Aspects Of Bariatric Surgery Research Articles

Various aspects of bariatric surgery - a review

Introduction and purpose Obesity is a complex, chronic disease that has recently reached epidemic proportions. According to the World Health Organization, the prevalence of this disease tripled since 1975, reaching 13% of the global population in 2016. A body mass index (BMI) > 30 kg/m² is typically the reference point for obesity in adults, and the mortality risk associated with obesity increases by 100% at BMI > 40 kg/ m² compared to individuals with normal body weight. The aim of the article is to present the benefits of bariatric surgery, encompassing not only weight loss but also a range of other advantages for obese patients undergoing the procedure. Materials and methods The literature included in the PubMed databases is searched through the words such as obesity, bariatric surgery. Description of the state of knowledge: The literature review shows the breadth of the issue. Obesity constitutes a public health crisis and a significant risk factor for many diseases, including cardiovascular diseases, diabetes, cancer, and numerous others. Since in most cases, lifestyle optimization and low-calorie diet alone are not sufficient, pharmacological interventions as well as surgical interventions are often necessary. Bariatric surgery remains the most effective treatment option, as it has been demonstrated to not only reduce body weight but also decrease mortality from cardiovascular diseases and extend overall life expectancy. Conclusions The benefits, complications, and selection of the best surgical method for treating obesity are still under investigation. However, research demonstrates the long-term effectiveness of bariatric surgery in weight loss and the remission of comorbidities such as type 2 diabetes, as well as in preventing obesity-related cancers.

Long-term outcomes of bariatric surgery: An eight-year study at a tertiary care hospital in Lebanon

BackgroundObesity management presents a persistent challenge. Bariatric surgery, recognized for its transformative impact on weight loss and comorbidities, demands a thorough examination of its long-term implications. ObjectivesOur goal is to investigate different aspects of bariatric surgery, such as complications, comorbidities, infection rates, the long-term sustainability of weight loss, and factors predicting weight loss over an extended period following the procedure. SettingThis study involves 100 patients who underwent primary bariatric surgery. Methodsa sophisticated Longitudinal Observational Study design. With a Retrospective Component and a Follow-Up Component spanning eight years. ResultsThe study included participants with a mean age of 36.4 years (±12.1) and a pre-surgery BMI of 44.5 kg/m² (±7.5). Excess Weight Loss (%EWL) peaked at 75.09 % by the third year, while Total Weight Loss (%TWL) sustained at 33.41 % after two years. Among individuals with type 2 diabetes, medication discontinuation rates reached 26.3 % at 5 years. Zero leaks, a low incidence of major complications and no incidence of mortality have been noted. In an extended 7-year follow-up, 40 % of patients experienced weight regain. Multivariate analyses identified age and preoperative BMI as negatively associated significant predictors impacting %EWL at three years, with standardized beta coefficients of −0.488 (p = 0.001) and −0.450 (p < 0.001), respectively. Conversely, smoking and Type 2 Diabetes Mellitus exhibited positive associations, with standardized beta coefficients of 0.336 (p = 0.004) and 0.286 (p = 0.063), respectively. ConclusionsBariatric surgery is acknowledged as a safe and efficacy procedure for reducing weight and comorbidities, with a relatively low incidence of major complications.

Communicable and noncommunicable liver disease in HIV

The aim of this study was to highlight the profound changes in the cause in chronic liver disease in HIV-infected individuals. Hepatitis C virus (HCV) has been transformed into a curable viral infection by highly effective treatments. This has resulted in elimination of chronic hepatitis C in HIV-coinfected individuals at least in resource-rich settings. Hepatitis B virus (HBV) has become a chronic infection, which is easily controlled by long-term therapy with HBV polymerase inhibitors. As a result, nonalcoholic steatohepatitis (NASH) has gained clinical importance. The obesity epidemic in the general population has also included people with HIV and weight gain has been associated with some newer antiretroviral drugs, such as HIV integrase inhibitors and tenofovir alafenamide fumarate. Medical treatment for obesity is a focus of intense research efforts, but currently, the only convincing therapeutic option in morbidly obese patients is bariatric surgery, which can also improve liver outcomes. The wider use of this approach has included HIV-infected individuals allowing to assess at least the safety aspects of bariatric surgery in this special population. The shift from communicable to noncommunicable liver disease is changing the clinical practice in HIV-infected individuals. Research activities are focusing more on treatment of NASH and obesity, although a curative therapy for HBV infection would have a great clinical impact.

