevilla, Samantha; Hubal, Monica J

    2014-02-01

    Obesity is a highly heritable trait. While acute and chronic changes in body weight or obesity-related comorbidities are heavily influenced by environmental factors, there are still strong genomic modifiers that help account for inter-subject variability in baseline traits and in response to interventions. This review is intended to provide an up-to-date overview of our current understanding of genetic influences on obesity, with emphasis on genetic modifiers of baseline traits and responses to intervention. We begin by reviewing how genetic variants can influence obesity. We then examine genetic modifiers of weight loss via different intervention strategies, focusing on known and potential modifiers of surgical weight loss outcomes. We will pay particular attention to the effects of patient age on outcomes, addressing the risks and benefits of adopting early intervention strategies. Finally, we will discuss how the field of bariatric surgery can leverage knowledge of genetic modifiers to adopt a personalized medicine approach for optimal outcomes across this widespread and diverse patient population.

  16. Sugammadex and Ideal Body Weight in Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Maria Sanfilippo

    2013-01-01

    Full Text Available Background. The obese patients have differences in body composition, drug distribution, and metabolism. Sugammadex at recovery in a dose of 2 mg kg−1 of real body weight (RBW can completely reverse the NMB block; in our study we investigated the safety and efficacy of Sugammadex dose based on their ideal body weight (IBW. Methods. 40 patients of both sexes undergoing laparoscopic bariatric surgery were enrolled divided into 2 groups according to the dose of Sugammadex: the first received a dose of 2 mg kg−1 of IBW and the second received a dose of 2 mg kg−1 of RBW. Both were anesthetized with doses calculated according to the IBW: fentanyl 2 μg kg−1, propofol 3 mg kg−1, rocuronium 0,6 mg kg−1, oxygen, air, and desflurane (6–8%. Maintenance doses of rocuronium were 1/4 of the intubation dose. Sugammadex was administrated at recovery. Results. The durations of intubation and maintenance doses of rocuronium were similar in both groups. In IBW group, the / value of 0.9 was reached in 151 ± 44 seconds and in 121 ± 55 seconds in RBW group (. Discussion. Recovery times to / of 0.9 are surprisingly similar in both groups without observing any postoperative residual curarization. Conclusion. Sugammadex doses calculated according to the IBW are certainly safe for a rapid recovery and absence of PORC.

  17. Pre-operative history of depression and cognitive changes in bariatric surgery patients.

    Science.gov (United States)

    Alosco, Michael L; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D; Mitchell, James E; Gunstad, John

    2015-01-01

    Obesity-associated cognitive impairments may be partially reversible through bariatric surgery. Depression, a prevalent comorbidity in bariatric surgery candidates, is linked with cognitive impairment and poorer surgical outcomes in other populations. No study has examined the effects of pre-operative depression on cognitive changes in bariatric surgery patients. Sixty-seven bariatric surgery patients completed a computerized cognitive test battery prior to surgery and 12 months post-operatively. The structured clinical interview for the DSM-IV Axis I disorders assessed major depressive disorder (MDD). Pre-surgery history of MDD was found in 47.8% of patients, but was not associated with greater baseline cognitive impairments. Repeated measures revealed improved cognitive abilities 12 months after surgery. Pre-surgery history of MDD did not influence post-operative cognitive function. Pre-operative history of MDD did not limit post-operative cognitive improvements. Larger studies with extended follow-ups are needed to clarify our findings and identify factors (e.g. older age) that may modify cognitive changes following surgery.

  18. Collateral Weight Loss in Children Living with Adult Bariatric Surgery Patients: A Case Control Study

    Science.gov (United States)

    Hirsch, Annemarie G.; Wood, G. Craig; Bailey-Davis, Lisa; Lent, Michelle R.; Gerhard, Glenn S.; Still, Christopher D.

    2014-01-01

    Objective To evaluate the impact of adult bariatric surgery on the Body Mass Index (BMI) of children living in the same household. Design and Methods A retrospective case-control study. Case dyads (n=128) were composed of one adult who had bariatric surgery and one child at the same address. Control dyads (n=384) were composed of an adult with obesity but no bariatric surgery and a child at the same address. We used a two-sample t-test to determine whether the differences between actual and expected BMI at follow-up (post-surgery) differed between children in the case and control dyads. Results Among boys who were overweight, boys who lived with a surgery patient had a lower than expected BMI post-surgery, while boys who did not live with a surgery patient had a higher than expected BMI at follow-up (p=0.045). Differences between actual and expected BMIs of children were not significantly different between cases and controls in girls or in children in other weight classes. Conclusions Overweight boys who lived with an adult bariatric surgery patient had a lower than expected BMI after surgery as compared to controls. Future studies may be warranted to determine the mechanisms by which these children experience collateral weight loss. PMID:24989939

  19. Is Bariatric Surgery an Effective Treatment for Type II Diabetic Kidney Disease?

    Science.gov (United States)

    Friedman, Allon N; Wolfe, Bruce

    2016-03-07

    Type II diabetic kidney disease is devastating to patients and society alike. This review will evaluate bariatric surgery as a treatment for diabetic kidney disease primarily through its ability to induce and maintain regression of type II diabetes. The review begins by outlining the global challenge of diabetic kidney disease, its link to obesity, and the comparative benefits of bariatric surgery on weight and type II diabetes. It then surveys comprehensively the relevant literature, which reports that although bariatric surgery is associated with reductions in albuminuria, its effect on harder clinical end points like progression of diabetic kidney disease is not known. The review also includes a critical assessment of the risks and costs of bariatric surgery and concludes by acknowledging the major knowledge gaps in the field and providing research strategies to overcome them. Until these knowledge gaps are filled, clinicians will be forced to rely on their own subjective judgment in determining the benefit-risk ratio of bariatric surgery for patients with diabetic kidney disease.

  20. The effect of bariatric surgery on renal function and disease: a focus on outcomes and inflammation.

    Science.gov (United States)

    Neff, Karl J; Frankel, Andrew H; Tam, Frederick W K; Sadlier, Denise M; Godson, Catherine; le Roux, Carel W

    2013-11-01

    Renal dysfunction and disease, including hyperfiltration, proteinuria and hypofiltration, are commonly associated with obesity. Diabetic kidney disease is also common in obese cohorts. Weight loss interventions, including bariatric surgery, can effectively reduce weight and improve renal outcomes. Some of this effect may be due to the remission of Type 2 diabetes and hypertension. However, other mechanisms, including the resolution of inflammatory processes, may also contribute. The effect of bariatric surgery on renal function has only recently become a focus of particular investigation. In this study, we will review the effects of bariatric surgery on obesity-associated kidney disease. We will discuss the pitfalls in assessing renal function in obese cohorts and will examine the effect of bariatric surgery on renal function and urinary protein excretion using different mechanisms. We will give particular attention to the evidence for bariatric surgery in cohorts with established renal disease and suggest future directions. In particular, we will outline the evidence for inflammation as an important therapeutic target, and the emerging medical therapies being considered to exploit this target in obesity- and diabetes-related kidney disease.

  1. Does bariatric surgery reduce cancer risk? A review of the literature.

    Science.gov (United States)

    Maestro, Alba; Rigla, Mercedes; Caixàs, Assumpta

    2015-03-01

    Bariatric surgery has been shown to provide sustained weight loss and to decrease obesity-related mortality in most patients with morbid obesity, but its effect on cancer risk is less clear. Our aim was to review the published studies on the association between bariatric surgery and cancer risk. A literature search for relevant articles published in English, with no limitation on the year of publication, was conducted using PubMed. Studies reporting data on preoperative cancer, case reports, and publications with no abstract available were excluded. Overall, the published literature suggests that bariatric surgery may decrease risk of cancer, although this effect appears to be limited to women. However, two recent studies contradict these findings and state that risk of cancer has not been actually shown to decrease after surgery, and an increased risk of colorectal cancer has even been seen. Although most studies report lower cancer risk after bariatric surgery, the main limitations include their designs, which do not achieve the highest levels of evidence. Moreover, several mechanisms have been proposed to explain the protective effect of surgery, but the exact mechanisms have not been elucidated yet, which suggests the need for further research. Bariatric surgery may have a protective effect from overall cancer risk, mainly in women, but additional research is needed. Further research is also required to better examine the relationship between bariatric surgery and risk of colorectal cancer before confirming or dismissing the above reported higher risk, as well as the risk of esophagogastric cancer, which has not been adequately studied to date. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  2. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies.

    Science.gov (United States)

    Dalfrà, Maria Grazia; Busetto, Luca; Chilelli, Nino Cristiano; Lapolla, Annunziata

    2012-09-01

    It is well known that maternal obesity has adverse effects on the health of offspring, causing immediate and long-term morbidities. The various types of procedure coming under the heading of bariatric surgery have proved effective in preventing some maternal and foetal complications in morbidly obese pregnant women. This review aims to assess the role, the risks and the benefits of bariatric surgery for mothers and offspring. According to recent findings, pregnancy and neonatal outcomes in morbidly obese women who have undergone bariatric surgery depend to some extent on the type of surgery used. Maternal complications, nutritional defects and intestinal obstruction are more frequently reported after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) than after laparoscopic adjustable gastric banding (LAGB) procedures, whereas caesarean section, preterm delivery and neonatal death are more commonly reported after RYGB than after LAGB. The authors of the only long-term follow-up study conducted on this subject reported that the rate of obesity in the children dropped by 52% after bariatric surgery for the mother, and the cases of severe obesity decreased by 45%. Data on pregnancy and bariatric surgery confirm that the procedure is more effective than dietary measures alone in morbidly obese women, and that pregnancy outcome is generally favorable after surgery. Some studies have indicated, nonetheless, that pregnancies after bariatric surgery are at higher risk: the women affected require special medical attention, particularly as concerns gastrointestinal symptoms and vitamin deficiencies, warranting nutritional/dietary counselling by a multidisciplinary team before, during and after pregnancy.

  3. Impact of bariatric surgery on life expectancy in severely obese patients with diabetes: A Decision analysis

    Science.gov (United States)

    Schauer, Daniel P.; Arterburn, David E.; Livingston, Edward H.; Coleman, Karen J.; Sidney, Steve; Fisher, David; O'Connor, Patrick; Fischer, David; Eckman, Mark H.

    2014-01-01

    Objective To create a decision analytic model to estimate the balance between treatment risks and benefits for severely obese patients with diabetes. Summary Background Data Bariatric surgery leads to many desirable metabolic changes, but long-term impact of bariatric surgery on life expectancy in patients with diabetes has not yet been quantified. Methods We developed a Markov state transition model with multiple Cox proportional hazards models and logistic regression models as inputs to compare bariatric surgery versus no surgical treatment for severely obese diabetic patients. The model is informed by data from three large cohorts: 1) 159,000 severely obese diabetic patients (4,185 had bariatric surgery) from 3 HMO Research Network sites, 2) 23,000 subjects from the Nationwide Inpatient Sample (NIS), and 3) 18,000 subjects from the National Health Interview Survey linked to the National Death Index. Results In our main analyses, we found that a 45 year-old female with diabetes and a BMI of 45 kg/m2 gained an additional 6.7 years of life expectancy with bariatric surgery (38.4 years with surgery vs. 31.7 without). Sensitivity analyses revealed that the gain in life expectancy decreased with increasing BMI, until a BMI of 62 kg/m2 is reached, at which point nonsurgical treatment was associated with greater life expectancy. Similar results were seen for both men and women in all age groups. Conclusions For most severely obese patients with diabetes, bariatric surgery appears to improve life expectancy; however, surgery may reduce life expectancy for the super obese with BMIs over 62 kg/m2. PMID:25844968

  4. Implementation of the Spanish National Enhanced Recovery Program (ERAS) in Bariatric Surgery: A Pilot Study.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Royo, Pablo; Muñoz, José L; Duran, Manuel; Redondo, Elisabeth; Ramirez, Jose M

    2016-12-01

    The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish fast track group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery. A multicentric prospective pilot study was performed, including 125 consecutive patients undergoing bariatric surgery at 3 Spanish hospitals between January and June 2015, after the Spanish National ERAS protocol in bariatric surgery. Compliance with the protocol, morbidity, mortality, hospital stay, and readmission were evaluated. Bariatric techniques performed included 68 Roux-en-Y gastric bypass (54.4%) and 57 laparoscopic sleeve gastrectomy (45.6%) cases. All surgeries were laparoscopically performed with conversion in only 1 case (0.8%). Median postoperative pain evaluated by visual analogic scale 24 hours after surgery was 2 (range, 0 to 5). Postoperative nausea or vomiting appeared in 7 patients (5.6%). Complications appeared in 6 patients (4.8%). The reoperation rate was 4%. The mortality rate was 0.8%. The median hospital stay was 2 days (range, 2 to 10 d) and readmission rate was 2.4%. The compliance of all the items of the protocol was achieved in 78.4% of the patients. The Spanish National ERAS protocol is a safe issue with a high implementation rate. It can be recommended to establish this protocol to other institutions.

  5. Quality of life among patients undergoing bariatric surgery: associations with mental health- A 1 year follow-up study of bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    Stubhaug Bjarte

    2011-09-01

    Full Text Available Abstract Background Preoperative mental health seems to have useful predictive value for Health Related Quality of Life (HRQOL after bariatric surgery. The aim of the present study was to assess pre- and postoperative psychiatric disorders and their associations with pre- and postoperative HRQOL. Method Data were assessed before (n = 127 and one year after surgery (n = 87. Psychiatric disorders were assessed by Mini International Neuropsychiatric Interview (M.I.N.I. and Structured Clinical Interview (SCID-II. HRQOL was assessed by the Short Form 36 (SF-36 questionnaire. Results Significant improvements were found in HRQOL from preoperative assessment to follow-up one year after surgery. For the total study population, the degree of improvement was statistically significant (p values Conclusion This study reports the novel finding that patients without postoperative psychiatric disorders achieved a HRQOL comparable to the general population one year after bariatric surgery; while patients with postoperative psychiatric disorders did not reach the HRQOL level of the general population. Our results support monitoring patients with psychiatric disorders persisting after surgery for suboptimal improvements in quality of life after bariatric surgery. Trial Registration The trial is registered at http://www.clinicaltrials.gov prior to patient inclusion (ProtocolID16280.

  6. Effects of bariatric surgery on hepatic and intestinal lipoprotein particle metabolism in obese, nondiabetic humans.

    Science.gov (United States)

    Padilla, Nadège; Maraninchi, Marie; Béliard, Sophie; Berthet, Bruno; Nogueira, Juan-Patricio; Wolff, Estelle; Nicolay, Alain; Bégu, Audrey; Dubois, Noémie; Grangeot, Rachel; Mattei, Catherine; Vialettes, Bernard; Xiao, Changting; Lewis, Gary F; Valéro, René

    2014-10-01

    The dyslipidemia of obesity and other insulin-resistant states is characterized by the elevation of plasma triglyceride-rich lipoproteins (TRL) of both hepatic (apoB-100-containing very low-density lipoprotein) and intestinal (apoB-48-containing chylomicrons) origin. Bariatric surgery is a well-established and effective modality for the treatment of obesity and is associated with improvements in several metabolic abnormalities associated with obesity, including a reduction in plasma triglycerides. Here, we have investigated the effect of bariatric surgery on TRL metabolism. Twenty-two nondiabetic, obese subjects undergoing bariatric surgery: sleeve gastrectomy (n=12) or gastric bypass (n=10) were studied. Each subject underwent 1 lipoprotein turnover study 1 month before surgery followed by a second study, 6 months after surgery, using established stable isotope enrichment methodology, in constant fed state. TRL-apoB-100 concentration was significantly reduced after sleeve gastrectomy, explained by a decrease (Psurgery (Pbariatric surgery. This is the first human lipoprotein kinetic study to explore the mechanism of improvement of TRL metabolism after bariatric surgery. These effects may contribute to the decrease of cardiovascular mortality after surgery. http://www.ClinicalTrials.gov. Unique identifier: NCT01277068. © 2014 American Heart Association, Inc.

  7. Benefits of bariatric surgery before elective total joint arthroplasty: is there a role for weight loss optimization?

    Science.gov (United States)

    Nearing, Emanuel E; Santos, Tyler M; Topolski, Mark S; Borgert, Andrew J; Kallies, Kara J; Kothari, Shanu N

    2017-03-01

    The association between obesity and osteoarthritis is well established, as is the increased risk of postoperative complications after total knee arthroplasty (TKA) and total hip arthroplasty (THA) among patients with obesity. To evaluate the outcomes after TKA/THA based on whether the surgery was performed before or after bariatric surgery. Integrated, multispecialty, community teaching hospital. The medical records of all patients who underwent bariatric surgery from 2001 to 2014 were reviewed. Statistical analysis included χ(2) test and t tests. A P valuebariatric procedure, 66 underwent TKA/THA after their bariatric procedure. TKAs/THAs were performed at a mean of 4.9±3.2 years before and 4.3±3.3 years after bariatric surgery. Body mass index for those undergoing TKA/THA after bariatric surgery was lower than those with TKA/THA before bariatric surgery (37.6±7.4 versus 43.7±5.7 kg/m(2); Pbariatric surgery: 81.7±33.9 min versus 117±38.1 min; Pbariatric surgery. Patients who underwent TKA/THA after bariatric surgery had lower body mass index before and 1 year after TKA/THA. Postoperative complication rates were similar. Benefits of bariatric surgery and subsequent weight loss should be considered among patients with obesity requiring TKA/THA. Optimal timing of TKA/THA and bariatric surgery has yet to be established. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  8. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery

    OpenAIRE

    2006-01-01

    Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involve...

  9. Multimorbidity: A Review of the Complexity of Mental Health Issues in Bariatric Surgery Candidates Informed by Canadian Data.

    Science.gov (United States)

    Taylor, Valerie H; Hensel, Jennifer

    2017-08-01

    Multimorbidity is significant for obesity and mental health issues. As a consequence, mental illness is overrepresented in patients seeking bariatric surgery. This review addresses that overlap, with a focus on Canadian data. The healthcare system in Canada is unique, but issues related to prevalence of mental health in patients seeking bariatric surgery are similar to those in studies conducted in other countries. Although data on suicide are lacking, Canadian data have shown similar rates of self-harm behaviours and linkages between psychopathology and weight regain after surgery. Geographic issues that make it difficult for individuals to attend regular follow-up appointments have encouraged the use of e-health tools to engage patients and ensure access to follow-up care, which may provide unique opportunities going forward. Additional work is needed to inform best practices in the Canadian system, but in keeping with other data, the consistent message from Canada is that appropriate evaluation and aftercare are essential components of a well-informed bariatric program. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

  10. Is social support associated with greater weight loss after bariatric surgery?: a systematic review.

    Science.gov (United States)

    Livhits, M; Mercado, C; Yermilov, I; Parikh, J A; Dutson, E; Mehran, A; Ko, C Y; Shekelle, P G; Gibbons, M M

    2011-02-01

    Social support may be associated with increased weight loss after bariatric surgery. The objective of this article is to determine impact of post-operative support groups and other forms of social support on weight loss after bariatric surgery. MEDLINE search (1988-2009) was completed using MeSH terms including bariatric procedures and a spectrum of patient factors with potential relationship to weight loss outcomes. Of the 934 screened studies, 10 reported on social support and weight loss outcomes. Five studies reported on support groups and five studies reported on other forms of social support (such as perceived family support or number of confidants) and degree of post-operative weight loss (total n = 735 patients). All studies found a positive association between post-operative support groups and weight loss. One study found a positive association between marital status (being single) and weight loss, while three studies found a non-significant positive trend and one study was inconclusive. Support group attendance after bariatric surgery is associated with greater post-operative weight loss. Further research is necessary to determine the impact of other forms of social support. These factors should be addressed in prospective studies of weight loss following bariatric surgery, as they may represent ways to improve post-operative outcomes. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity.

  11. Long-term Outcomes of Bariatric Surgery: A National Institutes of Health Symposium

    Science.gov (United States)

    Courcoulas, Anita P.; Yanovski, Susan Z.; Bonds, Denise; Eggerman, Thomas L.; Horlick, Mary; Staten, Myrlene A.; Arterburn, David E.

    2017-01-01

    Importance The clinical evidence base demonstrating bariatric surgery’s health benefits is much larger than it was when the NIH last held a Consensus Panel in 1991. Still, it remains unclear whether ongoing studies will address critical questions about long-term complication rates and the sustainability of weight loss and comorbidity control. Objective The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Heart, Lung, and Blood Institute (NHLBI) convened a multidisciplinary workshop in May 2013 to summarize the current state of knowledge of bariatric surgery, review research findings on the long-term outcomes of bariatric surgery, and establish priorities for future research directions. Evidence Review The evidence presented at the workshop was selected by the planning committee for both its quality and duration of follow up. The data review emphasized RCTs and large observational studies with long-term follow up, with or without a control group. Findings Several small RCTs showed greater weight loss and T2DM remission compared to non-surgical treatments within the first 2 years of follow-up after bariatric surgery. Large, long-term observational studies show durable (>5 years) weight loss, diabetes and lipid improvements with bariatric surgery. Still unclear are predictors of outcomes, long-term complications, long-term survival, micro- and macro-vascular events, mental health outcomes, and costs. The studies needed to address these knowledge gaps would be expensive and logistically difficult to perform. Conclusions and Relevance High-quality evidence shows that bariatric surgical procedures result in greater weight loss than non-surgical treatments and are more effective at inducing initial T2DM remission in obese patients. More information is needed about the long term durability of comorbidity control and complications after bariatric procedures and this evidence will most likely come from carefully designed

  12. Bariatric surgery: is it reasonable before the age of 16?

    Science.gov (United States)

    Massabki, Lilian Helena Polak; Sewaybricker, Letícia Esposito; Nakamura, Keila Hayashi; Mendes, Roberto Teixeira; Barros, Antonio DE Azevedo; Antonio, Maria Ângela Reis DE Góes Monteiro; Zambon, Mariana Porto

    2016-01-01

    to assess the severity of obesity in children and adolescents through the presence of comorbidities and the potential indication of bariatric surgery. we conducted a cross-sectional study with clinical and laboratory data of the first consultation of patients at the childhood obesity clinic at a tertiary hospital from 2005 to 2013. We divided the patients into groups with or without potential indication for surgery, and recorded age, gender, birth weight, age of obesity onset, BMI Z score, presence of acanthosis nigricans, blood pressure, total cholesterol and fractions, triglycerides, blood glucose and fasting insulin, HOMA1-IR, CRP and ESR. The group with potential indication for surgery included: BMI > 40 or between 35-40 with comorbidities (Triglycerides >130mg/dl, glucose levels >100mg/dl, HOMA1-IR >3.16, Total Cholesterol >200mg/dl, LDL >130mg/dl and HDL colesterol total e frações, triglicérides, glicemia e insulina de jejum, HOMA1-IR, PCR e VHS. O grupo com potencial indicação cirúrgica incluiu: IMC >40 ou IMC entre 35-40 com comorbidades (Triglicérides >130mg/dl, Glicemia >100mg/dl, HOMA1-IR >3,16, Colesterol total >200mg/dl, LDL >130mg/dl e HDL <45mg/dl), independente da idade, consolidação das epífises e tratamento prévio. de 296 pacientes incluídos no estudo, 282 (95,3%) tinham menos de 16 anos. A alteração mais frequente foi a do HDL (63,2%), seguido do HOMA1-IR (37,5%). Do grupo de 66 pacientes com potencial indicação cirúrgica (22,3%), apenas dez (15,1%) tinham mais de 16 anos. Acantose nigricans, as médias de HOMA1-IR, insulina, PCR, VHS, idade, escore z de IMC e pressões sistólica e diastólica foram significantes no grupo com potencial indicação cirúrgica. os resultados sugerem que a cirurgia bariátrica, poderia estar indicada pelo IMC e presença de comorbidades, em crianças e adolescentes com menos de 16 anos.

  13. Mechanisms underlying weight loss and metabolic improvements in rodent models of bariatric surgery.

    Science.gov (United States)

    Arble, Deanna M; Sandoval, Darleen A; Seeley, Randy J

    2015-02-01

    Obesity is a growing health risk with few successful treatment options and fewer still that target both obesity and obesity-associated comorbidities. Despite ongoing scientific efforts, the most effective treatment option to date was not developed from basic research but by surgeons observing outcomes in the clinic. Bariatric surgery is the most successful treatment for significant weight loss, resolution of type 2 diabetes and the prevention of future weight gain. Recent work with animal models has shed considerable light on the molecular underpinnings of the potent effects of these 'metabolic' surgical procedures. Here we review data from animal models and how these studies have evolved our understanding of the critical signalling systems that mediate the effects of bariatric surgery. These insights could lead to alternative therapies able to accomplish effects similar to bariatric surgery in a less invasive manner.

  14. Endoscopic Evaluation of Symptomatic Patients following Bariatric Surgery: A Literature Review

    Directory of Open Access Journals (Sweden)

    Miral Subhani

    2012-01-01

    Full Text Available Obesity is an epidemic in our society, and rates continue to rise, along with comorbid conditions associated with obesity. Unfortunately, obesity remains refractory to behavioral and drug therapy but has shown response to bariatric surgery. Not only can long-term weight loss be achieved, but a majority of patients have also shown improvement of the comorbid conditions associated with obesity. A rise in the use of surgical therapy for management of obesity presents a challenge with an increased number of patients with problems after bariatric surgery. It is important to be familiar with symptoms following bariatric surgery, such as nausea/vomiting, abdominal pain, dysphagia, and upper gastrointestinal bleeding and to utilize appropriate available tests for upper gastrointestinal tract pathology in the postoperative period.

  15. The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis.

    Science.gov (United States)

    Skubleny, Daniel; Switzer, Noah J; Gill, Richdeep S; Dykstra, Mark; Shi, Xinzhe; Sagle, Margaret A; de Gara, Christopher; Birch, Daniel W; Karmali, Shahzeer

    2016-01-01

    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.

  16. Bariatric surgery in type 1 diabetes mellitus: long-term experience in two cases

    Directory of Open Access Journals (Sweden)

    Nuria Fuertes-Zamorano

    2013-08-01

    Full Text Available In patients with obesity and type 2 diabetes, recommendations for bariatric surgery are well established. However, no consensus exists regarding its role for the management of patients with type 1 diabetes and morbid obesity. We present the long-term follow-up of two women with type 1 diabetes, morbid obesity and associated comorbidities, who underwent malabsorptive bariatric surgery. More than four years after the procedure, both have a body mass index (BMI within the normal range and HbA1c levels below 7%. Also, they have been able to reduce their insulin requirements in more than 50%, their associated comorbidities have disappeared, and their overall quality of life has significantly improved. We compare our results with other recently published ones, emphasizing potential indications of bariatric surgery for patients with type 1 diabetes.

  17. Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis.

    Science.gov (United States)

    Black, J A; White, B; Viner, R M; Simmons, R K

    2013-08-01

    The number of obese young people continues to rise, with a corresponding increase in extreme obesity and paediatric-adolescent bariatric surgery. We aimed to (i) systematically review the literature on bariatric surgery in children and adolescents; (ii) meta-analyse change in body mass index (BMI) 1-year post-surgery and (iii) report complications, co-morbidity resolution and health-related quality of life (HRQoL). A systematic literature search (1955-2013) was performed to examine adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass or biliopancreatic diversions operations among obese children and adolescents. Change in BMI a year after surgery was meta-analysed using a random effects model. In total, 637 patients from 23 studies were included in the meta-analysis. There were significant decreases in BMI at 1 year (average weighted mean BMI difference: -13.5 kg m(-2) ; 95% confidence interval [CI] -14.1 to -11.9). Complications were inconsistently reported. There was some evidence of co-morbidity resolution and improvements in HRQol post-surgery. Bariatric surgery leads to significant short-term weight loss in obese children and adolescents. However, the risks of complications are not well defined in the literature. Long-term, prospectively designed studies, with clear reporting of complications and co-morbidity resolution, alongside measures of HRQol, are needed to firmly establish the harms and benefits of bariatric surgery in children and adolescents.

  18. Food addiction and the outcome of bariatric surgery at 1-year: Prospective observational study.

    Science.gov (United States)

    Sevinçer, Güzin Mukaddes; Konuk, Numan; Bozkurt, Süleyman; Coşkun, Halil

    2016-10-30

    The objectives of the current study were to determine the prevalence of food addiction in bariatric surgery candidates and whether food addiction is associated with weight loss after bariatric surgery. This prospective observational study was performed on morbidly obese patients who had been found suitable for bariatric surgery. Follow-up was conducted at the 6 and 12 month post-surgery. The Yale Food Addiction Scale (YFAS) was used to determine food addiction. One hundred seventy-eight patients were included. Pre-operative food addiction was found in 57.8% of patients. Food addiction prevalence decreased at the 6 and 12 month follow ups, to 7.2% and 13.7% respectively. There were no statistically differences between those with food addiction and those without addiction with regard to weight loss measured as percent of excess BMI at the 12 month follow-up. Food addiction as measured by the YFAS decreases significantly after bariatric surgery. The presence of food addiction before surgery was not associated with weight loss as measured EBL%. However, in view of the increase in BMI, 2 years after surgery longer follow up studies are warranted. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Self-reported problems and wishes for plastic surgery after bariatric surgery

    DEFF Research Database (Denmark)

    Wagenblast, Lene; Laessoe, Line; Printzlau, Andreas

    2014-01-01

    , since some of the patients will experience problems due to excess skin. Foreign studies estimate that ∼30% of all bariatric surgery patients will at some point seek plastic surgical correction of excess skin. The aim of this study is to investigate to what extent the GB patients themselves consider...... plastic surgery for removal of excess skin, and their reasons and motivations for this. The investigation was performed as an anonymous questionnaire handed out to 150 patients at the 1-year standard consultation for GB patients at a private hospital. The questionnaire contained information about......, and the investigation showed that 89.9% of the patients had a wish for plastic surgery for several different reasons. This patient demand showed to have no correlation to age, gender, smoking habits, or earlier comorbidity....

  20. Guillain-Barré syndrome (demyelinating) six weeks after bariatric surgery: A case report and literature review.

    Science.gov (United States)

    Ishaque, Noman; Khealani, Bhojo A; Shariff, Amir H; Wasay, Muhammad

    2015-01-01

    Obesity is a major health problem worldwide. Bariatric surgery has been increasingly used to manage obesity. Many acute as well as chronic neurological complications have been reported after bariatric surgery including Guillain-Barré syndrome (GBS). An autoimmune process has been postulated as the underlying pathophysiology. Most of the reported cases of GBS after bariatric surgery are of the axonal variety. Here, we report a case of a demyelinating variety of GBS in a young woman who presented with acute onset of progressive weakness and paresthesia of all limbs within six weeks after bariatric surgery. She was treated with intravenous immunoglobulin (IVIG) and rehabilitation. She had complete recovery on follow-up. We believe that onset of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), which is demyelinating variety of GBS, is associated with changes in immune system after bariatric surgery.

  1. Bariatric Surgery Patients and Their Families: Health, Physical Activity, and Social Support.

    Science.gov (United States)

    Lent, Michelle R; Bailey-Davis, Lisa; Irving, Brian A; Wood, G Craig; Cook, Adam M; Hirsch, Annemarie G; Still, Christopher D; Benotti, Peter N; Franceschelli-Hosterman, Jennifer

    2016-12-01

    This study evaluated the social environment of bariatric surgery patients in the preoperative period. Forty bariatric surgery patients (mean = 46.2 ± 11.2 years), 35 adult cohabitating family members (mean = 45.2 ± 12.7 years), and 15 cohabitating children (mean = 11.5 ± 3.6 years) were recruited from a large rural medical center. Adult participants (patients and family members) completed height, weight, body composition, blood draws, and physical activity assessments (accelerometry), as well as eating behavior and social support inventories before the patient underwent bariatric surgery. Child participants completed demographic, height, and weight assessment only. Over 90 % of adult family members were overweight or obese (body mass index (BMI) ≥ 25 kg/m(2), as were 50 % of children (BMI percentile ≥ 85 %). More than one third (37.1 %) of family members met the criteria for moderate to severe insulin resistance. Physical activity measured by accelerometry was moderately correlated between the patient and adult family members (r = 0.46, p = 0.023). Bariatric surgery patients reported high levels of social support from their family members on multiple social support measures. Many family members of bariatric surgery patients also lived with obesity and related comorbidities, and demonstrate high sedentary behavior. However, patients reported high levels of support from family members, including support in following a healthy diet and engaging in physical activity. Engaging families in behavior change may help bariatric surgery patients and their families to become healthier.

  2. Weight loss by calorie restriction versus bariatric surgery differentially regulates the HPA axis in male rats

    Science.gov (United States)

    Grayson, Bernadette E.; Hakala-Finch, Andrew P.; Kekulawala, Melani; Laub, Holly; Egan, Ann E.; Ressler, Ilana B.; Woods, Stephen C.; Herman, James P.; Seeley, Randy J.; Benoit, Stephen C.; Ulrich-Lai, Yvonne M.

    2015-01-01

    Behavioral modifications for the treatment of obesity, including caloric restriction, have notoriously low long-term success rates relative to bariatric weight-loss surgery. The reasons for the difference in sustained weight loss are not clear. One possibility is that caloric restriction alone activates the stress-responsive hypothalamo-pituitary-adrenocortical (HPA) axis, undermining the long-term maintenance of weight loss, and that this is abrogated after bariatric surgery. Accordingly, we compared the HPA response to weight loss in 5 groups of male rats: (1) high-fat diet-induced obese (DIO) rats treated with Roux-en-Y gastric bypass surgery (RYGB, n=7), (2) DIO rats treated with vertical sleeve gastrectomy (VSG, n=11), (3) DIO rats given sham surgery and subsequently restricted to the food intake of the VSG/RYGB groups (Pair-fed, n=11), (4) ad libitum-fed DIO rats given sham surgery (Obese, n=11) and (5) ad libitum chow-fed rats given sham surgery (Lean, n=12). Compared to Lean controls, food-restricted rats exhibited elevated morning (nadir) non-stress plasma corticosterone concentrations and increased hypothalamic corticotropin releasing hormone and vasopressin mRNA expression, indicative of basal HPA activation. This was largely prevented when weight loss was achieved by bariatric surgery. DIO increased HPA activation by acute (novel environment) stress and this was diminished by bariatric surgery-, but not pair-feeding-, induced weight loss. These results suggest that the HPA axis is differentially affected by weight loss from caloric restriction versus bariatric surgery, and this may contribute to the differing long-term effectiveness of these two weight-loss approaches. PMID:25238021

  3. Non-alcoholic fatty liver disease: is bariatric surgery the answer?

    Science.gov (United States)

    Pillai, Anjana A; Rinella, Mary E

    2009-11-01

    As the worldwide obesity epidemic continues to increase, the prevalence of non-alcoholic fatty liver disease (NAFLD) and specifically non-alcoholic steatohepatitis (NASH) will become increasingly prominent. NASH will surpass chronic hepatitis C infection as the primary indication for orthotopic liver transplantation in the near future. With the evolution of surgical techniques, bariatric surgery is currently recognized as the most effective method for achieving sustained weight loss and reversing numerous comorbidities in severely obese individuals. This review focuses on the potential risks and benefits of bariatric surgery in subjects with NAFLD and explores its role in the management of NASH in the obese patient.

  4. Medical therapy versus bariatric surgery of obese patients with Type 2 diabetes

    DEFF Research Database (Denmark)

    Svane, Maria Saur; Bojsen-Møller, Kirstine Nyvold; Madsbad, Sten

    2016-01-01

    Bariatric surgery induces large and sustainable weight loss in obese patients and improves glycaemic control in patients with Type 2 diabetes. Eleven randomized controlled trials have shown superior glycaemic outcomes after bariatric procedures vs. medical therapy/intensive lifestyle interventions...... in obese patients with Type 2 diabetes. Furthermore, many patients experience remission of Type 2 diabetes after surgery but relapse may occur during follow-up. Data from observational studies show reduced incidence of micro- and macrovascular complications in addition to reduced cardiovascular and total...

  5. Dissociated incretin response to oral glucose at 1 year after restrictive vs. malabsorptive bariatric surgery

    DEFF Research Database (Denmark)

    Guldstrand, M; Ahrén, B; Näslund, E

    2009-01-01

    AIM: Compare the response to oral glucose of the two incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) at 1 year after restrictive vs. malabsorptive bariatric surgery. METHODS: Vertical banded gastroplasty (VBG, n = 7) or jejunoileal bypass...... = 0.007). CONCLUSIONS: We conclude that at 1 year after bariatric surgery, the two incretins show dissociated responses in that the GIP secretion is higher after VBG whereas GLP-1 secretion is higher after JIB. This dissociated incretin response is independent from reduction in body weight, glucose...

  6. Assessment of hot flushes and vaginal dryness among obese women undergoing bariatric surgery.

    Science.gov (United States)

    Goughnour, S L; Thurston, R C; Althouse, A D; Freese, K E; Edwards, R P; Hamad, G G; McCloskey, C; Ramanathan, R; Bovbjerg, D H; Linkov, F

    2016-01-01

    Menopausal symptoms are associated with a negative impact on the quality of life, leading women to seek medical treatment. Obesity has been linked to higher levels of menopausal symptoms such as hot flushes. This assessment will explore whether the prevalence and bother of hot flushes and vaginal dryness change from pre- to post-bariatric surgery among obese midlife women. This study is a longitudinal analysis of data from 69 women (ages 35-72 years) undergoing bariatric surgery with reported reproductive histories and menopausal symptoms at preoperative and 6-month postoperative visits. Prevalence of and degree of bother of hot flushes and vaginal dryness at pre- and post-surgery were compared using McNemar's test and Wilcoxon signed-rank test. The reported degree of bother of symptoms associated with hot flushes decreased from pre- to post-surgery (p bariatric surgery. These results highlight important secondary gains, including less bothersome menopausal symptoms, for women who choose bariatric surgery for weight loss.

  7. Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

    Directory of Open Access Journals (Sweden)

    Elinton Adami CHAIM

    Full Text Available ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.

  8. Perioperative Outcome of Adolescents Undergoing Bariatric Surgery: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

    Science.gov (United States)

    Inge, T.H.; Zeller, M.H.; Jenkins, T.M.; Helmrath, M.; Brandt, M.L.; Michalsky, M.P.; Harmon, C.M.; Courcoulas, A.; Horlick, M.; Xanthakos, S.A.; Dolan, L.; Mitsnefes, M.; Barnett, S.J.; Buncher, C.R.

    2014-01-01

    -term complication profile, supporting the early postoperative safety of WLS in select adolescents. Further longitudinal study of this cohort will permit accurate assessment of long-term outcomes for adolescents undergoing bariatric surgery. PMID:24189578

  9. EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Marco Aurelio SANTO

    2013-03-01

    Full Text Available Context Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2. Results Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years. Contexto A cirurgia bariátrica tem mostrado ser o método mais eficaz de tratamento da obesidade grave. No entanto, sua aceitação como terapia padrão-ouro ainda é questionada. As complicações cirúrgicas observadas no início do período p

  10. The impact of a standardized program on short and long-term outcomes in bariatric surgery.

    Science.gov (United States)

    Aird, Lisa N F; Hong, Dennis; Gmora, Scott; Breau, Ruth; Anvari, Mehran

    2017-02-01

    The purpose of this study was to determine whether there has been an improvement in short- and long-term clinical outcomes since 2010, when the Ontario Bariatric Network led a province-wide initiative to establish a standardized system of care for bariatric patients. The system includes nine bariatric centers, a centralized referral system, and a research registry. Standardization of procedures has progressed yearly, including guidelines for preoperative assessment and perioperative care. Analysis of the OBN registry data was performed by fiscal year between April 2010 and March 2015. Three-month overall postoperative complication rates and 30 day postoperative mortality were calculated. The mean percentage of weight loss at 1, 2, and 3 years postoperative, and regression of obesity-related diseases were calculated. The analysis of continuous and nominal data was performed using ANOVA, Chi-square, and McNemar's testing. A multiple logistic regression analysis was performed for factors affecting postoperative complication rate. Eight thousand and forty-three patients were included in the bariatric registry between April 2010 and March 2015. Thirty-day mortality was rare (bariatric care has contributed to improvements in complication rates and supported prolonged weight loss and regression of obesity-related diseases in patients undergoing bariatric surgery in Ontario.

  11. Animal models in bariatric surgery--a review of the surgical techniques and postsurgical physiology.

    Science.gov (United States)

    Rao, Raghavendra S; Rao, Venkatesh; Kini, Subhash

    2010-09-01

    Bariatric surgery is considered the most effective current treatment for morbid obesity. Since the first publication of an article by Kremen, Linner, and Nelson, many experiments have been performed using animal models. The initial experiments used only malabsorptive procedures like intestinal bypass which have largely been abandoned now. These experimental models have been used to assess feasibility and safety as well as to refine techniques particular to each procedure. We will discuss the surgical techniques and the postsurgical physiology of the four major current bariatric procedures (namely, Roux-en-Y gastric bypass, gastric banding, sleeve gastrectomy, and biliopancreatic diversion). We have also reviewed the anatomy and physiology of animal models. We have reviewed the literature and presented it such that it would be a reference to an investigator interested in animal experiments in bariatric surgery. Experimental animal models are further divided into two categories: large mammals that include dogs, cats, rabbits, and pig and small mammals that include rats and mice.

  12. Sir David Cuthbertson Medal Lecture. Bariatric surgery as a model to study appetite control.

    Science.gov (United States)

    Bueter, Marco; le Roux, Carel W

    2009-08-01

    The obesity epidemic and its associated morbidity and mortality have led to major research efforts to identify mechanisms that regulate appetite. Gut hormones have recently been found to be an important element in appetite regulation as a result of the signals from the periphery to the brain. Candidate hormones include ghrelin, peptide YY, glucagon-like peptide-1 and gastric inhibitory polypeptide, all of which are currently being investigated as potential obesity treatments. Bariatric surgery is currently the most effective therapy for substantial and sustained weight loss. Understanding how levels of gut hormones are modulated by such procedures has greatly contributed to the comprehension of the underlying mechanisms of appetite and obesity. The present paper is a review of how appetite and levels of gastrointestinal hormones are altered after bariatric surgery. Basic principles of common bariatric procedures and potential mechanisms for appetite regulation by gut hormones are also addressed.

  13. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study.

    Science.gov (United States)

    Sarosiek, Konrad; Pappan, Kirk L; Gandhi, Ankit V; Saxena, Shivam; Kang, Christopher Y; McMahon, Heather; Chipitsyna, Galina I; Tichansky, David S; Arafat, Hwyda A

    2016-01-01

    The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D) patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery.

  14. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study

    Directory of Open Access Journals (Sweden)

    Konrad Sarosiek

    2016-01-01

    Full Text Available The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery.