Rate and Determinants of Excessive Fat-Free Mass Loss After Bariatric Surgery

PurposeFat-free mass (FFM) loss is a concerning aspect of bariatric surgery, but little is known about its time-course and factors related with excessive FFM loss. This study examined (i) the progress of FFM loss up to 3 years post-bariatric surgery and (ii) the prevalence and determinants of excessive FFM loss.Materials and MethodsA total of 3596 patients (20% males, 43.5 ± 11.1 years old, BMI = 44.2 ± 5.5 kg/m2) underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. Bioelectrical impedance analysis was performed preoperatively and 3, 6, 9, 12, 18, 24 and 36 months post-surgery. Changes in body composition were assessed by mixed model analysis. Prevalence of excessive FFM loss (based on three different cutoff values: ≥ 25%, ≥ 30% and ≥ 35% FFM loss/weight loss (= %FFML/WL)) was estimated and its determinants were assessed by linear regression analysis.ResultsHighest rates of FFM loss were found at 3 and 6 months post-surgery, reflecting 57% and 73% of peak FFM loss, respectively. Prevalence of excessive FFM loss ranged from 14 to 46% at 36 months post-surgery, with an older age (β = 0.14, 95%CI = 0.10–0.18, P < .001), being male (β = 3.99, 95%CI = 2.86–5.12, P < .001), higher BMI (β = 0.13, 95%CI = 0.05–0.20, P = .002) and SG (β = 2.56, 95%CI = 1.36–3.76, P < .001) as determinants for a greater %FFML/WL.ConclusionPatients lost most FFM within 3 to 6 months post-surgery. Prevalence of excessive FFM loss was high, emphasizing the need for more vigorous approaches to counteract FFM loss. Furthermore, future studies should assess habitual physical activity and dietary intake shortly after surgery in relation to FFM loss.

Эндокринологические аспекты бариатрической хирургии

Эндокринологические аспекты бариатрической хирургии

Bariatric surgery today: the good, the bad, and the ugly

Background: Metabolic surgery has changed significantly over the last 70 years. While the field has evolved and the long-term data continues to be pub-lished, we are beginning to appreciate the full spectrum of the effects of bariatric surgery in addition to weight loss. Methods: Here we review the literature from the 2015 and 2016 and present our perspective of the good, the bad, and the ugly side of bariatric surgery and how they have contributed to the field over the years. Results: Weight loss and remission of comorbidities are the reasons for success in bariatric surgery. With a plethora of long-term data being published recently, the extent of benefit that bariatric surgery provides is growing. Contrary to the good, complications from surgery and endoscopic bariatric therapies continue to be det-rimental to our patients, but remain the impetus for improvement. Conclusions: We conclude by briefly touching on the physio-logic and psychosocial aspects of bariatric surgery that are driving the future of the field, namely the biochemical changes created by bariatric surgery, predicting the population of patients who will fail their initial intervention, and how revisional surgery has become more commonplace in the long-term.

Metabolic deficiencies after a restrictive bariatric operation

Introduction: Bariatric surgery has resulted in an effective and long term loss of excess weight in morbidly obese patients with a simultaneous improvement of their metabolic profile. Another aspect of bariatric surgery is the malabsorption of vitamins that requires the administration of supplements. Aim: To ascertain the incidence of metabolic deficiencies after a restrictive bariatric operation (gastric sleeve or plication). Materials and methods: Retrospective study of morbidly obese patients that underwent a restrictive bariatric operation in the years 2010-2013. Levels of folic acid, B12, ferritin and serum protein were measured 3,6 and 9 months postoperatively. Patients with preoperative deficiencies in the above were excluded. 108 patients were included in the study. In cases of deficiency, supplements were administered. Results: Out of 108 patients, 20 (19,4 %) presented low folic acid levels, 3 (2,7%) low B12, 12(11%), low ferritin and 6(5,5%) low serum protein levels. The abnormalities presented mostly at 3 months and tended to improve at 6 and 9 months. 1 case proved refractory to folic acid administration, 1 to iron administration and 1 case of B12 deficiency endured because of patient noncompliance to parenteral administration. Conclusions: Restrictive bariatric operations are followed by a drop of consumed calories and fat but also by vitamin deficiencies, especially water soluble, to a degree that requires supplementation. It is pending whether it is because of changes to the anatomy and physiology of the GI tract or because of changes in eating habits. In any case the monitoring and support of a dietician is imperative to ensure a balanced diet and a healthy weight loss.