  15. Kidney outcomes three years after bariatric surgery in severely obese adolescents.

    Science.gov (United States)

    Nehus, Edward J; Khoury, Jane C; Inge, Thomas H; Xiao, Nianzhou; Jenkins, Todd M; Moxey-Mims, Marva M; Mitsnefes, Mark M

    2017-02-01

    A significant number of severely obese adolescents undergoing bariatric surgery have evidence of early kidney damage. To determine if kidney injury is reversible following bariatric surgery, we investigated renal outcomes in the Teen-Longitudinal Assessment of Bariatric Surgery cohort, a prospective multicenter study of 242 severely obese adolescents undergoing bariatric surgery. Primary outcomes of urine albumin-to-creatinine ratio and cystatin C-based estimated glomerular filtration rate (eGFR) were evaluated preoperatively and up to 3 years following bariatric surgery. At surgery, mean age of participants was 17 years and median body mass index (BMI) was 51 kg/m(2). In those with decreased kidney function at baseline (eGFR under 90 mL/min/1.73m(2)), mean eGFR significantly improved from 76 to 102 mL/min/1.73m(2) at three-year follow-up. Similarly, participants with albuminuria (albumin-to-creatinine ratio of 30 mg/g and more) at baseline demonstrated significant improvement following surgery: geometric mean of ACR was 74 mg/g at baseline and decreased to 17 mg/g at three years. Those with normal renal function and no albuminuria at baseline remained stable throughout the study period. Among individuals with a BMI of 40 kg/m(2) and more at follow-up, increased BMI was associated with significantly lower eGFR, while no association was observed in those with a BMI under 40 kg/m(2). In adjusted analysis, eGFR increased by 3.9 mL/min/1.73m(2) for each 10-unit loss of BMI. Early kidney abnormalities improved following bariatric surgery in adolescents with evidence of preoperative kidney disease. Thus, kidney disease should be considered as a selection criteria for bariatric surgery in severely obese adolescents who fail conventional weight management. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  16. Bariatric Surgery in Obese Patients with Type 1 Diabetes: Effects on Weight Loss and Metabolic Control.

    Science.gov (United States)

    Faucher, Pauline; Poitou, Christine; Carette, Claire; Tezenas du Montcel, Sophie; Barsamian, Charles; Touati, Eliabelle; Bouillot, Jean-Luc; Torcivia, Adriana; Czernichow, Sébastien; Oppert, Jean-Michel; Ciangura, Cécile

    2016-10-01

    Type 1 diabetes patients, although typically lean, experience an increased prevalence of obesity, and bariatric surgery is considered in severe cases. Bariatric surgery in such patients leads to significant weight loss and decreased insulin requirements; however, effects on glycemic control remain discussed. We assessed, in obese patients with type 1 diabetes, the effects of bariatric surgery upon body weight, body composition, and glycemic control, including the occurrence of hypoglycemic events. Thirteen obese patients with type 1 diabetes who underwent bariatric surgery (Roux-en-Y gastric bypass n = 6, sleeve gastrectomy n = 7) were matched with obese patients without diabetes and with type 2 diabetes patients during 12 months of follow-up. Outcomes included body weight, DXA-assessed body composition, HbA1c, and incidence of hypoglycemia. At 12 months, median surgery-induced weight loss was 27.9 % (21.1-33.3), 26.1 % (24.8-29.7), and 27.5 % (21.8-32.1) in patients with type 1 diabetes, type 2 diabetes, and without diabetes, respectively, with no significant differences across the groups. Similar findings were observed for body fat changes. At 12 months, median HbA1c decreased from 8.3 to 7.6 % in type 1 diabetes patients versus 8.0 to 5.9 % in type 2 diabetes patients (P = 0.04 between the groups). In type 1 diabetes patients, the number of reported minor hypoglycemia increased transiently only at 6 months. Two patients reported severe hypoglycemia (one episode each). Type 1 diabetes patients benefit from bariatric surgery in terms of weight loss and glycemic control. Close monitoring of insulin therapy appears warranted to prevent minor hypoglycemia in the first months post-surgery.

  17. Application of BAROS' questionnaire in obese patients undergoing bariatric surgery with 2 years of evolution.

    Science.gov (United States)

    Queiroz, Caetano de; Sallet, José Afonso; DE Barros E Silva, Pedro Gabriel Melo; Queiroz, Luzia da Gloria Pereira de Sousa; Pimentel, Jélis Arenas; Sallet, Paulo Clemente

    2017-01-01

    -In recent decades, the high prevalence of obesity in the general population has brought serious concerns in terms of public health. Contrarily to conventional treatment involving dieting and physical exercising, often ineffective in generating long term results, bariatric opera-tions have been an effective method for sustained weight loss in morbidly obese individuals. The Bariatric Analysis and Reporting Outcome System (BAROS) is an objective and recognized system in the overall evaluation of results after bariatric surgery. - To investigate results concerning a casuistic of morbidly obese patients undergoing bariatric surgery over a 2-year follow-up in terms of weight loss, related medical conditions, safety and changes in quality of life. - A total of 120 obese (17 male and 103 female) patients, who underwent bariatric surgery, were assessed and investigated using the BAROS system after a 2- year follow-up. - Patients obtained a mean excess weight loss of 74.6 (±15.9) % and mean body mass index reduction of 15.6 (±4.4) Kg/m2. Pre-surgical comorbidities were present in 71 (59%) subjects and they were totally (86%) or partially (14%) resolved. Complications resulting specifically from the surgical procedure were observed in 4.2% of cases (two bowel obstructions requiring re-operation, and three stomal stenosis treated with endoscopic dilation). Sixteen subjects (13% of total number of patients) presented minor clinical complications managed through outpatient care. The final scores for the BAROS questionnaire showcased excellent to good results in 99% of cases (excellent 44%, very good 38%, good 23%, acceptable 1%). - According to the BAROS questionnaire, bariatric surgery is a safe and effective method for managing obesity and associated clinical comorbidities, allowing for satisfactory results after a 2-year follow-up. Future studies should address other clinical and psychosocial variables that impact outcome as well as allow for longer follow-ups.

  18. Pregnancy after Bariatric Surgery: Obstetric and Perinatal Outcomes and the Growth and Development of Children.

    Science.gov (United States)

    Dell'Agnolo, Cátia Millene; Cyr, Caroline; de Montigny, Francine; de Barros Carvalho, Maria Dalva; Pelloso, Sandra Marisa

    2015-11-01

    Several outcomes of pregnancy after bariatric surgery are currently being studied. This cross-sectional, retrospective study evaluated the obstetric and perinatal outcomes of pregnancies in 19 women who underwent bariatric surgery, as well as the growth and development of their children, in the Southern Brazil. Among these women, 11 children were born prior to surgery and 32 were born post-surgery. The mean time between the surgery and the first pregnancy was 42.96 months. Preterm newborns were more common among the pre-surgery childbirths. Regarding growth, normal weights were observed in 27.3 % of the children in the pre-surgery births and obesity was observed in 54.5 %. In contrast, normal weights were observed in 59.4 % of the children born during the postoperative period and obesity was observed in 31.2 %. The average excess weight that the women lost prior to pregnancy was 64.88. Speech delays were found in three male children evaluated using the Denver Developmental Screening Test II. A statistical association was found between the interval from the surgery to the pregnancy and the outcome of the questionable Denver II test results (p = 0.011). Except for the large index of low birth weight, it can be concluded that pregnancy after bariatric surgery is safe. The growth rate was found to be adequate in the children born after the surgery, with reduced obesity. Although changes in speech development were detected, no factors were supported an association with pregnancy after bariatric surgery.

  19. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study.

    Science.gov (United States)

    Lu, Chia-Wen; Chang, Yu-Kang; Chang, Hao-Hsiang; Kuo, Chia-Sheng; Huang, Chi-Ting; Hsu, Chih-Cheng; Huang, Kuo-Chin

    2015-12-01

    Bariatric surgery has been shown to impair bone health. This study aimed to investigate the fracture risk in patients after bariatric surgery versus propensity score-matched controls. The authors used the National Health Insurance Research Database of Taiwan and identified 2064 patients who underwent bariatric surgery during 2001 to 2009. These patients were matched to 5027 obese patients who did not receive bariatric surgery, using propensity score matching accounting for age, sex, Charlson Comorbidity Index, diabetes, hypertension, hyperlipidemia and the year morbid obesity was diagnosed. The authors followed the surgical and control cohorts to death, any diagnosis of fracture, or December 31, 2012, whichever occurred first. Cox proportional hazard regression models were used to calculate relative rates of fractures in the surgical group and control group. At the end of the 12-year study period, there were 183 fractures in the surgical group (mean follow-up 4.8 years) and 374 fractures in the matched control group (mean follow-up 4.9 years). Overall, there was a 1.21-fold [95% confidence interval (CI): 1.02-1.43] significantly increased risk of fracture in the surgical group compared with the control group. Stratified by surgical procedures, malabsorptive procedures showed a significantly higher fracture risk (1.47, 95% CI: 1.01-2.15). The Kaplan-Meier estimated fracture rates were 1.60% at 1 year, 2.37% at 2 years, 1.69% at 5 years, and 2.06% after 5 years for the surgical patients, compared with 1.51%, 1.65%, 1.53%, and 1.42%, respectively, for the matched controls. Adjusted analysis showed a trend towards an increased fracture risk, 1 to 2 years after bariatric surgery. (1.42, 95% CI: 0.99-2.05). Bariatric surgery was significantly associated with an increased risk of fractures, mainly with malabsorptive procedures, with a trend of an increased fracture risk 1 to 2 years after surgery. These results provide further evidence for the adverse effects of bariatric

  20. Effect of Bariatric Surgery on Emergency Department Visits and Hospitalizations for Atrial Fibrillation.

    Science.gov (United States)

    Shimada, Yuichi J; Tsugawa, Yusuke; Camargo, Carlos A; Brown, David F M; Hasegawa, Kohei

    2017-09-15

    Atrial fibrillation (AF) and obesity are major health problems in the United States. However, little is known about whether bariatric surgery affects AF-related morbidities. This study investigated whether bariatric surgery is associated with short-term and long-term changes in the risk of emergency department (ED) visits or hospitalizations for AF. We performed a self-controlled case series study of obese adults with AF who underwent bariatric surgery by using population-based ED and inpatient databases in California, Florida, and Nebraska from 2005 to 2011. The primary outcome was ED visit or hospitalization for AF. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using presurgery months 13 to 24 as a reference period. Our sample consisted of 523 obese adults with AF who underwent bariatric surgery. The median age was 57 years (interquartile range 48 to 64 years), 59% were female, and 84% were non-Hispanic white. During the reference period, 15.9% (95% confidence interval [CI] 12.7% to 19.0%) of patients had an ED visit or hospitalization for AF. The risk remained similar in the subsequent 12-month presurgery period (adjusted OR [aOR] 1.29 [95% CI, 0.94 to 1.76] p = 0.11). In contrast, the risk significantly increased within 12 months after bariatric surgery (aOR 1.53 [95% CI 1.13 to 2.07] p = 0.006). The risk remained elevated during 13-24 months after bariatric surgery (aOR 1.41 [95% CI, 1.03 to 1.91] p = 0.03). In conclusion, this population-based study demonstrated that bariatric surgery was associated with an increased risk of AF episodes requiring an ED visit or hospitalization for at least 2 years after surgery among obese patients with AF. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Polycystic ovary syndrome and endometrial hyperplasia: an overview of the role of bariatric surgery in female fertility.

    Science.gov (United States)

    Charalampakis, Vasileios; Tahrani, Abd A; Helmy, Ahmed; Gupta, Janesh K; Singhal, Rishi

    2016-12-01

    One of the most effective methods to tackle obesity and its related comorbidities is bariatric surgery. Polycystic ovary syndrome (PCOS) and endometrial hyperplasia (EH), which are associated with increased risk of endometrial carcinoma, have been identified as potentially new indications for bariatric surgery. PCOS is the most common endocrine disorder in women in the reproductive age and is associated with several components of the metabolic syndrome such as obesity, insulin resistance and hypertension. EH is a pre-cancerous condition which arises in the presence of chronic exposure to estrogen unopposed by progesterone such as both in PCOS and obesity. The main bariatric procedures are Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. These procedures are well established and when correctly selected and performed by experienced bariatric surgeons, they can achieve significant weight loss and remission of obesity related co-morbidities. Studies have shown that bariatric surgery can play an important role in the management of patients with PCOS and improve fertility. Similarly, bariatric surgery has a positive effect on endometrial hyperplasia, making surgically induced weight loss a potentially attractive option for endometrial cancer prevention and treatment. Obesity has an adverse impact on spontaneous pregnancy, assisted reproduction methods and feto-maternal outcomes. After bariatric surgery obese women with subfertility can achieve spontaneous pregnancy. However, while bariatric surgery reduces the risk of pre-eclampsia and gestational diabetes, there is an increased risk of small for gestational age and possible increased risk of stillborn or neonatal death. In this article we will review the evidence regarding the use of bariatric surgery as a treatment modality in patients with PCOS and EH. We also provide an overview of the common bariatric procedures. Copyright © 2016 Elsevier Ireland Ltd. All rights

  2. Cognitive function and nonfood-related impulsivity in post-bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    Ekaterini eGeorgiadou

    2014-12-01

    Full Text Available Initial evidence that cognitive function improves after bariatric surgery exists. The post-surgery increase in cognitive control might correspond with a decrease of impulsive symptoms after surgery. The present study investigated cognitive function and nonfood-related impulsivity in patients with substantial weight loss due to bariatric surgery by using a comparative cross-sectional design. Fifty post-bariatric surgery patients (postBS group who had significant percent weight loss (M = 75.94, SD = 18.09 after Roux-en-Y gastric bypass (body mass index, BMI Mpost = 30.54 kg/m2, SDpost = 5.14 were compared with 50 age and gender matched bariatric surgery candidates (preBS group (BMI Mpre = 48.01 kg/m2, SDpre = 6.56. To measure cognitive function the following computer-assisted behavioral tasks were utilized: Iowa Gambling Task, Tower of Hanoi, Stroop Test, Trail Making Test-Part B, and Corsi Block Tapping Test. Impulsive symptoms and behaviors were assessed using impulsivity questionnaires and a structured interview for impulse control disorders. No group differences were found with regard to performance-based cognitive control, self-reported impulsive symptoms and impulse control disorders. The results indicate that the general tendency to react impulsively does not differ between pre-surgery and post-surgery patients. The question of whether nonfood-related impulsivity in morbidly obese patients changes post-surgery should be addressed in longitudinal studies given that impulsive symptoms should be considered potential targets for pre- as well post-surgery interventions.

  3. EFFICACY OF BARIATRIC SURGERY IN OBESE INDIAN WITH TYPE 2 DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    Subodh

    2013-01-01

    Full Text Available ABSTRACT: CONTEXT: Individuals with morbid obesity and type 2 diabetes benefit from weight loss, as this allows better glycemic control and modifies the coexisting risk factors for coronary heart disease, namely hypertension, dyslipid emia, insulin resistance, sleep apnea, and other comorbidities that constitute the metabolic s yndrome. AIMS: The purpose of the present study was to investigate whether weight loss after bariatric surgery can correct glycemic control and reduces the need of anti-diabetic treat ment in morbidly obese patients with type 2 diabetes. SETTINGS AND DESIGN: This is a prospective cohort study performed in Sri Aurobindo Medical College & PG Institute, Indore. S ampling done was nonrandom and purposive. METHODS AND MATERIAL: Forty patients with body mass index (BMI > 35 and had known type 2 diabetes were enrolled in study, al l these patient undergone bariatric surgery. Their obesity status in terms of height, weight and BMI, Glycemic status in terms of fasting blood sugar (FBS, postprandial blood sugar (PPBS and glycosylated haemoglobin (HbA1c, and treatment status in terms of oral hypoglycemic a gents and insulin were noted in details preoperatively Statistical analysis used: Quantitative variables w ere tested using Chi square test and p values were calculated between two groups. p val ue of ≤ 0.05 was considered statistically significant. Averages were expressed between groups a s mean ± standard deviation or percentage. RESULTS: Our study shows good control of glycemic status af ter bariatric surgery with mean HbA1c within desired level after 6 months of bariatric surgery. CONCLUSIONS: In conclusion, our study shows that bariatric surgery is an effective option for morbidly obese patients with type 2 diabetes mellitus. Weight loss d ue to surgery is strongly associated with good glycemic control and improved treatment efficac y.

  4. An Update on Less Invasive and Endoscopic Techniques Mimicking the Effect of Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Froukje J. Verdam

    2012-01-01

    Full Text Available Obesity (BMI 30–35 kg/m2 and its associated disorders such as type 2 diabetes, nonalcoholic fatty liver disease, and cardiovascular disease have reached pandemic proportions worldwide. For the morbidly obese population (BMI 35–50 kg/m2, bariatric surgery has proven to be the most effective treatment to achieve significant and sustained weight loss, with concomitant positive effects on the metabolic syndrome. However, only a minor percentage of eligible candidates are treated by means of bariatric surgery. In addition, the expanding obesity epidemic consists mostly of relatively less obese patients who are not (yet eligible for bariatric surgery. Hence, less invasive techniques and devices are rapidly being developed. These novel entities mimic several aspects of bariatric surgery either by gastric restriction (gastric balloons, gastric plication, by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve stimulation, or by partial exclusion of the small intestine (duodenal-jejunal sleeve. In the last decade, several novel less invasive techniques have been introduced and some have been abandoned again. The aim of this paper is to discuss the safety, efficacy, complications, reversibility, and long-term results of these latest developments in the treatment of obesity.

  5. Competence assessment in minors, illustrated by the case of bariatric surgery for morbidly obese children

    NARCIS (Netherlands)

    Bolt, L.L.E.; Summeren van, M

    2014-01-01

    Clinicians have to assess children's competence frequently. In order to do justice to children who are competent to make decisions and to protect incompetent children, valid assessment is essential. We address this issue by using bariatric surgery for morbidly obese minors as a case study. Our previ

  6. Factors Associated with Suicide Ideation in Severely Obese Bariatric Surgery-Seeking Individuals

    Science.gov (United States)

    Chen, Eunice Y.; Fettich, Karla C.; Tierney, Megan; Cummings, Hakeemah; Berona, Johnny; Weissman, Jessica; Ward, Amanda; Christensen, Kara; Southward, Matthew; Gordon, Kathryn H.; Mitchell, James; Coccaro, Emil

    2012-01-01

    There are high rates of suicide ideation and/or behavior in severely obese individuals. The potential contributors to suicide ideation in a sample of 334 severely obese bariatric surgery candidates was explored. Lack of college education, a history of suicide ideation and/or behavior, psychological distress, hopelessness, loneliness, history of…

  7. Bariatric surgery: studies on its consequences with emphasis on thrombotic and bleeding complications

    NARCIS (Netherlands)

    Çelik, F.

    2014-01-01

    Obesity is a steadily growing problem that is associated with several diseases such as diabetes type 2, hypertension and dyslipidemia. For morbidly obese persons who have failed to achieve weight loss after several weight loss interventions, bariatric surgery is at this moment the only long-lasting,

  8. A Qualitative Assessment of the My True Body Bariatric Surgery Preparation Program

    Science.gov (United States)

    Nakamura, Tracy; Mamary, Edward

    2013-01-01

    Background: The My True Body (MTB) group intervention incorporates cognitive restructuring and social support into bariatric surgery preparation. Purpose: To identify and describe program components that support long-term behavioral modifications and influence confidence in healthy weight maintenance. Methods: Semistructured telephone interviews…

  9. Best evidence topic: Should ventral hernia repair be performed at the same time as bariatric surgery?

    Directory of Open Access Journals (Sweden)

    Mohammed Saif Sait

    2016-11-01

    Until large volume, high quality randomized control trials can be performed, a case by case approach is best, where the patients' symptoms, anatomy, type of bariatric surgery and their personal preferences are considered, and an open discussion on the risks and benefits of each approach is undertaken.

  10. Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Letícia Baltieri

    Full Text Available Abstract Background and objective: To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI, gender and age on the prevalence of atelectasis. Method: Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. Results: There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR = 1.48. There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR = 0.68. There was no significant influence of BMI on the prevalence of atelectasis. Conclusion: The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

  11. Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery

    NARCIS (Netherlands)

    Zijlstra, H.; Middendorp, H. van; Devaere, L.; Larsen, J.K.; Ramshorst, B. van; Geenen, R.

    2012-01-01

    Emotional eating, the tendency to eat when experiencing negative affect, is prevalent in morbid obesity and may indicate that ways to deal with emotions are disturbed. Our aim was to compare emotion processing and regulation between 102 women with morbid obesity who apply for bariatric surgery and 1

  12. Circulating endothelial progenitor cells, microvascular density and fibrosis in obesity before and after bariatric surgery.

    Science.gov (United States)

    De Ciuceis, Carolina; Rossini, Claudia; Porteri, Enzo; La Boria, Elisa; Corbellini, Claudia; Mittempergher, Francesco; Di Betta, Ernesto; Petroboni, Beatrice; Sarkar, Annamaria; Agabiti-Rosei, Claudia; Casella, Claudio; Nascimbeni, Riccardo; Rezzani, Rita; Rodella, Luigi F; Bonomini, Francesca; Agabiti-Rosei, Enrico; Rizzoni, Damiano

    2013-06-01

    It is not known whether, in obesity, the capillary density or the number of circulating endothelial progenitor cells (EPCs) are reduced, or whether fibrosis of small vessels is also present. In addition, possible effects of weight reduction on these parameters have never been evaluated. Therefore, we investigated EPCs and capillary density in 25 patients with severe obesity, all submitted to bariatric surgery, and in 18 normotensive lean subjects and 12 hypertensive lean patients as controls. All patients underwent a biopsy of subcutaneous fat during bariatric surgery. In five patients, a second biopsy was obtained after consistent weight loss, about 1 year later, during a surgical intervention for abdominoplasty. EPCs and capillary density were reduced in obesity, and EPCs were significantly increased after weight reduction. Vascular collagen content was clearly increased in obese patients. No significant difference in vascular collagen was observed between normotensive obese patients and hypertensive obese patients. After pronounced weight reduction, collagen content was nearly normalized. No difference in stress-strain relation was observed among groups or before and after weight loss. In conclusion, our data suggest that microvascular rarefaction occurs in obesity. EPCs were significantly reduced in obese patients. Pronounced weight loss induced by bariatric surgery seems to induce a significant improvement of EPC number, but not of capillary rarefaction. A pronounced fibrosis of subcutaneous small resistance arteries is present in obese patients, regardless of the presence of increased blood pressure values. Consistent weight loss induced by bariatric surgery may induce an almost complete regression of microvascular fibrosis.

  13. A Qualitative Assessment of the My True Body Bariatric Surgery Preparation Program

    Science.gov (United States)

    Nakamura, Tracy; Mamary, Edward

    2013-01-01

    Background: The My True Body (MTB) group intervention incorporates cognitive restructuring and social support into bariatric surgery preparation. Purpose: To identify and describe program components that support long-term behavioral modifications and influence confidence in healthy weight maintenance. Methods: Semistructured telephone interviews…

  14. Factors Associated with Suicide Ideation in Severely Obese Bariatric Surgery-Seeking Individuals

    Science.gov (United States)

    Chen, Eunice Y.; Fettich, Karla C.; Tierney, Megan; Cummings, Hakeemah; Berona, Johnny; Weissman, Jessica; Ward, Amanda; Christensen, Kara; Southward, Matthew; Gordon, Kathryn H.; Mitchell, James; Coccaro, Emil

    2012-01-01

    There are high rates of suicide ideation and/or behavior in severely obese individuals. The potential contributors to suicide ideation in a sample of 334 severely obese bariatric surgery candidates was explored. Lack of college education, a history of suicide ideation and/or behavior, psychological distress, hopelessness, loneliness, history of…

  15. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  16. Dumping syndrome after esophageal, gastric or bariatric surgery : pathophysiology, diagnosis, and management

    NARCIS (Netherlands)

    van Beek, A. P.; Emous, M.; Laville, Maurice; Tack, Johannes

    2017-01-01

    Background: Dumping syndrome, a common complication of esophageal, gastric or bariatric surgery, includes early and late dumping symptoms. Early dumping occurs within 1 h after eating, when rapid emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and rele

  17. Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery.

    Science.gov (United States)

    Baltieri, Letícia; Peixoto-Souza, Fabiana Sobral; Rasera-Junior, Irineu; Montebelo, Maria Imaculada de Lima; Costa, Dirceu; Pazzianotto-Forti, Eli Maria

    To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  18. [Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery].

    Science.gov (United States)

    Baltieri, Letícia; Peixoto-Souza, Fabiana Sobral; Rasera-Junior, Irineu; Montebelo, Maria Imaculada de Lima; Costa, Dirceu; Pazzianotto-Forti, Eli Maria

    To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years. Copyright © 2016. Publicado por Elsevier Editora Ltda.

  19. Dumping syndrome after esophageal, gastric or bariatric surgery : pathophysiology, diagnosis, and management

    NARCIS (Netherlands)

    van Beek, A P; Emous, M; Laville, M; Tack, J

    2017-01-01

    BACKGROUND: Dumping syndrome, a common complication of esophageal, gastric or bariatric surgery, includes early and late dumping symptoms. Early dumping occurs within 1 h after eating, when rapid emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and rele

  20. Mental Healthcare Utilization in Patients Seeking Bariatric Surgery : The Role of Attachment Behavior

    NARCIS (Netherlands)

    Aarts, Floor; Hinnen, Chris; Gerdes, Victor E. A.; Brandjes, Dees P. M.; Geenen, Rinie

    2013-01-01

    Obesity may be a factor contributing to mental health in patients seeking bariatric surgery. Whether a person uses mental healthcare may have its roots in attachment behavior. The present study (N=260) identified that attachment anxiety was associated with more mental healthcare visits (OR=1.86, 95%

  1. Bariatric surgery: studies on its consequences with emphasis on thrombotic and bleeding complications

    NARCIS (Netherlands)

    Çelik, F.

    2014-01-01

    Obesity is a steadily growing problem that is associated with several diseases such as diabetes type 2, hypertension and dyslipidemia. For morbidly obese persons who have failed to achieve weight loss after several weight loss interventions, bariatric surgery is at this moment the only long-lasting,

  2. [Usefulness of upper gastrointestinal series to detect leaks in the early postoperative period of bariatric surgery].

    Science.gov (United States)

    Medina, Francisco J; Miranda-Merchak, Andrés; Martínez, Alonso; Sánchez, Felipe; Bravo, Sebastián; Contreras, Juan Eduardo; Alliende, Isabel; Canals, Andrea

    2016-04-01

    Postoperative leaks are the most undesirable complication of bariatric surgery and upper gastrointestinal (GI) series are routinely ordered to rule them out. Despite the published literature recommending against its routine use, it is still being customarily used in Chile. To examine the usefulness of routine upper GI series using water-soluble iodinated contrast media for the detection of early postoperative leaks in patients undergoing bariatric surgery. A cohort of 328 patients subjected to bariatric surgery was followed from October 2012 to October 2013. Most of them underwent sleeve gastrectomy. Upper GI series on the first postoperative day were ordered to 308 (94%) patients. Postoperative leaks were observed in two patients, with an incidence of 0.6%. The sensitivity for upper GI series detection of leak was 0% and the negative predictive value was 99%. Routine upper GI series after bariatric surgery is not useful for the diagnosis of postoperative leak, given the low incidence of this complication and the low sensitivity of the technique.

  3. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

    Directory of Open Access Journals (Sweden)

    Patel Pranav H

    2012-03-01

    Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  4. Psychologists' Evaluation of Bariatric Surgery Candidates Influenced by Patients' Attachment Representations and Symptoms of Depression and Anxiety

    NARCIS (Netherlands)

    Aarts, Floor; Hinnen, Chris; Gerdes, Victor E. A.; Acherman, Yair; Brandjes, Dees P. M.

    2014-01-01

    This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists' evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric surg

  5. Psychologists' Evaluation of Bariatric Surgery Candidates Influenced by Patients' Attachment Representations and Symptoms of Depression and Anxiety

    NARCIS (Netherlands)

    Aarts, Floor; Hinnen, Chris; Gerdes, Victor E. A.; Acherman, Yair; Brandjes, Dees P. M.

    This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists' evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric

  6. Evaluation of an In Silico PBPK Post-Bariatric Surgery Model through Simulating Oral Drug Bioavailability of Atorvastatin and Cyclosporine

    OpenAIRE

    2013-01-01

    An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (F oral). In the absence of clinical data, an indication of changes to F oral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual “post-bariatric surgery” population was evaluated through mimicki...

  7. From bariatric to metabolic surgery: Looking for a "diseasemodifier" surgery for type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    In this review the recent evolution of the comprehensionof clinical and metabolic consequences of bariatricsurgery is depicted. At the beginning bariatric surgeryaim was a significant and durable weight loss. Later on,it became evident that bariatric surgery was associatedwith metabolic changes, activated by unknown pathways,partially or totally independent of weight loss. Paradigmof this "metabolic" surgery is its effects on type 2diabetes mellitus (T2DM). In morbid obese subjects itwas observed a dramatic metabolic response leadingto decrease blood glucose, till diabetesremission,before the achievement of clinically significant weightloss, opening the avenue to search for putative antidiabetic"intestinal" factors. Both proximal duodenal(still unknown) and distal (GLP1) signals have beensuggested as hormonal effectors of surgery on bloodglucose decrease. Despite these findings T2DMremission was never considered a primary indicationfor bariatric surgery but only a secondary one. RecentlyT2DM remission in obese subjects with body massindex (BMI) greater than 35 has become a primaryaim for surgery. This change supports the idea that"metabolic surgery" definition could more appropriatethan bariatric, allowing to explore the possibility thatmetabolic surgery could represent a "disease modifier"for T2DM. Therefore, several patients have undergonesurgery with a primary aim of a definitive cure of T2DMand today this surgery can be proposed as an alternativetherapy. How much surgery can be considered trulymetabolic is still unknown. To be truly "metabolic" itshould be demonstrated that surgery could cause T2DMremission not only in subjects with BMI 〉 35 but alsowith BMI 〈 35 or even 〈 30. Available evidence on thistopic is discussed in this mini-review.

  8. Experimental Bariatric Surgery in Rats Generates a Cytotoxic Chemical Environment in the Gut Contents.

    Directory of Open Access Journals (Sweden)

    Jia eLi

    2011-09-01

    Full Text Available Bariatric surgery, also known as metabolic surgery, is an effective treatment for morbid obesity which also offers pronounced metabolic effects including the resolution of type 2 diabetes and a decrease in cardiovascular disease and long-term cancer risk. However, the mechanisms of surgical weight loss and the long term consequences of bariatric surgery remain unclear. Bariatric surgery has been demonstrated to alter the composition of both the microbiome and the metabolic phenotype. We observed a marked shift towards Gammaproteobacteria, particularly Enterobacter hormaechei, following Roux-en-Y gastric bypass (RYGB surgery in a rat model compared with sham operated controls. Fecal water from RYGB surgery rats was highly cytotoxic to rodent cells (mouse lymphoma cell line, although In contrast, fecal water from sham operated animals showed no/very low cytotoxicity. This shift in the gross structure of the microbiome correlated with greatly increased cytotoxicity in a regulatory acceptable mouse lymphoma assay. Urinary phenylacetylglycine and indoxyl sulfate and fecal GABA, putrescine, tyramine and uracil were found to be inversely correlated with cell survival rate. This profound co-dependent response of mammalian and microbial metabolism to RYGB surgery and the impact on the cytotoxicity of the gut luminal environment suggests that RYGB exerts local and global metabolic effects which may have an influence on long term cancer risk and cytotoxic load.

  9. Bariatric surgery-induced weight loss causes remission of food addiction in extreme obesity.

    Science.gov (United States)

    Pepino, Marta Yanina; Stein, Richard I; Eagon, J Christopher; Klein, Samuel

    2014-08-01

    To test the hypotheses that bariatric surgery-induced weight loss: induces remission of food addiction (FA), and normalizes other eating behaviors associated with FA. Forty-four obese subjects (BMI= 48 ± 8 kg/m(2) ) were studied before and after ∼20% weight loss induced by bariatric surgery (25 Roux-en-Y gastric bypass, 11 laparoscopic adjustable gastric banding, and eight sleeve gastrectomy). We assessed: FA (Yale Food Addiction Scale), food cravings (Food Craving Inventory), and restrictive, emotional and external eating behaviors (Dutch Eating Behavior Questionnaire). FA was identified in 32% of subjects before surgery. Compared with non-FA subjects, those with FA craved foods more frequently, and had higher scores for emotional and external eating behaviors (all P-values 0.8). Surgery-induced weight loss resulted in remission of FA in 93% of FA subjects; no new cases of FA developed after surgery. Surgery-induced weight loss decreased food cravings, and emotional and external eating behaviors in both groups (all P-values 1.1). Bariatric surgery-induced weight loss induces remission of FA and improves several eating behaviors that are associated with FA. Copyright © 2014 The Obesity Society.

  10. Thickening of inner retinal layers in the parafovea after bariatric surgery in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Brynskov, Troels; Laugesen, Caroline S; Floyd, Andrea K;

    2016-01-01

    PURPOSE: Bariatric surgery dramatically improves the metabolic profile in patients with type 2 diabetes (T2D). We have previously reported a thickening of the retina after bariatric surgery and aimed to investigate these subclinical changes in retinal thickness and vessel calibres in more detail....... METHODS: We examined 51 patients with T2D 2 weeks before and 1, 3, 6 and 12 months after bariatric surgery. Retinal thickness was measured with optical coherence tomography and automated segmentation in the fovea, parafovea and perifovea in each retinal layer. Retinal vessels were semiautomatically...

  11. The Exchange of Social Support on Online Bariatric Surgery Discussion Forums: A Mixed-Methods Content Analysis.

    Science.gov (United States)

    Atwood, Molly E; Friedman, Aliza; Meisner, Brad A; Cassin, Stephanie E

    2017-03-10

    Bariatric surgery patients often experience physical and psychosocial stressors, and difficulty adjusting to significant lifestyle changes. As a result, social support groups that provide patients with support, coping skills, and nutritional information are valuable components of bariatric care. Support group attendance at bariatric centers is associated with greater post-surgery weight loss; however, several barriers hinder attendance at in-person support groups (e.g., travel distance to bariatric centers). Consequently, online support forums are an increasingly utilized resource for patients both before and after surgery. This study examined and described the type and frequency of social support provided on a large online bariatric surgery forum. A total of 1,412 messages in the pre- (n = 822) and post-surgery (n = 590) sections of the forum were coded using qualitative content analysis according to Cutrona and Suhr's (1992) Social Support Behavior Code model (i.e., including informational, tangible, esteem, network, and emotional support types). The majority of messages provided informational and emotional support regarding: a) factual information about the bariatric procedure and nutrition; b) advice for coping with the surgery preparation process, and physical symptoms; and c) encouragement regarding adherence to surgical guidelines, and weight loss progress. Network, esteem, and tangible support types were less frequent than informational and emotional support types. The results inform healthcare providers about the types of social support available to bariatric patients on online support forums and, thus, encourage appropriate referrals to this resource.

  12. Influences of general self-efficacy and weight bias internalization on physical activity in bariatric surgery candidates.

    Science.gov (United States)

    Hübner, Claudia; Baldofski, Sabrina; Zenger, Markus; Tigges, Wolfgang; Herbig, Beate; Jurowich, Christian; Kaiser, Stefan; Dietrich, Arne; Hilbert, Anja

    2015-01-01

    Physical activity (PA) seems to be important for long-term weight loss after bariatric surgery; however, studies provide evidence for insufficient PA levels in bariatric patients. Research found self-efficacy to be associated with PA and weight bias internalization, for which an influence on mental and physical health has been shown in recent studies. The purpose of the present study was to investigate the influence of general self-efficacy on PA, mediated by weight bias internalization. In 179 bariatric surgery candidates, general self-efficacy, weight bias internalization, and different intensities of PA were assessed by self-report questionnaires. Structural equation modeling was used to analyze the assumed mediational relationship. After controlling for sociodemographic variables, weight bias internalization fully mediated the association between general self-efficacy and moderate-intense as well as vigorous-intense PA. Lower general self-efficacy predicted greater weight bias internalization, which in turn predicted lower levels of moderate-intense and vigorous-intense PA. The results suggest an influence of weight bias internalization on preoperative PA in bariatric surgery candidates. Subsequently, implementation of interventions addressing weight bias internalization in the usual treatment of bariatric surgery candidates might enhance patients' preoperative PA, while longitudinal analyses are needed to further examine its predictive value on PA after bariatric surgery. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  13. Systematic review and retrospective validation of prediction models for weight loss after bariatric surgery.

    Science.gov (United States)

    Sharples, Alistair J; Mahawar, Kamal; Cheruvu, Chandra V N

    2017-08-12

    Patients often have less than realistic expectations of the weight loss they are likely to achieve after bariatric surgery. It would be useful to have a well-validated prediction tool that could give patients a realistic estimate of their expected weight loss. To perform a systematic review of the literature to identify existing prediction models and attempt to validate these models. University hospital, United Kingdom. A systematic review was performed. All English language studies were included if they used data to create a prediction model for postoperative weight loss after bariatric surgery. These models were then tested on patients undergoing bariatric surgery between January 1, 2013 and December 31, 2014 within our unit. An initial literature search produced 446 results, of which only 4 were included in the final review. Our study population included 317 patients. Mean preoperative body mass index was 46.1 ± 7.1. For 257 (81.1%) patients, 12-month follow-up was available, and mean body mass index and percentage excess weight loss at 12 months was 33.0 ± 6.7 and 66.1% ± 23.7%, respectively. All 4 of the prediction models significantly overestimated the amount of weight loss achieved by patients. The best performing prediction model in our series produced a correlation coefficient (R(2)) of .61 and an area under the curve of .71 on receiver operating curve analysis. All prediction models overestimated weight loss after bariatric surgery in our cohort. There is a need to develop better procedures and patient-specific models for better patient counselling. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  14. Incidence and Prognosis of Psoriasis and Psoriatic Arthritis in Patients Undergoing Bariatric Surgery

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Sørensen, Jens Ahm; Gislason, Gunnar Hilmar

    2017-01-01

    Importance: Psoriasis and obesity are strongly linked, and weight loss appears to improve psoriasis symptoms and severity. Bariatric surgery may induce remission of psoriasis, but data are limited to small studies and case series. Objective: To examine the incidence and prognosis of psoriasis...... and psoriatic arthritis in patients undergoing bariatric surgery (gastric bypass and gastric banding). Design, Setting, and Participants: This population-based cohort study used individual-level linkage of administrative and public health registers in Denmark. All Danish citizens who received gastric bypass...... and 41.0 (10.0) years at the time of surgery. The gastric banding subset was composed of 800 (74.7%) women and 271 (25.3) men; the mean (SD) age of these patients was 32.3 (10.1) years at the study start and 41.7 (10.0) years at the time of surgery. Adjusted HRs of psoriasis were 0.52 (95% CI, 0...

  15. Bariatric surgery decreases carotid intima-media thickness in obese subjects

    Directory of Open Access Journals (Sweden)

    Gonzalo García

    2013-08-01

    Full Text Available Background: Obesity has long been associated with an increased risk of cardiovascular disease (CVD. The aim of this study was to evaluate the impact of substantial weight loss induced by bariatric surgery on carotid intima media thickness (C-IMT (surrogate marker of early atherosclerosis and classic factors of cardiovascular risk (CVRFs. Methods: thirty-one obesity patients were evaluated for bariatric surgery. Twenty-seven were undergone surgery, 14 Roux-en-Y gastric bypass surgery (GBS and 13 sleeve gastrectomy. The four obese patients who did not undergo surgery, were performed the same evaluations. Measurements: Body weight, BMI, blood pressure, total cholesterol, TC levels, LDL-C, HDL-C, TG, fasting plasma glucose and insulin, HOMA IR, and US B-mode C-IMT was measured. Results: After 354 ± 92 days follow up, 27 patients that underwent bariatric surgery evidenced a mean body mass index decrease from 38 to 27 k/m² (p < 0.001, simultaneously was observed improvement in CVRFs, 10 years Framingham risk and a significant reduction of therapeutic requirements. C-IMT diminished from a mean of 0.58 ± 0.14 mm to 0.49 ± 0.09 mm (p = 0.0001. Four patients that did not undergo surgery increased C-IMT from 0.52 ± 0.12 to 0.58 ± 0.13 mm (p = 0.03 with no significant changes in CVRFs. Conclusion: Weight loss, one year after bariatric surgery, GBS and sleeve gastrectomy, decreases C-IMT; improve CVRFs and 10 years Framingham risk.

  16. The Role of Hormonal Factors in Weight Loss and Recidivism after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    S. D. Pedersen

    2013-01-01

    Full Text Available Substantial heterogeneity exists in weight loss trajectories amongst patients following bariatric surgery. Hormonal factors are postulated to be amongst the contributors to the variation seen. Several hormones involved in hunger, satiety, and energy balance are affected by bariatric surgery, with the alteration in hormonal milieu varying by procedure. Limited research has been conducted to examine potential hormonal mediators of weight loss failure or recidivism following bariatric surgery. While hormonal factors that influence weight loss success following gastric banding have not been identified, data suggest that hormonal factors may be involved in modulating weight loss success following gastric bypass. There may be hormonal mediators involved in determining the weight trajectory following sleeve gastrectomy, though the extremely limited data currently available prohibits definitive conclusions from being drawn. There is great need for future research studies to explore this knowledge gap, as improving this knowledge base could be of benefit to guide clinicians toward understanding the hormonal contributors to a patient’s postoperative weight loss failure or recidivism or perhaps be of value in selecting the most appropriate bariatric procedure based on the preoperative hormone milieu. Integrative interdisciplinary approaches exploring these complex interrelationships could potentially increase the explanatory power of such investigations.

  17. The relationship between duration of stay and readmissions in patients undergoing bariatric surgery.

    Science.gov (United States)

    Lois, Alex W; Frelich, Matthew J; Sahr, Natasha A; Hohmann, Samuel F; Wang, Tao; Gould, Jon C

    2015-08-01

    Hospital readmissions are a quality indicator in bariatric surgery. In recent years, duration of stay after bariatric surgery has trended down greatly. We hypothesized that a shorter postoperative hospitalization does not increase the likelihood of readmission. The University HealthSystem Consortium (UHC) is an alliance of academic medical centers and affiliated hospitals. The UHC's clinical database contains information on inpatient stay and returns (readmissions) up to 30 days after discharge. A multicenter analysis of outcomes was performed by the use of data from the January 2009 to December 2013 for patients 18 years and older. Patients were identified by bariatric procedure International Classification of Diseases, Ninth Revision, codes and restricted by diagnosis codes for morbid obesity. A total of 95,294 patients met inclusion criteria. The mean patient age was 45.4 (±0.11) years, and 73,941 (77.6%) subjects were female. There were 5,423 (5.7%) readmissions within the study period. Patients with hospitalizations of 3 days and more than 3 days were twice and four times as likely to be readmitted than those with hospitalizations of one day, respectively (P bariatric surgery. Early discharge does not appear to be associated with increased readmission rates. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Deterioration of mental health in bariatric surgery after 10 years despite successful weight loss.

    Science.gov (United States)

    Canetti, L; Bachar, E; Bonne, O

    2016-01-01

    The present study evaluated the mental health and psychological functioning of bariatric patients before surgery, and after 1 year and 10 year follow-ups, and compared them with participants in a dietary program. Such long follow-up is rare, but strongly recommended by the American Association of Bariatric Surgeons. Thirty-six bariatric surgery patients and 34 participants of a weight loss program were weighed and assessed at all 3 points in time. Participants were administered the mental health inventory, neuroticism, sense of control and fear of intimacy scales. Along with these mental and psychological measurements, the medical outcome short form (SF-36) was used. The surgery group achieved successful weight loss outcomes (27% reduction of pre-operative weight) after 10 years and better than baseline health-related quality-of-life scores. However, their general mental health, neuroticism, sense of control and fear of intimacy scores showed significant deterioration in comparison to pre-operative levels after 10 years. The dietary group participants remained psychologically stable among all three points in time. This study highlights the importance of identifying a risk group among bariatric patients for which the dietary and psychological follow-up may be of special significance.

  19. Benign, Premalignant, and Malignant Lesions Encountered in Bariatric Surgery

    OpenAIRE

    Raghavendra, Rao S.; Kini,

    2012-01-01

    Background: Obesity is associated with several comorbidities like diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. It is also well established that obese patients have an increased risk of several types of cancer like kidney, pancreas, endometrial, breast, and others. The bariatric surgeon needs to be aware of the problem of benign tumors and cancer in obese patients as well as the optimal management of these conditions that may be present at the time of evaluation for bar...

  20. Strategic laparoscopic surgery for improved cosmesis in general and bariatric surgery: analysis of initial 127 cases.

    Science.gov (United States)

    Nguyen, Ninh T; Smith, Brian R; Reavis, Kevin M; Nguyen, Xuan-Mai T; Nguyen, Brian; Stamos, Michael J

    2012-05-01

    Strategic laparoscopic surgery for improved cosmesis (SLIC) is a less invasive surgical approach than conventional laparoscopic surgery. The aim of this study was to examine the feasibility and safety of SLIC for general and bariatric surgical operations. Additionally, we compared the outcomes of laparoscopic sleeve gastrectomy with those performed by the SLIC technique. In an academic medical center, from April 2008 to December 2010, 127 patients underwent SLIC procedures: 38 SLIC cholecystectomy, 56 SLIC gastric banding, 26 SLIC sleeve gastrectomy, 1 SLIC gastrojejunostomy, and 6 SLIC appendectomy. SLIC sleeve gastrectomy was initially performed through a single 4.0-cm supraumbilical incision with extraction of the gastric specimen through the same incision. The technique evolved to laparoscopic incisions that were all placed within the umbilicus and suprapubic region. There were no 30-day or in-hospital mortalities or 30-day re-admissions or re-operations. For SLIC cholecystectomy, gastric banding, appendectomy, and gastrojejunostomy, conversion to conventional laparoscopy occurred in 5.3%, 5.4%, 0%, and 0%, respectively; there were no major or minor postoperative complications. For SLIC sleeve gastrectomy, there were no significant differences in mean operative time and length of hospital stay compared with laparoscopic sleeve gastrectomy; 1 (3.8%) of 26 SLIC patients required conversion to five-port laparoscopy. There were no major complications. Minor complications occurred in 7.7% in the SLIC sleeve group versus 8.3% in the laparoscopic sleeve group. SLIC in general and bariatric operations is technically feasible, safe, and associated with a low rate of conversion to conventional laparoscopy. Compared with laparoscopic sleeve gastrectomy, SLIC sleeve gastrectomy can be performed without a prolonged operative time with comparable perioperative outcomes.

  1. Weight regain among women after metabolic and bariatric surgery: a qualitative study in Brazil

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    Ataliba de Carvalho Jr.

    2014-09-01

    Full Text Available INTRODUCTION: Due to the increased number of bariatric surgeries over the years, aspects contributing or hindering the achievement of outcomes, among them weight regain, have acquired increased significance. Psychological factors directly influence on this unwanted situation, but there are few studies and controversies about the degree of participation of these factors. We propose a qualitative investigation to analyze the meanings of weight regain after surgery among women and how these factors influence this outcome.METHOD: This study uses the clinical-qualitative method, by means of a semi-structured interview with open questions in an intentional sample, closed by saturation, with eight women who underwent surgery at the Bariatric Surgery Outpatient Clinic of Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP, in the state of São Paulo, Brazil.RESULTS: A feeling of defeat and failure emerges with weight regain, which contributes to social isolation; there is no regret, but gratitude for the surgery; among patients, there is a sense of feeling rejected greater than a rejection that actually exists.CONCLUSION: We found out the need for further qualitative studies that help the health team to better understand the dynamic psychological factors involved in the meaning of weight regain after bariatric surgery among women, in order to adopt appropriate conducts to deal with this problem.

  2. Patient experiences of adjusting to life in the first 2 years after bariatric surgery: a qualitative study.

    Science.gov (United States)

    Graham, Y; Hayes, C; Small, P K; Mahawar, K; Ling, J

    2017-10-01

    There is currently little research into the experiences of those who have undergone bariatric surgery, or how surgery affects their lives and social interactions. Adopting a constructivist grounded theory methodological approach with a constant comparative analytical framework, semi-structured interviews were carried out with 18 participants (11 female, 7 male) who had undergone permanent bariatric surgical procedures 5-24 months prior to interview. Findings revealed that participants regarded social encounters after bariatric surgery as underpinned by risk. Their attitudes towards social situations guided their social interaction with others. Three profiles of attitudes towards risk were constructed: Risk Accepters, Risk Contenders and Risk Challengers. Profiles were based on participant-reported narratives of their experiences in the first two years after surgery. The social complexities which occurred as a consequence of bariatric surgery required adjustments to patients' lives. Participants reported that social aspects of bariatric surgery did not appear to be widely understood by those who have not undergone bariatric surgery. The three risk attitude profiles that emerged from our data offer an understanding of how patients adjust to life after surgery and can be used reflexively by healthcare professionals to support both patients pre- and post-operatively. © 2017 World Obesity Federation.

  3. Efficacy of a Required Preoperative Weight Loss Program for Patients Undergoing Bariatric Surgery.

    Science.gov (United States)

    Conaty, Eliza A; Bonamici, Nicolas J; Gitelis, Matthew E; Johnson, Brandon J; DeAsis, Francis; Carbray, JoAnn M; Lapin, Brittany; Joehl, Raymond; Denham, Woody; Linn, John G; Haggerty, Stephen P; Ujiki, Michael B

    2016-04-01

    The efficacy of mandatory medically supervised preoperative weight loss (MPWL) prior to bariatric surgery continues to be a controversial topic. The purpose of this observational study was to assess the efficacy of a MPWL program in a single institution, which mandated at least 10% excess body weight loss before surgery, by comparing outcomes of patients undergoing primary bariatric surgery with and without a compulsory preoperative weight loss regimen. We analyzed our database of 757 patients who underwent primary bariatric surgery between March 2008 and January 2015. Patients were placed into two cohorts based on their participation in a MPWL program requiring at least 10% excess weight loss (EWL) prior to surgery. Patients were evaluated at 3, 6, 12, and 24 months after surgery for weight loss, comorbidity resolution, and the occurrences of hospital readmissions. A total of 717 patients met the inclusion criteria of whom 465 underwent surgery without a preoperative weight loss requirement and 252 participated in the MPWL program. One year after surgery, 67.1% of non-participants and 62.5% of MPWL participants showed a resolution of at least one of five associated comorbidities (p = 0.45). Non-participants showed an average of 58.6% EWL, while MPWL participants showed 59.1% EWL at 1 year postoperatively (p = 0.84). Readmission rates, excluding those which were ulcer-related, at 30 days (3.4 vs. 6.40%, p = 0.11) and 90 days (9.9 vs. 7.5%, p = 0.29) postoperatively were not significantly different between the non-participants and MPWL patients, respectively. A mandatory preoperative weight loss program prior to bariatric surgery did not result in significantly greater %EWL or comorbidity resolution 1 year after surgery compared to patients not required to lose weight preoperatively. Additionally, the program did not result in significantly lower 30- or 90-day readmission rates for these patients. The value of a MPWL program must be weighed against

  4. FROM COMPLEX EVOLVING TO SIMPLE: CURRENT REVISIONAL AND ENDOSCOPIC PROCEDURES FOLLOWING BARIATRIC SURGERY.

    Science.gov (United States)

    Zorron, Ricardo; Galvão-Neto, Manoel Passos; Campos, Josemberg; Branco, Alcides José; Sampaio, José; Junghans, Tido; Bothe, Claudia; Benzing, Christian; Krenzien, Felix

    Roux-en-Y gastric bypass (RYGB) is a standard therapy in bariatric surgery. Sleeve gastrectomy and gastric banding, although with good results in the literature, are showing higher rates of treatment failure to reduce obesity-associated morbidity and body weight. Other problems after bariatric may occur, as band erosion, gastroesophageal reflux disease and might be refractory to medication. Therefore, a laparoscopic conversion to a RYGB can be an effective alternative, as long as specific indications for revision are fulfilled. The objective of this study was to analyse own and literature data on revisional bariatric procedures to evaluate best alternatives to current practice. Institutional experience and systematic review from the literature on revisional bariatric surgery. Endoscopic procedures are recently applied to ameliorate failure and complications of bariatric procedures. Therapy failure following RYGB occurs in up to 20%. Transoral outlet reduction is currently an alternative method to reduce the gastrojejunal anastomosis. The diameter and volume of sleeve gastrectomy can enlarge as well, which can be reduced by endoscopic full-thickness sutures longitudinally. Dumping syndrome and severe hypoglycemic episodes (neuroglycopenia) can be present in patients following RYGB. The hypoglycemic episodes have to be evaluated and usually can be treated conventionally. To avoid partial pancreatectomy or conversion to normal anatomy, a new laparoscopic approach with remnant gastric resection and jejunal interposition can be applied in non-responders alternatively. Hypoglycemic episodes are ameliorated while weight loss is sustained. Revisional and endoscopic procedures following bariatric surgery in patients with collateral symptomatic or treatment failure can be applied. Conventional non-surgical approaches should have been applied intensively before a revisional surgery will be indicated. Former complex surgical revisional procedures are evolving to less

  5. Effects of bariatric surgery on the level of hormones that regulate body weight. What is the basis of success?

    Directory of Open Access Journals (Sweden)

    Alina Yur'evna Babenko

    2014-06-01

    Full Text Available The growth of obesity and type 2 diabetes incidence has made bariatric surgery a widespread method of treatment. The effectiveness of bariatricoperations in the treatment of obesity and related metabolic diseases is thoroughly highlighted in medical literature. However, the resultsof surgery do not always correlate with type of operation. As before, the mechanisms have not been fully studied of how the bariatric surgeryinfluence on insulinresistance, entero-insulin axes, adipokines. Understanding such mechanisms will allow us to determine more precisely theindications relating to surgical treatment, and enhance the effectiveness of surgery in specific patient. The review is focusing on the influence ofvarious types of bariatric surgery on the level of adipokines and incretines that participate in regulation of appetite and of fat and carbohydratemetabolism. The article elaborates modern concepts related to the impact of bariatric operations on metabolic disorders in obesity.

  6. Post-bariatric surgery satisfaction and body-contouring consideration after massive weight loss

    Directory of Open Access Journals (Sweden)

    Saleh M Aldaqal

    2013-01-01

    Full Text Available Background: Following a bariatric surgery and massive weight-loss, the outcome is usually sullied by consequences on the body′s contour and redundant skin. Aims: We aimed to record the frequency of contour irregularities and quantify patients′ satisfaction with appearance and anticipations from body contouring surgery. Materials and Methods: The ethical committee at King Abdulaziz University Hospital approved the study, and patients were consented. A cross-sectional study targeting the post-bariatric patients from May 2011 to April 2012 was conducted at our hospital. We used post-massive weight loss Satisfaction Questionnaire. Results: The total numbers of patients were 64 (51 women and 13 men, of which 57 patients (89.2% developed sagging skin. Most patients were dissatisfied with their appearance after weight loss. The most common zones were the upper arms (50% and abdomen (45%. Considerably more women (36.2% than men (24% were dissatisfied with certain body areas. The most noticeable expectation of patients from body contouring surgery was improved cosmetic appearance (65.6% and self-confidence (64.1%. More women (70.58% than men (46.15% expected a better cosmetic appearance after body contouring (P = 0.003. Conclusion: After bariatric surgery, sagging excess skin is an unsatisfactory problem. Therefore, body contouring surgery must be included in morbid obesity management.

  7. Becoming a normal guy: Men making sense of long-term bodily changes following bariatric surgery.

    Science.gov (United States)

    Groven, Karen Synne; Galdas, Paul; Solbrække, Kari Nyheim

    2015-01-01

    To date, research on bodily changes following bariatric surgery has focused predominantly on women, leaving the long-term experience of men relatively unexplored. In this paper, we draw on interviews with men who have undergone an irreversible gastric bypass procedure to explore their bodily changes more than 4 years post-surgery. We apply a phenomenological framework that draws on Leder's perspectives on the "disappearing" and "dys-appearing" body, combined with a gender-sensitive lens that draws on Connell's theory of hegemonic masculinity and Robertson's conceptions of embodied masculinity. Our principal finding was that the men negotiated their bodily changes following bariatric surgery in profoundly ambivalent ways. Although they enthusiastically praised the surgery for improving their health, self-esteem, and social functioning, they also emphasized their efforts to cope with post-surgical side effects and life-threatening complications. Our analysis elaborates on their efforts to adjust to and come to terms with these changes, focusing on episodes of hypoglycemia, severe pain and internal herniation, and the significance of physical activity and exercise. Our findings point to the need to acknowledge men's ways of making sense of profound and ongoing bodily changes following bariatric surgery and how these negotiations are closely intertwined with masculine ideals of embodiment and social value.

  8. Does weight loss immediately before bariatric surgery improve outcomes: a systematic review.

    Science.gov (United States)

    Livhits, Masha; Mercado, Cheryl; Yermilov, Irina; Parikh, Janak A; Dutson, Erik; Mehran, Amir; Ko, Clifford Y; Gibbons, Melinda Maggard

    2009-01-01

    Preoperative weight loss before bariatric surgery has been proposed as a predictive factor for improved patient compliance and the degree of excess weight loss achieved after surgery. In the present study, we sought to determine the effect of preoperative weight loss on postoperative outcomes. A search of MEDLINE was completed to identify the patient factors associated with weight loss after bariatric surgery. Of the 909 screened reports, 15 had reported on preoperative weight loss and the degree of postoperative weight loss achieved. A meta-analysis was performed that compared the postoperative weight loss and perioperative outcomes in patients who had lost weight preoperatively compared to those who had not. Of the 15 articles (n = 3404 patients) identified, 5 found a positive effect of preoperative weight loss on postoperative weight loss, 2 found a positive short-term effect that was not sustained long term, 5 did not find an effect difference, and 1 found a negative effect. A meta-analysis revealed a significant increase in the 1-year postoperative weight loss (mean difference of 5% EWL, 95% confidence interval 2.68-7.32) for patients who had lost weight preoperatively. A meta-analysis of other outcomes revealed a decreased operative time for patients who had lost weight preoperatively (mean difference 23.3 minutes, 95% confidence interval 13.8-32.8). Preoperative weight loss before bariatric surgery appears to be associated with greater weight loss postoperatively and might help to identify patients who would have better compliance after surgery.

  9. Becoming a normal guy: Men making sense of long-term bodily changes following bariatric surgery

    Directory of Open Access Journals (Sweden)

    Karen Synne Groven

    2015-12-01

    Full Text Available Background: To date, research on bodily changes following bariatric surgery has focused predominantly on women, leaving the long-term experience of men relatively unexplored. In this paper, we draw on interviews with men who have undergone an irreversible gastric bypass procedure to explore their bodily changes more than 4 years post-surgery. We apply a phenomenological framework that draws on Leder's perspectives on the “disappearing” and “dys-appearing” body, combined with a gender-sensitive lens that draws on Connell's theory of hegemonic masculinity and Robertson's conceptions of embodied masculinity. Findings: Our principal finding was that the men negotiated their bodily changes following bariatric surgery in profoundly ambivalent ways. Although they enthusiastically praised the surgery for improving their health, self-esteem, and social functioning, they also emphasized their efforts to cope with post-surgical side effects and life-threatening complications. Our analysis elaborates on their efforts to adjust to and come to terms with these changes, focusing on episodes of hypoglycemia, severe pain and internal herniation, and the significance of physical activity and exercise. Conclusions: Our findings point to the need to acknowledge men's ways of making sense of profound and ongoing bodily changes following bariatric surgery and how these negotiations are closely intertwined with masculine ideals of embodiment and social value.

  10. The impact of bariatric surgery on inflammation: quenching the fire of obesity?

    Science.gov (United States)

    Hafida, Samar; Mirshahi, Tooraj; Nikolajczyk, Barbara S

    2016-10-01

    Numerous lines of evidence support the likelihood that inflammation drives the transition from obese/metabolically healthy to obese/type 2 diabetes (T2D). Given the temporal flexibility of inflammation in obesity-associated T2D, investigators have hypothesized that a precipitous drop in diabetogenic cytokines is critical for rapid 'T2D remission' following surgery but prior to significant weight loss. We review the evidence that changes in diabetogenic cytokines play a role in outcomes of bariatric surgery, including improved glycemic control. A 2016 indication for bariatric surgery to treat T2D integrates the large body of data showing rapid metabolic improvement. Parameters that account for improved glycemic control prior to significant weight loss, T2D recidivism over the long term, or failure of surgery to remit T2D in some patients are incompletely understood. We review the evidence that changes in diabetogenic cytokines play a role in outcomes of bariatric surgery, including improved glycemic control. We brainstorm future research directions that may improve surgical results.

  11. Outcomes of bariatric surgery in type 2 diabetic patients with diminished pancreatic secretory reserve.

    Science.gov (United States)

    Aminian, Ali; Brethauer, Stacy A; Daigle, Christopher R; Kirwan, John P; Burguera, Bartolome; Kashyap, Sangeeta R; Schauer, Philip R

    2014-12-01

    Although the marked and durable effects of bariatric surgery on early type 2 diabetes is known, there are limited data on the impact of surgery in patients with reduced beta-cell function/reserve. Clinical outcomes of 15 morbidly obese patients with poorly controlled diabetes who underwent bariatric surgery in a 10-year period and had a baseline fasting serum c-peptide ≤0.5 ng/mL were assessed. All patients had glycated hemoglobin >7 % and were on insulin before surgery. Surgical procedures included laparoscopic gastric bypass (n = 9), sleeve (n = 5), and banding (n = 1) without any intraoperative complications. At a mean follow-up of 39.6 ± 22.9 months, a mean reduction in body mass index of 25.1 ± 9.2 % and a mean percent excess weight loss of 61.5 ± 19.7 % were associated with a significant improvement in daily insulin requirement and lipid profile. At the last follow-up point, three patients (20 %) were off insulin, five patients (33.3 %) had a glycated hemoglobin ≤7 %, and one patient (6.7 %) had remission of diabetes. Hypertension resolved or improved in 5 of 11 (45.5 %) hypertensive patients. In conclusion, bariatric surgery can result in improvement of glycemic status and comorbid conditions of obese diabetic patients with diminished beta-cell reserve and may facilitate medical management of diabetes.

  12. Long-term complications and side effects of bariatric surgery: a systematic review

    Directory of Open Access Journals (Sweden)

    Alfonso Enrique Martínez-Núñez

    2017-09-01

    Full Text Available Background and objective: Bariatric surgery is a procedure that has gained popularity in the last decades as a treatment for obesity and is generally regarded as safe and effective in the short term, though the complications on the long term have been poorly described. We aim to review studies with long term follow-up reporting complications after a bariatric procedure. Method: A search was conducted on the data bases MEDLINE, EBSCO, Cochrane Library, and Google Scholar, and also scanning through references list in publications. We included cohort studies and clinical trials published from January 1st 2014 to April 15th 2017 with a follow up ≥ 5 years, retention rate above 50%, written in the following languages; English, Spanish, or Portuguese. We conducted qualitative bias assessment and analysis of heterogeneity. Result: Only four studies met the inclusion criteria, all of them were conducted with different bariatric procedures (vertical sleeve gastrectomy, laparoscopic sleeve gastrectomy, laparoscopic adjustable gastric banding, and billiopancreatic diversion with or without duodenal shift. Study design, outcome assessment, and complication definition were highly heterogeneous. The most frequent long term complications were gastroesophageal reflux disease, several nutritional deficits, incisional hernias, and failure to weight loss. Conclusions: There is insufficient evidence to ensure the quantity and severity of long-term complications of bariatric surgery.

  13. Can Flaxseed Help Satisfy Appetite in Women Subjected to Bariatric Surgery?

    Directory of Open Access Journals (Sweden)

    Gigliane Cosendey-Menegati

    2014-05-01

    Full Text Available Background: Bariatric surgery is considered the most effective immediate weight loss method for the morbidly obese, despite widely reported weight regain after a few years. Appetite, satiety and satiation control are essential to maintaining a long-term result post-surgery. Dietary fatty acids composition may be implicated in the satiety. As flaxseed is a food high in linolenic acid, we aimed to verify the influence of flaxseed fat on appetite and satiety of women after bariatric surgery.Material and methods: Six women who underwent bariatric surgery at least 2 years before participated in a single-blind crossover trial that compared the effect of two isocaloric meals on satiety, one containing whole golden flaxseed (high in polyunsaturated fatty acids and fiber (G1 and another withdefatted flaxseed (high in fiber (G2, with one week of washout period. This variable was estimated by visual analogue scales in both meals at baseline (T0, immediately after ingestion (T1 and 60, 120, and 180 minutes after the meal (T60, T120 and T180. Fasting anthropometric, body composition, laboratory tests (glucose and lipids and dietary variables, were evaluated while fasting.Results: The volunteers were obese and had excess central adiposity, even after two years of surgery and still showed habitual fibre intake below recommended levels. G1 had reduced hunger after 180 minutes compared to G2 (P=.046. Other parameters related to appetite and satiety did not differ between groups.Conclusions: Less hunger was observed after 180 minutes in whole golden flaxseed meal compared with the defatted flaxseed meal, indicating that the whole golden flaxseed meal, possibly, supports obesity treatment in the long-term after bariatric surgery by controlling appetite and satiety sensations.

  14. Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery

    Institute of Scientific and Technical Information of China (English)

    Sarah; E; Messiah; Gabriela; Lopez-Mitnik; Deborah; Winegar; Bintu; Sherif; Kristopher; L; Arheart; Kirk; W; Reichard; Marc; P; Michalsky; Steven; E; Lipshultz; Tracie; L; Miller; Alan; S; Livingstone; Nestor; de; la; Cruz-Muoz

    2013-01-01

    AIM:To investigate whether or not bariatric surgeryweight outcomes vary by ethnicity in a large,nationally representative sample of adolescents.METHODS:The Bariatric Outcomes Longitudinal Database was used for analysis and contains data on surgeries performed on adolescents from 2004 to 2010from 423 surgeons at 360 facilities across the United States Adolescents(n=827)between 11 and 19 years old who underwent either gastric bypass or adjustable gastric banding surgery were included in the analysis.Outcome measures included changes in anthropometric measurements[weight(kg)and body mass index]from baseline to 3(n=739),6(n=512),and 12(n=247)mo after surgery.RESULTS:A year after patients underwent either gastric bypass(51%)or adjustable gastric banding(49%)surgery,mean estimated weight loss for all ethnic groups differed by a maximum of only 1.5 kg,being34.3 kg(95%CI:30.0-38.5 kg)for Hispanics,33.8 kg(95%CI:27.3-40.3 kg)for non-Hispanic blacks,and32.8 kg(95%CI:30.9-34.7 kg)for non-Hispanic whites.No overall pairwise group comparisons were significant,indicating that no ethnic group had better weight loss outcomes than did another.CONCLUSION:Bariatric surgery substantially reduces the weight of severely obese adolescents at 1 year post-procedure with little variation by ethnicity and/or gender.These results suggest that bariatric surgery is a safe and reasonable treatment for all severely obese adolescents with the appropriate indications.

  15. Impact of Bariatric Surgery on Healthcare Utilization and Costs among Patients with Diabetes

    Science.gov (United States)

    Bleich, Sara N.; Chang, Hsien-Yen; Lau, Bryan; Steele, Kimberly; Clark, Jeanne M.; Richards, Thomas; Weiner, Jonathan P; Wu, Albert W.; Segal, Jodi B.

    2011-01-01

    Background The effect of bariatric surgery on health care utilization and costs among individuals with type 2 diabetes remains unclear. Objective To examine healthcare utilization and costs in an insured cohort of individuals with type 2 diabetes after bariatric surgery. Research Design Cohort study derived from administrative data from 2002–2008 from 7 Blue Cross Blue Shield Plans. Subjects 7,806 individuals with type 2 diabetes who had bariatric surgery Measures Cost (inpatient, outpatient, pharmacy, other) and utilization (number of inpatient days, outpatient visits, specialist visits). Results Compared to pre-surgical costs, the ratio of hospital costs (excluding the initial surgery), among beneficiaries who had any hospital costs, was higher in years 2 through 6 of the post-surgery period and increased over time [post 1: OR = 0.58 (95% CI: 0.50, 0.67); post 6: OR = 3.43 (95% CI: 2.60, 4.53)]. In comparison to the pre-surgical period, the odds of having any healthcare costs was lower in the post-surgery period and remained relatively flat over time. Among those with hospitalizations, the adjusted ratio of inpatient days was higher after surgery [post 1: OR = 1.05 (95% CI: 0.94, 1.16); post 6: OR = 2.77 (95% CI: 1.57, 4.90)]. Among those with primary care visits, the adjusted odds ratio was lower after surgery [post 1: OR = 0.80 (95% CI: 0.78, 0.82); post 6: OR = 0.66 (95% CI: 0.57, 0.76)]. Conclusion In the six years following surgery, individuals with type 2 diabetes did not have lower healthcare costs than before surgery. PMID:22167064

  16. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies.

    Science.gov (United States)

    Tack, Jan; Deloose, Eveline

    2014-08-01

    Bariatric surgical procedure are increasingly and successfully applied in the treatment of morbid obesity. Nevertheless, these procedures are not devoid of potential long-term complications. Dumping syndrome may occur after procedures involving at least partial gastric resection or bypass, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy. Diagnosis is based on clinical alertness and glucose tolerance testing. Treatment may involve dietary measures, acarbose and somatostatin analogues, or surgical reintervention for refractory cases. Gastro-esophageal reflux disease (GERD) can be aggravated by vertical banded gastroplasty and sleeve gastrectomy procedures, but pre-existing GERD may improve after RYGB and with adjustable gastric banding. Nutrient deficiencies constitute the most important long-term complications of bariatric interventions, as they may lead to haematological, metabolic and especially neurological disorders which are not always reversible. Malabsorptive procedures, poor postoperative nutrient intake, recurrent vomiting and poor compliance with vitamin supplement intake and regular follow-up are important risk factors. Preoperative nutritional assessment and rigourous postoperative follow-up plan with administration of multi-vitamin supplements and assessment of serum levels is recommended in all patients.

  17. [Evolution of type 2 diabetes and carbohydrate intolerance following bariatric surgery in a Mexican mestizo population].

    Science.gov (United States)

    Ramírez-Avilés, Eva; Espinosa-González, Omar; Amado-Galván, Mónica; Maydón-González, Hernán; Sepúlveda-Guerrero, Elisa; Zerrweck-López, Carlos

    Bariatric surgery continues to be the best treatment for weight loss and control of obesity related comorbidities. Gastric bypass and sleeve gastrectomy have demonstrated to be the most effective surgeries, but this has not been established in a Mexican (non-American) population. To analyse the improvement in type 2 diabetes mellitus and carbohydrate intolerance in obese patients after bariatric surgery. A retrospective analysis was performed on the data collected prospectively between 2013 and 2015 on every obese patient with diabetes and carbohydrate intolerance submitted for bariatric surgery. Analysis was performed at baseline, and at 1, 3, 6, 9 and 12 months, and included metabolic, clinical, lipid, and anthropometrical parameters. A peri-operative and morbidity and mortality analysis was also performed. Remission rates for patients with diabetes were also established. The analysis included 73 patients, 46 with diabetes and 27 with carbohydrate intolerance. Sixty-two patients were female with a mean age of 42 years. Baseline glucose and glycosylated haemoglobin were 123±34mg/dl and 6.8±1.6%, and at 12 months they were 90.1±8mg/dl and 5.4±0.3%, respectively. Diabetes remission was observed in 68.7% of patients, including 9.3% with partial remission and 21.8% with an improvement. There was also a significant improvement in all metabolic and non-metabolic parameters. Bariatric surgery safely improves the metabolic status of patients with diabetes mellitus or carbohydrate intolerance during the first year, inducing high rates of complete remission. It has also shown a significant improvement on blood pressure, lipid, and anthropometric parameters during the first year of follow-up. Copyright © 2017 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  18. Ménage-à-trois of bariatric surgery, bile acids and the gutmicrobiome

    Institute of Scientific and Technical Information of China (English)

    Rajendra Raghow

    2015-01-01

    Bariatric surgeries have emerged as highly effectivetreatments for obesity associated type-2 diabetesmellitus. Evidently, the desired therapeutic endpointssuch as rates of weight loss, lower levels of glycatedhemoglobin and remission of diabetes are achievedmore rapidly and last longer following bariatric surgery,as opposed to drug therapies alone. In light of thesefindings, it has been suspected that in addition tocausing weight loss dependent glucose intolerance,bariatric surgery induces other physiological changesthat contribute to the alleviation of diabetes. However,the putative post-surgical neuro-hormonal pathwaysthat underpin the therapeutic benefits of bariatricsurgery remain undefined. In a recent report, Ryan andcolleagues shed new light on the potential mechanismsthat determine the salutary effects of bariatric surgeryin mice. The authors demonstrated that the improvedglucose tolerance and weight loss in mice after verticalsleeve gastrectomy (VSG) surgery were likely to becaused by post-surgical changes in circulating bileacids and farnesoid-X receptor (FXR) signaling, both ofwhich were also mechanistically linked to changes inthe microbial ecology of the gut. The authors arrivedat this conclusion from a comparison of genome-wide,metabolic consequences of VSG surgery in obese wildtype (WT) and FXR knockout mice. Gene expressionin the distal small intestines of WT and FXR knockoutmice revealed that the pathways regulating bile acidcomposition, nutrient metabolism and anti-oxidantdefense were differentially altered by VSG surgeryin WT and FXR-/- mice. Based on these data Ryanet al , hypothesized that bile acid homeostasis andFXR signaling were mechanistically linked to the gutmicrobiota that played a role in modulating post-surgicalchanges in total body mass and glucose tolerance.The authors' data provide a plausible explanation forputative weight loss-independent benefits of bariatricsurgery and its relationship with metabolism of bileacids.

  19. Diagnosis and treatment of atypical presentations of hiatal hernia following bariatric surgery.

    Science.gov (United States)

    Flanagin, Brody A; Mitchell, Myrosia T; Thistlethwaite, William A; Alverdy, John C

    2010-03-01

    Bariatric surgery dramatically alters the normal stomach anatomy resulting in a significant incidence of hiatal hernia and gastroesophageal reflux disease. Although the majority of patients remain asymptomatic, many complain of severe heartburn refractory to medical management and additional highly atypical symptoms. Here, we describe the diagnosis and treatment regarding four cases of symptomatic hiatal hernia following bariatric surgery presenting with atypical symptoms in the University Hospital, USA. Four patients presented following laparoscopic Roux-en-Y gastric bypass or duodenal switch/pancreaticobiliary bypass (DS) with disabling and intractable midepigastric abdominal pain characterized as severe and radiating to the jaw, left shoulder, and midscapular area. The pain in all cases was described as paroxysmal and not necessarily associated with eating. All four patients also experienced nausea, vomiting, and failure to thrive at various intervals following laparoscopic bariatric surgery. Routine workup failed to produce any clear mechanical cause of these symptoms. However, complimentary use of multidetector CT and upper gastrointestinal contrast studies eventually revealed the diagnosis of hiatal hernia. Exploration identified the presence of a type I hiatal hernia in all four patients, with the stomach staple lines densely adherent to the diaphragm and parietal peritoneum. Operative intervention led to immediate and complete resolution of symptoms. The presence of a hiatal hernia following bariatric surgery can present with highly atypical symptoms that do not resolve without operative intervention. Recognition of this problem should lead to the consideration of surgery in cases where patients are dependent on artificial nutritional support and whose symptoms are poorly controlled with medication alone.

  20. Anastomotic leaks after bariatric surgery: it is the host response that matters.

    Science.gov (United States)

    Al-Sabah, Salman; Ladouceur, Martin; Christou, Nicolas

    2008-01-01

    Anastomotic leaks after bariatric surgery can lead to severe complications and adverse outcomes. We tested the hypothesis that not all patients with an anastomotic leak after bariatric surgery present with clinical symptoms and that their outcome is dependent on the aggressiveness of the host inflammatory response. This was a retrospective analysis of prospectively collected clinical data from 2384 bariatric surgeries from 1983 to 2006. All anastomotic leaks were identified from the database, and the vital signs, hematologic and biochemical data, mode of diagnosis, treatment, and outcome were recorded and analyzed. We identified 55 anastomotic leaks (2.3%) at a median of 4 days (range 1-26) after surgery. In 37 patients (67.3%), the leaks were identified at a median of 5 days (range 1-26) postoperatively because of clinical signs and symptoms of a systemic inflammatory response (SIRS leaks). In contrast, in 18 patients (32.7%), the leaks were identified at a median of 1.5 days (range 1-16) postoperatively only after routine contrast studies (non-SIRS leaks). Treatment included antibiotics and open drainage in 41.8%, laparoscopic drainage in 21.8%, computed tomography-guided drainage in 12.7%, conservative treatment in 14.5%, and other in 9.2%. All 6 deaths (4 men and 2 women, 10.9%) occurred in the SIRS group. Using logistic regression analysis, temperature (inflammatory response) and body mass index were independent predictors of mortality. The results of our study have shown that one third of patients with anastomotic leaks after bariatric surgery present with minimal clinical symptoms (non-SIRS) and are only detected if contrast studies are performed. Such leaks are unlikely to lead to death. Two thirds of patients with anastomotic leaks present with a systemic inflammatory response to the leak. Such leaks require urgent treatment that might not always prevent death.

  1. Nephrolithiasis after bariatric surgery: A review of pathophysiologic mechanisms and procedural risk.

    Science.gov (United States)

    Bhatti, Umer Hasan; Duffy, Andrew J; Roberts, Kurt Eric; Shariff, Amir Hafeez

    2016-12-01

    Obesity alone is a known risk factor for nephrolithiasis, and bariatric surgery has been linked to a higher incidence of post-operative new-onset nephrolithiasis. The mean interval from bariatric surgery to diagnosis of nephrolithiasis, ranges from 1.5 to 3.6 years. The stone risk is greatest for purely malabsorptive procedures, intermediate for Roux-en-Y gastric bypass and lowest for purely restrictive procedures (laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy) where it approaches or is reduced below that of non-operative obese controls. A history of nephrolithiasis and increasing age at the time of surgery are both associated with an increased risk of new stone formation post-operatively. The underlying pathophysiologic changes following bariatric surgery include increased colonic absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation, which predispose to stone formation. The majority of incident stones are medically managed, with some requiring interventions in the form of lithotripsy or ureteroscopy.

  2. Burden of Iron Deficiency Anemia in a Bariatric Surgery Population in the United States.

    Science.gov (United States)

    Knight, Tyler; D'Sylva, Lynell; Moore, Brad; Barish, Charles F

    2015-10-01

    Obesity is a serious condition affecting more than 35% of adults in the United States. In obese individuals for whom other weight control methods have been ineffective, bariatric surgery is a safe and effective method of weight control. An estimated 150,000 to 160,000 bariatric surgeries are performed in the United States yearly. Iron deficiency anemia is common in patients after bariatric surgery, with incidence rates up to 49%, and may be due to malabsorption of nutrients.  To (a) compare the medical resource utilization (MRU)- both medical care and treatment resources-and associated costs in a sample of commercially insured adult bariatric surgery patients with and without iron deficiency anemia (IDA), and (b) describe anti-anemia treatment patterns in those bariatric surgery patients diagnosed with IDA. Using Truven Health MarketScan claims data, bariatric surgery patients were identified by the ICD-9-CM and CPT procedure codes for bariatric surgery and classified by surgery and IDA diagnosis within 2 years of initial surgery. Intravenous (IV) iron treatment was determined by HCPCS codes, prescription oral iron by NDC numbers, and blood transfusions by CPT and ICD-9-CM codes. Clinical, MRU, and economic outcomes for all-cause health services were compared between IDA and non-IDA patients. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression, controlling for demographic and clinical characteristics on outcomes of complications and hospitalization. Of the 24,344 bariatric surgery patients analyzed, 11.6% received an IDA diagnosis 2 years after surgery (average days to diagnosis = 279). Most IDA patients (78.5%) received a test for iron in the post-index period; only 9.1% received IV iron treatment, with iron dextran (3.8%) and iron sucrose (3.4%) being the most common (average days to IV iron treatment = 403 days). Prescription oral iron was found in 4.9% of all IDA patients (average days to oral iron treatment

  3. Differential Effects of Bariatric Surgery Versus Exercise on Excessive Visceral Fat Deposits.

    Science.gov (United States)

    Wu, Fu-Zong; Huang, Yi-Luan; Wu, Carol C; Wang, Yen-Chi; Pan, Hsiang-Ju; Huang, Chin-Kun; Yeh, Lee-Ren; Wu, Ming-Ting

    2016-02-01

    The aim of the present study was to compare differential impacts of bariatric surgery and exercise-induced weight loss on excessive abdominal and cardiac fat deposition.Excessive fat accumulation around the heart may play an important role in the pathogenesis of cardiovascular disease. Recent evidences have suggested that bariatric surgery results in relatively less decrease in epicardial fat compared with abdominal visceral fat and paracardial fat.Sixty-four consecutive overweight or obese subjects were enrolled in the study. Clinical characteristics and metabolic profiles were recorded. The volumes of abdominal visceral adipose tissue (AVAT), abdominal subcutaneous adipose tissue (ASAT), epicardial (EAT), and paracardial adipose tissue (PAT) were measured by computed tomography in the bariatric surgery group (N = 25) and the exercise group (N = 39) at baseline and 3 months after intervention. Subjects in both the surgery and exercise groups showed significant reduction in body mass index (15.97%, 7.47%), AVAT (40.52%, 15.24%), ASAT (31.40, 17.34%), PAT (34.40%, 12.05%), and PAT + EAT (22.31%, 17.72%) (all P PAT, EAT+PAT) (P PAT, was relatively preserved despite weight reduction in both the groups. The physiological impact of persistent EAT deserves further investigation.

  4. Association between binge eating disorder and changes in cognitive functioning following bariatric surgery.

    Science.gov (United States)

    Lavender, Jason M; Alosco, Michael L; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Paul, Robert; Crosby, Ross D; Mitchell, James E; Wonderlich, Stephen A; Gunstad, John

    2014-12-01

    Evidence suggests that both obesity and binge eating disorder (BED) may be associated with deficits in cognitive functioning. The purpose of this study was to examine whether a lifetime history of BED would be associated with changes in several domains of cognitive functioning (attention, executive function, language, and memory) following bariatric surgery. Participants were 68 bariatric surgery patients who completed a computerized battery of cognitive tests within 30 days prior to undergoing surgery and again at a 12-Month postoperative follow-up. Results revealed that on the whole, participants displayed improvements from baseline to follow-up in attention, executive function, and memory, even after controlling for diagnostic history of depression; no changes were observed for language. However, individuals with and without a history of BED did not differ in changes in body mass index or in the degree of improvement in cognitive functioning from baseline to follow-up. Such results suggest that a history of BED does not influence changes in cognitive functioning following bariatric surgery. Future research will be needed to further clarify the role of BED in predicting cognitive function over time.

  5. Pregnancy outcomes and nutritional indices after 3 types of bariatric surgery performed at a single institution.

    Science.gov (United States)

    Mead, Nancy C; Sakkatos, Panagiotis; Sakellaropoulos, George C; Adonakis, George L; Alexandrides, Theodore K; Kalfarentzos, Fotis

    2014-01-01

    Nutritional status during pregnancy and the effects of nutritional deficiencies on pregnancy outcomes after bariatric surgery is an important issue that warrants further study. The objective of this study was to investigate pregnancy outcomes and nutritional indices after restrictive and malabsorptive procedures. We investigated pregnancy outcomes of 113 women who gave birth to 150 children after biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) between June 1994 and December 2011. Biochemical indices and pregnancy outcomes were compared among the different types of surgery and to overall 20-year hospital data, as well as to 56 presurgery pregnancies in 36 women of the same group. Anemia was observed in 24.2% and 15.6% of pregnancies after BPD and RYGB, respectively. Vitamin B12 levels decreased postoperatively in all groups, with no further decrease during pregnancy; however, low levels were observed not only after BPD (11.7%) and RYGB (15.6%), but also after SG (13.3%). Folic acid levels increased. Serum albumin levels decreased in all groups during pregnancy, but hypoproteinemia was seen only after BPD. Neonates after BPD had significantly lower average birth weight without a higher frequency of low birth weight defined aspregnancy outcomes in this sample population after all types of bariatric surgery provided nutritional supplement guidelines are followed. Closer monitoring is required in pregnancies after malabsorptive procedures especially regarding protein nutrition. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  6. Bariatric surgery improves urinary incontinence but not anorectal function in obese women.

    Science.gov (United States)

    Scozzari, Gitana; Rebecchi, Fabrizio; Giaccone, Claudio; Chiaro, Paolo; Mistrangelo, Massimiliano; Morino, Mario

    2013-07-01

    While the association between obesity and urinary incontinence (UI) in women has been clearly documented, the relationship with anal incontinence (AI) is less well defined; moreover, while bariatric surgery has been shown to improve UI, its effect on AI is still unclear. A total of 32 obese women were studied by means of PFDI-20 and PFIQ-7 questionnaires and anorectal manometry before and after bariatric surgery and compared with 71 non-obese women. Obese women showed worse overall questionnaire results (OR 5.18 for PFDI-20 and 2.66 for PFIQ-7). Whereas obese women showed worse results for urinary sub-items and a higher urge UI incidence (43.8 vs 18.3 %, p = 0.013), they did not show worsening in colorecto-anal symptoms. Post-operatively, median PFDI-20 total score did not change (24.2 vs 26.6, p = ns), while there was an improvement in urinary score (14.6 vs 8.3, p flatus incontinence increased from 18.8 to 37.5 % (p = ns). Anorectal manometry did not show significant changes after surgery. Obese women had worse questionnaire results, but while showing a higher incidence of UI, they did not experience anorectal function worsening. After bariatric surgery, there was a slight improvement in PFD symptoms related to UI, but anorectal function did not change significantly and flatus incontinence increased.

  7. The influence of methods of bariatric surgery for treatment of type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Bužga M

    2016-04-01

    Full Text Available Marek Bužga,1 Petra Maresova,2 Adela Seidlerová,1 Pavel Zonča,1 Pavol Holéczy,1 Kamil Kuča2,3 1Research Obesity Center, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 2Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic; 3Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Abstract: The constantly growing incidence of obesity represents a risk of health complications for individuals, and is a growing economic burden for health care systems and society. The aim of this study was to evaluate the efficacy of bariatric surgery, specifically laparoscopic greater curve plication, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass, in patients with type 2 diabetes mellitus. The effect of bariatric surgery on the changes in blood pressure before, and 12 months after, surgery and in pharmacotherapy in the 12 months after surgery was analyzed. For achieving this purpose, 74 patients from the Obesity and Surgery Department of Vitkovice Hospital in Ostrava in the Czech Republic, were monitored. They were operated in 2011 and 2012. The Bonferroni method was used to test hypotheses about the impact of surgery on blood pressure and pharmacotherapy. One year after the surgery, systolic and diastolic blood pressure values decreased, both with no statistically significant difference between surgery types. Improvement was observed in 68% of cases, with 25% of patients discontinuing pharmacotherapy entirely. Keywords: type 2 diabetes mellitus, bariatric surgery, blood pressure, pharmacotherapy

  8. Bariatric surgery outcomes: a single-center study in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Abusnana S

    2015-09-01

    Full Text Available Salah Abusnana,1 Sarah Abdi,1 Brigette Tagure,1 Murtada Elbagir,1 Almantas Maleckas2 1Rashid Center for Diabetes and Research, Ministry of Health, Ajman, United Arab Emirates; 2Kaunas University of Medicine, Kaunas, LithuaniaBackground: Bariatric surgery has become an attractive treatment for severe obesity over the last decade, due to its impacts on weight loss and remission of type 2 diabetes and metabolic syndrome. In the United Arab Emirates, a country where the rate of obesity is dramatically increasing bariatric surgery has gained popularity in recent years; however, published data on its outcomes in the Emirati population are lacking.Methods: We retrospectively reviewed the medical records of 95 patients who underwent bariatric surgery (ie, laparoscopic Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy at the Rashid Center for Diabetes and Research in Ajman, United Arab Emirates. Weight outcomes and metabolic marker data were abstracted at baseline and at 3, 6, and 12 months postoperatively.Results: Laparoscopic RYGB was the main procedure performed by our bariatric unit. All variables demonstrated postoperative improvement. An average excess weight loss of 68% was observed at 12 months. Fat mass was the body component that decreased the most, with an average reduction of 46%. Additionally, lipid profiles were significantly different (P<0.01 at 12 months, with triglyceride levels improving by 27% and low-density lipoprotein levels improving by 21%. Similarly, glycated hemoglobin (HbA1c levels decreased significantly (P<0.001 in patients with type 2 diabetes, with an average reduction of 73%.Conclusion: Our results show that a substantial short-term reduction in weight and significant improvements in metabolic markers followed bariatric surgery in severely obese Emirati patients. Our results are consistent with the outcomes of other internationally published studies. Additional studies are warranted to determine whether

  9. Is Pancreatic Exocrine Insufficiency a cause of Malabsorption in Patients after Bariatric Surgery?

    Directory of Open Access Journals (Sweden)

    Vujasinovic Miroslav

    2016-07-01

    Full Text Available Introduction It is known that afferent and efferent loop syndromes can develop following gastric surgery procedures, which can result in accelerated intestinal transit time as well as colonization by pathogenic bacteria in the upper gastrointestinal tract with inadequate stimulation and poorly synchronized pancreatic enzyme secretion. This condition is known as pancreaticocibal asynchrony and can cause pancreatic exocrine insufficiency. The aim of our study was to determine whether pancreatic exocrine insufficiency is impaired in patients after bariatric surgery. We are presenting the results of a pilot study. Patients and methods Patients were selected from the bariatric surgery outpatient clinic of the Slovenj Gradec General Hospital (Slovenian centre of excellence for bariatric surgery. All patients were Caucasians over 18 years of age. The eligibility criteria for surgery were determined according to European guidelines body mass index ≥40 kg/ m2 or ≥35 kg/m2 in patients with obesity-related comorbidities. All procedures were performed by laparoscopic surgery (as Roux-en-Y or mini-omega loop gastric bypass. All patients received standard supplementation after surgery. Faecal elastase-1 (FE1 measurements were performed using the enzyme-linked immunosorbent assay method. Results Twenty-two consecutive patients were included in the study: 21 (95.5% female and 1 (4.5% male; the mean age was 42.0 ± 9.2 years, with a range of 24 to 57 years. Patients were included in the study one year after bariatric surgery. Weight outcomes Body mass index pre-surgery: 42.5±4.0 (range 34.9-49.1. Body mass index present: 27.4 ± 3.2 (range 23.1-34.6. Pre-surgery weight: 119.5±15.0 kg (range 97-149. Lowest post-surgery weight (present weight: 76.7±9.6 kg (range 63-100. Total weight loss: 42.8±7.3 kg. Pancreatic exocrine insufficiency was present in two patients (9.1%: mild to moderate pancreatic exocrine insufficiency (FE1 191 μg/g in a 39-year-old male

  10. Cirurgia bariátrica: como e por que suplementar Bariatric surgery: how and why to supplement

    Directory of Open Access Journals (Sweden)

    Livia Azevedo Bordalo

    2011-02-01

    resulting from anatomical changes due to surgical techniques nutritional supplementation is usually necessary. The success of oral nutritional supplementation to correct or prevent nutritional deficiencies depends on several factors. Thus, to understand how nutrients can be administered is very important for clinical practice. This review aims to provide help for the best selection of nutrients to ensure an adequate replacement of nutrients in patients who have undergone bariatric surgery.

  11. Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

    Directory of Open Access Journals (Sweden)

    McGrice M

    2015-06-01

    Full Text Available Melanie McGrice, Kathlene Don Paul Nutrition Plus Enterprises, Melbourne, VIC, Australia Abstract: Bariatric surgery aims to provide long-term weight loss and improvement in weight-related comorbidities. Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2–10 years postsurgery. A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments.Keywords: weight, bariatric, surgery

  12. Financial costs and patients' perceptions of medical tourism in bariatric surgery.

    Science.gov (United States)

    Kim, David H; Sheppard, Caroline E; de Gara, Christopher J; Karmali, Shahzeer; Birch, Daniel W

    2016-02-01

    Many Canadians pursue surgical treatment for severe obesity outside of their province or country - so-called "medical tourism." We have managed many complications related to this evolving phenomenon. The costs associated with this care seem substantial but have not been previously quantified. We surveyed Alberta general surgeons and postoperative medical tourists to estimate costs of treating complications related to medical tourism in bariatric surgery and to understand patients' motivations for pursuing medical tourism. Our analysis suggests more than $560 000 was spent treating 59 bariatric medical tourists by 25 surgeons between 2012 and 2013. Responses from medical tourists suggest that they believe their surgeries were successful despite some having postoperative complications and lacking support from medical or surgical teams. We believe that the financial cost of treating complications related to medical tourism in Alberta is substantial and impacts existing limited resources.

  13. Addictive personality and maladaptive eating behaviors in adults seeking bariatric surgery.

    Science.gov (United States)

    Lent, Michelle R; Swencionis, Charles

    2012-01-01

    This study examined the relationship between addictive personality and maladaptive eating behaviors in bariatric surgery candidates. Ninety-seven bariatric surgery candidates completed the Eysenck Personality Questionnaire (EPQ-R) Addiction Scale, the Overeating Questionnaire (OQ), binge-eating questions from the Questionnaire of Eating and Weight Patterns (QEWP-R), and the Eating Attitudes and Behaviors Questionnaire. Participants with Binge Eating Disorder (BED) displayed addictive personality scores comparable to individuals addicted to substances (M=17.5, SD=5.3). Addictive personality was associated with Overeating (r=.45, p<.001), Cravings (r=.31, p=.005), Affective Disturbances (r=.62, p<.001) and Social Isolation (r=.53, p<.001). Addictive personality was associated with maladaptive eating behaviors, suggesting the potential for addictive eating.

  14. Cushing's Syndrome in a Morbidly Obese Patient Undergoing Evaluation before Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Livia Borsoi

    2014-06-01

    Full Text Available Objective: Cushing's syndrome (CS is extremely rare in morbidly obese patients. To date, no occurrences in obese patients with BMI above 60 kg/m2 have been reported in the literature. Case Report: This case report describes a patient who was admitted to the ward of the Clinical Division of Endocrinology and Metabolism of the Medical University of Vienna in preparation for bariatric surgery. The patient was a 49-year-old female who showed morbid obesity (BMI 61.6 kg/m2, hypertension, and substituted hypothyroidism. Preoperative work-up revealed CS due to an adrenal adenoma. Therefore, the patient underwent unilateral adrenalectomy followed by bariatric surgery 6 months later. Conclusion: Since undiagnosed CS might result in severe perioperative complications in a population already at increased risk, this case report underlines the importance of careful endocrine evaluation of morbidly obese patients. After all, even rare endocrine causes should be excluded.

  15. Evaluation of older Adults with obesity for bariatric surgery: Geriatricians' perspective

    Directory of Open Access Journals (Sweden)

    John A. Batsis, MD

    2015-06-01

    Full Text Available The prevalence of obesity in the general population is increasing worldwide, and those surviving are at an increased risk for developing comorbidity and physical limitations. With aging, obesity places this high-risk population at an increased risk for future morbidity, institutionalization, and functional decline. Traditional weight loss programs lead to inconsistent improvements in comorbidity, function, and quality of life. Bariatric surgery may offer a reasonable alternative in selected patients to achieve improvements in these outcomes. We present our approach in assessing the physiologic age of older candidates for bariatric surgery from a geriatrician's perspective that may be useful for general internists, bariatricians, and general surgeons alike. We present how a focus on function and physiological parameters of aging provides more predictive power than that on chronological age alone.

  16. Impact of Spanish-language information sessions on Spanish-speaking patients seeking bariatric surgery.

    Science.gov (United States)

    Martin, Allison N; Marino, Miguel; Killerby, Marie; Rosselli-Risal, Liliana; Isom, Kellene A; Robinson, Malcolm K

    2017-06-01

    Bariatric centers frequently provide preoperative educational programs to inform patients about the risks and benefits of weight loss surgery. However, most programs are conducted in English, which may create barriers to effective treatment and access to care for non-English speaking populations. To address this concern, we instituted a comprehensive Spanish-language education program consisting of preoperative information and group nutrition classes conducted entirely in, and supported with Spanish-language materials. The primary aim was to examine the effect of this intervention on Spanish-speaking patients' decision to undergo surgery in a pilot study. University Hospital/Community Health Center, United States. Three cohorts of patients seeking bariatric surgery between January 1, 2011 and March 31, 2012 were identified: 1) primary English speakers attending English-language programs ("English-English"); 2) primary Spanish speakers attending Spanish-language programs ("Spanish-Spanish"); and 3) primary Spanish speakers attending English-speaking programs with the assistance of a Spanish-to-English translator ("Spanish-English"). 26% of the English-English cohort ultimately underwent surgery compared with only 12% of the Spanish-Spanish cohort (P = .009). Compared with the English-English group, time to surgery was 35 days longer for the Spanish-Spanish and 185 days longer for the Spanish-English group (both Pspeaking patients were less likely to undergo bariatric surgery regardless of the language in which educational sessions are provided. For those choosing surgery, providing Spanish-language sessions can shorten time to surgery. A barrier to effective obesity treatment may exist for Spanish speakers, which may be only partially overcome by providing support in Spanish. Copyright © 2017. Published by Elsevier Inc.

  17. Fuzzy obesity index (MAFOI) for obesity evaluation and bariatric surgery indication

    OpenAIRE

    2011-01-01

    Abstract Background The Miyahira-Araujo Fuzzy Obesity Index (MAFOI) for being used as an alternative in bariatric surgery indication (BSI) is validated in this paper. The search for a more accurate method to evaluate obesity and to indicate a better treatment is important in the world health context. Body mass index (BMI) is considered the main criteria for obesity treatment and BSI. Nevertheless, the fat excess related to the percentage of Body Fat (%BF) is actually the principal harmful fac...

  18. Could the mechanisms of bariatric surgery hold the key for novel therapies?

    DEFF Research Database (Denmark)

    Tam, C S; Berthoud, H-R; Bueter, M;

    2011-01-01

    Bariatric surgery is the most effective method for promoting dramatic and durable weight loss in morbidly obese subjects. Furthermore, type 2 diabetes is resolved in over 80% of patients. The mechanisms behind the amelioration in metabolic abnormalities are largely unknown but may be due to chang...... of obesity and diabetes. Promising data on energy metabolism, gastrointestinal physiology, hedonic response and food intake were reviewed and discussed....

  19. Home parenteral nutrition (HPN) in patients with post-bariatric surgery complications

    DEFF Research Database (Denmark)

    Van Gossum, A; Pironi, L; Chambrier, C

    2017-01-01

    support. The aim of this retrospective observational study was to determine the indications and outcomes for patients on Home parenteral nutrition (HPN) due to post-bariatric surgery complications. METHODS: A specific questionnaire was designed by the ESPEN HAN/CIF working group and submitted to HPN...... is a major late complication. Rates of re-hospitalization and CVC infection were high. HPN may be a "bridge therapy" before surgical revision after BS. The high mortality rate reflects the complexity of these cases....

  20. Cost of bariatric surgery and factors associated with increased cost: an analysis of national inpatient sample.

    Science.gov (United States)

    Khorgami, Zhamak; Aminian, Ali; Shoar, Saeed; Andalib, Amin; Saber, Alan A; Schauer, Philip R; Brethauer, Stacy A; Sclabas, Guido M

    2017-08-01

    In the current healthcare environment, bariatric surgery centers need to be cost-effective while maintaining quality. The aim of this study was to evaluate national cost of bariatric surgery to identify the factors associated with a higher cost. A retrospective analysis of 2012-2013 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS). We included all patients with a diagnosis of morbid obesity (ICD9 278.01) and a Diagnosis Related Group code related to procedures for obesity, who underwent Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB) as their primary procedure. We converted "hospital charges" to "cost," using hospital specific cost-to-charge ratio. Inflation was adjusted using the annual consumer price index. Increased cost was defined as the top 20th percentile of the expenditure and its associated factors were analyzed using the logistic regression multivariate analysis. A total of 45,219 patients (20,966 RYGBs, 22,380 SGs, and 1,873 AGBs) were included. The median (interquartile range) calculated costs for RYGB, SG, and AGB were $12,543 ($9,970-$15,857), $10,531 ($8,248-$13,527), and $9,219 ($7,545-$12,106), respectively (P<.001). Robotic-assisted procedures had the highest impact on the cost (odds ratio 3.6, 95% confidence interval 3.2-4). Hospital cost of RYGB and SG increased linearly with the length of hospital stay and almost doubled after 7 days. Furthermore, multivariate analysis showed that certain co-morbidities and concurrent procedures were associated with an increased cost. Factors contributing to the cost variation of bariatric procedures include co-morbidities, robotic platform, complexity of surgery, and hospital length of stay. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  1. ANALYSIS OF FOOD TOLERANCE IN PATIENTS SUBMITTED TO BARIATRIC SURGERY USING THE QUESTIONNAIRE QUALITY OF ALIMENTATION

    Science.gov (United States)

    STUMPF, Matheo Augusto Morandi; RODRIGUES, Marcos Ricardo da Silva; KLUTHCOVSKY, Ana Claudia Garabeli Cavalli; TRAVALINI, Fabiana; MILLÉO, Fábio Quirillo

    2015-01-01

    Background : Due to the increased prevalence of obesity in many countries, the number of bariatric surgeries is increasing. They are considered the most effective treatment for obesity. In the postoperative there may be difficulties with the quality of alimentation, tolerance to various types of food, as well as vomiting and regurgitation. Few surveys are available to assess these difficulties in the postoperative. Aim : To perform a systematic literature review about food tolerance in patients undergoing bariatric surgery using the questionnaire "Quality of Alimentation", and compare the results between different techniques. Method : A descriptive-exploratory study where the portals Medline and Scielo were used. The following headings were used in english, spanish and portuguese: quality of alimentation, bariatric surgery and food tolerance. A total of 88 references were found, 14 used the questionnaire "Quality of Alimentation" and were selected. Results : In total, 2745 patients were interviewed of which 371 underwent to gastric banding, 1006 to sleeve gastrectomy, 1113 to Roux-en-Y gastric bypass, 14 to biliopancreatic diversion associated with duodenal switch, 83 were non-operated obese, and 158 non-obese patients. The questionnaire showed good acceptability. The biliopancreatic diversion with duodenal switch had the best food tolerance in the postoperative when compared to other techniques, but it was evaluated in a single article with a small sample. The longer the time after the operation, the better is the food tolerance. Comparing the sleeve gastrectomy and the Roux-en-Y gastric bypass, there are still controversial results in the literature. The gastric banding had the worst score of food tolerance among all the techniques evaluated. Conclusion: The questionnaire is easy and fast to assess the food tolerance in patients after bariatric surgery. Biliopancreatic diversion with duodenal switch had the best food tolerance in the postoperative when compared

  2. Predictive Factors of Type 2 Diabetes Mellitus Remission Following Bariatric Surgery: a Meta-analysis

    OpenAIRE

    Wang, Guo-Feng; Yan, Yong-Xin; Xu, Ning; Yin, Dong; Hui, Yuan; Zhang, Ji-Ping; Han, Guan-Jun; MA, Ning; Wu, Yan; Xu, Jing-Zi; YANG, Tao

    2014-01-01

    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. Methods The Cochrane Library, PubMed, MEDLINE, Embase, and CINAHL databases were searched. All human studies published in English between 1 January 1992 and 1 September 2013 reporting on the parameters of int...

  3. Effects of Bariatric Surgery on Adipokine-Induced Inflammation and Insulin Resistance

    Directory of Open Access Journals (Sweden)

    Zeynep eGoktas

    2013-06-01

    Full Text Available Over a third of the US population is obese and at high risk for developing type 2 diabetes, insulin resistance and other metabolic disorders. Obesity is considered a chronic low grade inflammatory condition that is primarily attributed to expansion and inflammation of adipose tissues. Indeed, adipocytes produce and secrete numerous proinflammatory and anti-inflammatory cytokines known as adipokines. When the balance of these adipokines is shifted towards higher production of proinflammatory factors, local inflammation within adipose tissues and subsequently systemic inflammation occur. These adipokines including leptin, visfatin, resistin, apelin, vaspin, and retinol binding protein-4 can regulate inflammatory responses and contribute to the pathogenesis of diabetes. These effects are mediated by key inflammatory signaling molecules including activated serine kinases such as c-Jun N-terminal kinase (JNK and serine kinases inhibitor κB kinase (IKK and insulin signaling molecules including insulin receptor substrates, protein kinase B (PKB, also known as Akt, and nuclear factor kappa B (NF-kB. Bariatric surgery can decrease body weight and improve insulin resistance in morbidly obese subjects. However, despite reports suggesting reduced inflammation and weight-independent effects of bariatric surgery on glucose metabolism, mechanisms behind such improvements are not yet well understood. This review article focuses on some of these novel adipokines and discusses their changes after bariatric surgery and their relationship to insulin resistance, fat mass, inflammation, and glucose homeostasis.

  4. The Relationship Between Length of Stay and Readmissions in Bariatric Surgery Patients

    Science.gov (United States)

    Lois, Alex W.; Frelich, Matthew J.; Sahr, Natasha A.; Hohmann, Samuel F.; Wang, Tao; Gould, Jon C.

    2015-01-01

    Background Hospital readmissions are a quality indicator in bariatric surgery. In recent years, length of stay following bariatric surgery has trended down significantly. We hypothesized that a shorter postoperative hospitalization does not increase the likelihood of readmission. Methods The University HealthSystem Consortium (UHC) is an alliance of academic medical centers and affiliated hospitals. The UHC’s clinical database contains information on inpatient stay and returns (readmissions) up to 30 days post-discharge. A multicenter analysis of outcomes was performed using data from the January 2009 to December 2013 for patients 18 years and older. Patients were identified by bariatric procedure ICD-9 codes and restricted by diagnosis codes for morbid obesity. Results A total of 95,294 patients met inclusion criteria. The mean patient age was 45.4 (±0.11) years and 73,941 (77.6%) subjects were female. There were 5,423 (5.7%) readmissions within the study period. Patients with hospitalizations of 3 days and more than 3 days were twice and four times as likely to be readmitted than those with hospitalizations of one day, respectively (pbariatric surgery. Early discharge does not appear to be associated with increased readmission rates. PMID:26032831

  5. A CONTROLLED METABOLIC DIET REDUCES CALCIUM OXALATE SUPERSATURATION BUT NOT OXALATE EXCRETION AFTER BARIATRIC SURGERY

    Science.gov (United States)

    Pang, Ran; Linnes, Michael; O’Connor, Helen M.; Li, Xujian; Bergstralh, Eric; Lieske, John C.

    2012-01-01

    Objective To identify the effect of controlled metabolic diet on reducing urinary calcium oxalate supersaturation in subjects with hyperoxaluric nephrolithiasis after potentially malabsorptive forms of bariatric surgery. Materials and Methods Subjects with a history of CaOx kidney stones and mild hyperoxaluria after bariatric surgery (n=9) collected baseline 24-hour urine samples while on a free choice diet. They were then placed on a controlled diet low in oxalate (70 – 80 mg/day), normal in calcium (1000 mg/day), and moderate in protein prior to 2 final 24-hour urine collections. Results Overall urinary CaOx supersaturation fell from 1.97 ± 0.49 delta Gibbs (DG) on the free choice diet to 1.13 ± 0.75 DG on the controlled diet (P0.05), contributing to the significant CaOx supersaturation change. Conclusions A controlled metabolic diet normal in calcium, moderate in protein and reduced in oxalate can positively impact urinary CaOx supersaturation after bariatric surgery. However, this diet did not appear to decrease urinary oxalate excretion. Therefore, restriction of dietary oxalate alone may not be enough to reduce urinary oxalate excretion to normal levels in this group of known enteric hyperoxaluric patients. Additional strategies may be necessary, such as use of oral calcium supplements as oxalate binders and a lower fat diet. PMID:22554593

  6. Controlled metabolic diet reduces calcium oxalate supersaturation but not oxalate excretion after bariatric surgery.

    Science.gov (United States)

    Pang, Ran; Linnes, Michael P; O'Connor, Helen M; Li, Xujian; Bergstralh, Eric; Lieske, John C

    2012-08-01

    To identify the effect of a controlled metabolic diet on reducing urinary calcium oxalate (CaOx) supersaturation in subjects with hyperoxaluric nephrolithiasis after potentially malabsorptive forms of bariatric surgery. Subjects with a history of CaOx kidney stones and mild hyperoxaluria after bariatric surgery (n = 9) collected baseline 24-hour urine samples while consuming a free choice diet. They were then instructed to consume a controlled diet low in oxalate (70-80 mg/d), normal in calcium (1000 mg/d), and moderate in protein before 2 final 24-hour urine collections. Overall, the urinary CaOx supersaturation decreased from 1.97 ± 0.49 delta Gibbs (DG) with the free choice diet to 1.13 ± 0.75 DG with the controlled diet (P .05), contributing to the significant CaOx supersaturation change. A controlled metabolic diet normal in calcium, moderate in protein, and reduced in oxalate can positively affect urinary CaOx supersaturation after bariatric surgery. However, this diet did not appear to decrease urinary oxalate excretion. Therefore, restriction of dietary oxalate alone might not be enough to reduce urinary oxalate excretion to normal levels in this group of patients with known enteric hyperoxaluria. Additional strategies could be necessary, such as the use of oral calcium supplements as oxalate binders and a lower fat diet. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. The Impact of Impulsivity on Weight Loss Four Years after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Kathrin Schag

    2016-11-01

    Full Text Available Bariatric surgery has serious implications on metabolic health. The reasons for a failure of bariatric surgery, i.e., limited weight loss, are multifactorial and include psychological factors. We established a theoretical model of how impulsivity is related to weight loss outcome. We propose that depressive symptoms act as a mediator between impulsivity and pathological eating behavior, and that pathological eating behavior has a direct impact on weight loss outcome. We calculated excessive weight loss (%EWL and assessed self-reported impulsivity (using the Baratt Impulsiveness Scale (BIS-15 total score, depressive symptoms (the Patient Health Questionnaire (PHQ-9 score, and pathological eating behavior (the Eating Disorder Inventory 2 (EDI-2 total score in 65 patients four years after laparoscopic sleeve gastrectomy. Regression and mediation analyses were computed to validate the theoretical model. The BIS-15, PHQ-9, and EDI-2 have medium to high correlations between each other, and EDI-2 correlated with %EWL. The mediation analysis yielded that the PHQ-9 represents a significant mediator between BIS-15 and EDI-2. The regression model between EDI-2 and %EWL was also significant. These results support our theoretical model, i.e., suggest that impulsivity has an indirect impact on weight loss outcome after bariatric surgery, mediated by depression and transferred through pathological eating behavior. Thus, the underlying psychological factors should be addressed in post-operative care to optimize weight loss outcome.

  8. Metabolic Mechanisms in Obesity and Type 2 Diabetes: Insights from Bariatric/Metabolic Surgery

    Directory of Open Access Journals (Sweden)

    Adriana Florinela Cătoi

    2015-11-01

    Full Text Available Obesity and the related diabetes epidemics represent a real concern worldwide. Bariatric/metabolic surgery emerged in last years as a valuable therapeutic option for obesity and related diseases, including type 2 diabetes mellitus (T2DM. The complicated network of mechanisms involved in obesity and T2DM have not completely defined yet. There is still a debate on which would be the first metabolic defect leading to metabolic deterioration: insulin resistance or hyperinsulinemia? Insight into the metabolic effects of bariatric/metabolic surgery has revealed that, beyond weight loss and food restriction, other mechanisms can be activated by the rearrangements of the gastrointestinal tract, such as the incretinic/anti-incretinic system, changes in bile acid composition and flow, and modifications of gut microbiota; all of them possibly involved in the remission of T2DM. The complete elucidation of these mechanisms will lead to a better understanding of the pathogenesis of this disease. Our aim was to review some of the metabolic mechanisms involved in the development of T2DM in obese patients as well as in the remission of this condition in patients submitted to bariatric/metabolic surgery.

  9. Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?

    Science.gov (United States)

    Miras, A D; le Roux, C W

    2014-03-01

    The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal-jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A 'medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals.

  10. Clinical Practice Update: Expert Review on Endoscopic Bariatric Therapies.

    Science.gov (United States)

    Abu Dayyeh, Barham K; Edmundowicz, Steven; Thompson, Chris C

    2017-03-01

    Multiple endoscopic bariatric therapies (EBTs) currently are being evaluated or are in clinical use in the United States. EBTs are well positioned to fill an important gap in the management of obesity and metabolic disease. The purpose of this expert review is to update gastroenterologists on these therapies and provide practice advice on how to incorporate them into clinical practice. The evidence reviewed in this work is a distillation of comprehensive search of several English-language databases and a manual review of relevant publications (including systematic reviews and meeting abstracts). Best Practice Advice 1: EBTs should be considered in patients with obesity who have been unsuccessful in losing or maintaining weight loss with lifestyle interventions. Best Practice Advice 2: EBTs can be used in patients with severe obesity as a bridge to traditional bariatric surgery. They also can be used as a bridge to allow unrelated interventions that are unable to be performed because of weight limits (ie, orthopedic surgery, organ transplantation). Best Practice Advice 3: Clinicians should use EBTs as part of a structured weight loss program that includes dietary intervention, exercise therapy, and behavior modification, in both the active weight loss phase and the long-term maintenance phase. Best Practice Advice 4: Clinicians should screen all potential EBT candidates with a comprehensive evaluation for medical conditions, comorbidities, and psychosocial or behavioral patterns that contribute to their condition before enrolling patients in a weight loss program that includes EBTs. Best Practice Advice 5: Clinicians incorporating EBTs into their clinical practice should follow up patients prospectively to capture the impact of the EBT program on weight and weight-related comorbidities, and all related adverse outcomes. Poor responders should be identified and offered a detailed evaluation and alternative therapy. Best Practice Advice 6: Clinicians embarking on

  11. Current challenges in providing bariatric surgery in France: A nationwide study.

    Science.gov (United States)

    Czernichow, Sébastien; Paita, Michel; Nocca, David; Msika, Simon; Basdevant, Arnaud; Millat, Bertrand; Fagot-Campagna, Anne

    2016-12-01

    Bariatric surgery is a well-accepted procedure for severe and massive obesity management. We aimed to determine trends, geographical variations, and factors influencing bariatric surgery and the choice of procedure in France in a large observational study.The Health Insurance Fund for Salaried Workers (Caisse National Assurance Maladie Travailleurs Salariés) covers about 86% of the French population. The Système National d'Information Inter-régimes de l'Assurance Maladie database contains individualized and anonymized patient data on all reimbursements for healthcare expenditure. All types of primary bariatric procedures (Roux-en-Y gastric bypass [RYGB] or omega loop, adjustable gastric banding [AGB], or longitudinal sleeve gastrectomy [LSG]) performed during 2011 to 2013 were systematically recorded. Surgical techniques performed by region of residence and age-range relative risks with 95% confidence intervals of undergoing LSG or RYGB versus AGB were computed.In 2013, LSG was performed more frequently than RYGB and AGB (57% vs 31% and 13%, respectively). A total of 41,648 patients underwent a bariatric procedure; they were predominantly female (82%) with a mean (±standard deviation) age of 40 (±12) years and a body mass index ≥40 kg/m for 68% of them. A total of 114 procedures were performed in patients younger than 18 years and 2381 procedures were performed in patients aged 60 years and older. Beneficiaries of the French universal health insurance coverage for low-income patients were more likely to undergo surgery than the general population. Large nationwide variations were observed in the type choice of bariatric surgical procedures. Significant positive predictors for undergoing RYGB compared to those for undergoing AGB were as follows: referral to a center performing a large number of surgeries or to a public hospital, older age, female gender, body mass index ≥50 kg/m, and treatment for obstructive sleep apnea syndrome, diabetes, or

  12. Bariatric surgery patients’ perceptions of weight-related stigma in healthcare settings impair post-surgery dietary adherence

    Directory of Open Access Journals (Sweden)

    Danielle M. Raves

    2016-10-01

    Full Text Available Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients’ experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery.Objectives: (1 Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2 understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3 explore provider and patient perspectives on adherence and stigma in healthcare settings. Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis.Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance.Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias

  13. Actual Situation of Thromboembolic Prophylaxis in Obesity Surgery: Data of Quality Assurance in Bariatric Surgery in Germany

    Directory of Open Access Journals (Sweden)

    Christine Stroh

    2012-01-01

    Full Text Available Background. Evidence-based data on optimal approach for prophylaxis of deep venous thrombosis (VTE and pulmonary embolism (PE in bariatric operations is discussed. Using antithrombotic prophylaxis weight adjusted the risk of VTE and its complications have to be balanced with the increased bleeding risk. Methods. Since 2005 the current situation for bariatric surgery has been examined by quality assurance study in Germany. As a prospective multicenter observational study, data on the type, regimen, and time course of VTE prophylaxis were documented. The incidences of clinically diagnosed VTE or PE were derived during the in-hospital course and follow up. Results. Overall, 11,835 bariatric procedures were performed between January 2005 and December 2010. Most performed procedures were 2730 gastric banding (GB; 4901 Roux-en-Y-gastric bypass (RYGBP procedures, and 3026 sleeve gastrectomies (SG. Study collective includes 72.5% (mean BMI 48.1 kg/m2 female and 27.5% (mean BMI 50.5 kg/m2 male patients. Incidence of VTE was 0.06% and of PE 0.08%. Conclusion. VTE prophylaxis regimen depends on BMI and the type of procedure. Despite the low incidence of VTE and PE there is a lack of evidence. Therefore, prospective randomized studies are necessary to determine the optimal VTE prophylaxis for bariatric surgical patients.

  14. Family history of Alzheimer’s disease limits improvement in cognitive function after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Michael L Alosco

    2014-06-01

    Full Text Available Background/Objective: Bariatric surgery can reverse cognitive impairments associated with obesity. However, such benefits may be attenuated in individuals with a predisposing risk for cognitive impairment such as family history of Alzheimer’s disease. Methods: In all, 94 bariatric surgery participants completed a computerized cognitive test battery before and 12 weeks after surgery. Family history of Alzheimer’s disease was obtained through self-report. Results: In the overall sample, cognitive function improved in memory and attention/executive function 12 weeks post-surgery. Repeated measures showed similar rates of improvements in attention/executive function between patients with and without a family history of Alzheimer’s disease. In contrast, only individuals without a family history of Alzheimer’s disease exhibited post-operative improvements in memory. A family history of Alzheimer’s disease was associated with greater post-surgery rates of cognitive impairment. Conclusions: Family history of Alzheimer’s disease may limit post-surgery cognitive benefits. Future studies should examine whether weight loss can modify the course of cognitive decline in patients at-risk for Alzheimer’s disease.

  15. Income status and approval for bariatric surgery in a publicly funded regional obesity program.

    Science.gov (United States)

    Halloran, Kieran; Padwal, Raj S; Johnson-Stoklossa, Carlene; Sharma, Arya M; Birch, Dan W

    2011-03-01

    Bariatric surgery has emerged as an effective and safe treatment for severe obesity and utilization rates have increased dramatically. In private health care settings, low socioeconomic status is associated with a reduced likelihood of undergoing a bariatric procedure. Whether this relationship is also present in a universally accessible, publicly funded health care system is not currently known. A retrospective analysis of the Edmonton Weight Wise obesity program clinical registry was conducted. Patients who were unemployed, on long-term disability or receiving social assistance were classified as "low income" status. The remaining patients were categorized as "regular income" status. Multivariable logistic regression analysis was used to examine the association between low income status and approval for surgery within 1 year of program entry. Thirty-three (7%) of 419 patients were ineligible for surgery or excluded because of missing income status data. Of the remaining 386 patients, 72 (19%) were of low income status and 89 (23%) were approved for surgery. Low income patients were older, heavier, and had greater comorbidity. Compared to patients of regular income status, those with low income status were less likely to be approved for surgery (15.3% versus 24.8%; adjusted OR 0.45; 95% CI 0.22 to 0.94). Within a publicly funded and universally accessible regional obesity program, lower income status patients were less likely to be approved for bariatric surgery. Further study is necessary to clarify this apparent disparity and to determine if program modifications are necessary to ensure equity across all socioeconomic strata.

  16. Current status of bariatric surgery in Japan and effectiveness in obesity and diabetes

    OpenAIRE

    2013-01-01

    The rate of obesity in Japan, defined as having a body mass index (BMI) of 25 kg/m2 or greater, is reportedly at 24 %, a lower level of severe obesity than in the EU and US. However, the incidence of obesity-related health problems is reportedly higher among Asians. Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery in Japan and accounted for 54 % of such surgeries in 2011; procedures such as laparoscopic adjustable gastric banding and laparoscopic Roux-e...

  17. Bariatric surgery prior to total joint arthroplasty may not provide dramatic improvements in post-arthroplasty surgical outcomes.

    Science.gov (United States)

    Inacio, Maria C S; Paxton, Elizabeth W; Fisher, David; Li, Robert A; Barber, Thomas C; Singh, Jasvinder A

    2014-07-01

    This study compared the total joint arthroplasty (TJA) surgical outcomes of patients who had bariatric surgery prior to TJA to TJA patients who were candidates but did not have bariatric surgery. Patients were retrospectively grouped into: Group 1 (n = 69), those with bariatric surgery >2 years prior to TJA, Group 2 (n = 102), those with surgery within 2 years of TJA, and Group 3 (n = 11,032), those without bariatric surgery. In Group 1, 2.9% (95% CI 0.0-6.9%) had complications within 1 year compared to 5.9% (95% CI 1.3%-10.4%) in Group 2, and 4.1% (95% CI 3.8%-4.5%) in Group 3. Ninety-day readmission (7.2%, 95% CI 1.1%-13.4%) and revision density (3.4/100 years of observation) was highest in Group 1. Bariatric surgery prior to TJA may not provide dramatic improvements in post-operative TJA surgical outcomes.

  18. Post-operative behavioural management in bariatric surgery: a systematic review and meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Rudolph, A; Hilbert, A

    2013-04-01

    Recent research has provided evidence that bariatric surgery maximizes long-term weight loss in patients with severe obesity. However, a substantial number of patients experience poor weight loss outcome and weight regain over time. Post-operative behavioural management may facilitate long-term weight control in bariatric surgery population. The objective of this systematic review and meta-analysis was to determine the effects of post-operative behavioural management on weight loss following bariatric surgery. Eligible articles were systematically searched in electronic databases. Among the 414 citations, five randomized controlled trials, two prospective and eight retrospective cohort trials analysing behavioural lifestyle interventions and support groups fulfilled the inclusion criteria. The main finding is that behavioural management had a positive effect on weight loss following surgery. In 13 studies, patients receiving behavioural management had greater weight loss than patients receiving usual care or no treatment. A meta-analysis of five randomized controlled trials suggests greater weight loss in patients with behavioural lifestyle interventions compared with control groups. Post-operative behavioural management has the potential to facilitate optimal weight loss following bariatric surgery, but conclusions were limited by the small and heterogeneous samples of studies. A more rigorous empirical evaluation on its clinical significance is warranted to improve effectiveness of bariatric surgery.

  19. Bariatric Surgery Prior to Total Joint Arthroplasty May Not Provide Dramatic Improvements In Post Arthroplasty Surgical Outcomes

    Science.gov (United States)

    Paxton, Elizabeth W.; Fisher, David; Li, Robert A.; Barber, Thomas C.; Singh, Jasvinder A.

    2014-01-01

    This study compared the total joint arthroplasty (TJA) surgical outcomes of patients who had bariatric surgery prior to TJA to TJA patients who were candidates but did not have bariatric surgery. Patients were retrospectively grouped into: Group 1 (n=69), those with bariatric surgery >2 years prior to TJA, Group 2 (n=102), those with surgery within 2 years of TJA, and Group 3 (n=11,032), those without bariatric surgery. In Group 1, 2.9% (95%CI 0.0–6.9%) had complications within 1 year compared to 5.9% (95%CI 1.3–10.4%) in Group 2, and 4.1% (95%CI 3.8–4.5%) in Group 3. 90-day readmission (7.2%, 95%CI 1.1–13.4%) and revision density (3.4/100 years of observation) was highest in Group 1. Bariatric surgery prior to TJA may not provide dramatic improvements in post-operative TJA surgical outcomes. PMID:24674730

  20. Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery

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    Adham do Amaral e Castro

    2014-12-01

    Full Text Available Objective: To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods: We studied three groups of individuals: 1 patients waiting for bariatric surgery (preoperative; 2 individuals who had already undergone the procedure (postoperative; and 3 control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results: We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls. There was a higher prevalence of paresthesias (p=0.0003, clinical tests (p=0.0083 on the preoperative group when compared with controls (p<0.00001. There were lowe levels of paresthesias (p=0.0002 and median nerve area (p=0.04 in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05 in those who performed non-manual work. Conclusion: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers.

  1. Surgical skill and complication rates after bariatric surgery.

    Science.gov (United States)

    Birkmeyer, John D; Finks, Jonathan F; O'Reilly, Amanda; Oerline, Mary; Carlin, Arthur M; Nunn, Andre R; Dimick, Justin; Banerjee, Mousumi; Birkmeyer, Nancy J O

    2013-10-10

    Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes. We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program. Each surgeon submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass. Each videotape was rated in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon. We then assessed relationships between these skill ratings and risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients. Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons. The bottom quartile of surgical skill, as compared with the top quartile, was associated with higher complication rates (14.5% vs. 5.2%, Pbariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department. Although these findings are preliminary, they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon's proficiency.

  2. A Gut Feeling to Cure Diabetes: Potential Mechanisms of Diabetes Remission after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Young Min Cho

    2014-12-01

    Full Text Available A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved β-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.

  3. [Bariatric surgery in 2013: principles, advantages and disadvantages of the available procedures].

    Science.gov (United States)

    Suter, Michel; Giusti, Vittorio

    2013-03-27

    For severe obesity (BMI > 35 kg/m2), bariatric surgery is not only the best, but often the only means of obtaining sufficient and durable weight loss. This article aims to review the available bariatric procedures. Gastric bypass remains the reference when it comes to the risk/benefit ratio. Gastric banding is declining rapidly due to the high prevalence of long-term complications. Primary malabsorptive procedures remain largely unpopular because of their potential nutritional complications. Sleeve gastrectomy, although it is not reversible as it includes a significant gastric resection, increases currently in popularity because of its apparent simplicity and the fact that early results regarding weight loss mimic those obtained with gastric bypass.

  4. Bariatric surgery results: reporting clinical characteristics and adverse outcomes from an integrated healthcare delivery system.

    Science.gov (United States)

    Li, Robert A; Fisher, David P; Dutta, Sanjoy; O'Brien, Rebecca M; Ackerson, Lynn M; Sorel, Michael E; Sidney, Stephen

    2015-01-01

    Limited data have been reported on bariatric surgery within a large, high-volume regional multicenter integrated healthcare delivery system. Review clinical characteristics and short- and intermediate-term outcomes and adverse events from a bariatric surgery program within an integrated healthcare delivery system. Single high-volume, multicenter regional integrated healthcare delivery system. Adult patients who underwent primary bariatric surgery during 2010-2011 were reviewed. Clinical characteristics, outcomes, and weight loss results were extracted from the electronic medical record. A total of 2399 patients were identified within the study period. The 30-day rates of clinical outcomes for Roux-en-Y gastric bypass (RYGB; n = 1313) and sleeve gastrectomy (SG; n = 1018) were 2.9% for readmission, 3.0% for major complications, .8% for reoperation, and 0% for mortality. One-year and 2-year weight loss results were as follows: percent weight loss (%WL) was 31.4 (±SD 8.5) and 34.2±12.0% for SG and 34.1±9.3 and 39.1±11.9 for RYGB; percent excess weight loss (%EBWL) was 64.2±18.0 and 69.8±23.7 for SG and 68.0±19.3 and 77.8±23.7 for RYGB; percent excess body mass index loss (%EBMIL) was 72.9±21.0 and 77.7±22.4 for SG and 76.6±22.1% and 85.6±21.6 for RYGB. Follow-up for each procedure at 1 year was 76% for SG (n = 778) and 80% for RYGB (n = 1052) and at 2 years was 65% for SG (n = 659) and 67% for RYGB (n = 875). A large regional high-volume multicenter bariatric program within an integrated healthcare delivery system can produce excellent short-term results with low rates of short- and intermediate-term adverse outcomes. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  5. Cost-effectiveness of Bariatric Surgery: Increasing the Economic Viability of the Most Effective Treatment for Type II Diabetes Mellitus.

    Science.gov (United States)

    Warren, Jeremy A; Ewing, Joseph A; Hale, Allyson L; Blackhurst, Dawn W; Bour, Eric S; Scott, John D

    2015-08-01

    There has been considerable debate on the cost-effectiveness of bariatric surgery within larger population groups. Despite the recognition that morbid obesity and its comorbidities are best treated surgically, insurance coverage is not universally available. One of the more costly comorbidities of obesity is Type II diabetes mellitus (T2DM). We propose a model that demonstrates the cost-effectiveness of increasing the number of bariatric surgical operations performed on patients with T2DM in the United States. We applied published population cost estimates (2012) for medical care of T2DM to a retrospective cohort of morbidly obese patients in South Carolina. We compared differences in 10-year medical costs between those having bariatric surgery and controls. Resolution of T2DM in the bariatric cohort was assumed to be 40 per cent. Considering only the direct medical costs of T2DM, the 10-year aggregate cost savings compared with a control group is $2.7 million/1000 patients; the total (direct and indirect) cost savings is $5.4 million/1000 patients. When considering resolution of T2DM alone, increasing the number of bariatric operations for a given population leads to a substantial cost savings over a 10-year period. This study adds to the growing body of evidence suggesting that bariatric surgery is a cost-effective means of caring for the obese patient.

  6. A Pilot Study of an Acceptance-Based Behavioral Intervention for Weight Regain After Bariatric Surgery.

    Science.gov (United States)

    Bradley, Lauren E; Forman, Evan M; Kerrigan, Stephanie G; Butryn, Meghan L; Herbert, James D; Sarwer, David B

    2016-10-01

    Tens of thousands of bariatric surgery patients e