Other aspects of bariatric surgery: liver steatosis, ferritin and cholesterol metabolism.

Bariatric surgery developed in the late 1970 to treat severe hyperlipidemias in overweight individuals, not necessarily obese. Several techniques have been developed, and the concept has come first of a surgery for morbid obesity, then of a cure for diabetes in morbid obesity. There are other aspects of bariatric surgery that deserve attention, beyond BMI and diabetes, such as hypertension, poor life expectancy, increased prevalence of cancer, congestive heart failure, social inadequacy. The aim of this presentation is to review some recent development in clinical research, in the fields of liver steatosis, ferritin metabolism, and cholesterol metabolism. Liver steatosis, also called fatty liver encompasses a graduation of diseases with different clinical relevance and prognosis. NAFLD correlates with atherosclerosis, insulin resistance and diabetes mellitus. There is now evidence that weight loss, obtained through diet or restrictive surgery, reduces the prevalence (and the severity) of NAFLD. An other issue is represented by serum ferritin concentrations, that are strongly associated with fibrosis, portal and lobular inflammation in NAFLD patients, especially in the presence of obesity. Body iron contributes to excess oxidative stress already at non iron overload concentrations. Moreover, serum ferritin is an important and independent predictor of the development of diabetes. Weight loss is accompanied by reduction of ferritin, more after restrictive than malabsorptive surgery. Metabolic changes are greater after malabsorptive or mixed surgery than after purely restrictive surgery, and this has been ascribed to a greater weight loss. Studies comparing the two kinds of surgery indicate that, for the same amount of weight loss, decrease of cholesterol is greater with the former than with the latter techniques, and this difference is mainly due to a greater reduction of intestinal absorption of cholesterol. In the choice of surgery for the single patient, among other aspects, malabsorptive surgery seems to be more indicated in subjects with hyperlipidemia, especially with high cholesterol levels.

Assessing the Nurses' Knowledge of Bariatric Surgery: A Performance Improvement Project

Background: The rise in obesity in the United States has led to an increase in the number of bariatric procedures performed annually to treat obesity. It has become the only treatment method that provides significant and sustained weight loss in obese patients with resultant improvement in obesity-related comorbidities.1 Objective: The aim of this project was to evaluate the knowledge and attitudes of the nurses regarding aspects of bariatric surgery at a hospital that is a Center for Excellence for bariatric surgery. Methods: A voluntary survey was conducted using SurveyMonkey® to assess the nurses' current knowledge of bariatric surgical procedures and attitudes toward patients undergoing bariatric surgery. Results: The results of the survey showed that 66.7% had no previous experience of caring for bariatric surgical patients, 3.3% did not understand gastric bypass surgery, 6.7% did not understand the sleeve, and 26.7% did not understand the duodenal switch surgery. In addition, 43.3% felt that bariatr...

An Update on Less Invasive and Endoscopic Techniques Mimicking the Effect of Bariatric Surgery

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.

Band and Port-Related Morbidity After Bariatric Surgery: An Underestimated Problem

To evaluate the magnitude of the morbidity related to the system used for gastric banding Methods Between January 1997 and December 2004, 286 consecutive patients underwent laparoscopic gastric banding (LAGB) in one center. We used 4 models of LapBand 9.75, 10, 11 and Vanguard with pars flacida route. Recalibration of band was performed in our consultation unit without systematic radiologic control. We considered four kinds of complication: port displacement, port rupture, band rupture and others problems. The mean follow up was 3.3+/-2.8 years with a median 2.9 years. Complications occurred within a mean time of 2.2+/-1.9 years. For the models vanguard and size 11, there were no rupture and 15 (27.7%) displacements whereas for size 9.75 and 10 there were 39 ruptures (14.7%) and 15 (5.6%) displacements. Types of complications were related to the bands used i.e. more port displacements for the models vanguard and size 11 and more band and port ruptures for the models size 9.75 and 10. But when we considered the respective follow up according to the type of band these differences were no longer significant. Moreover rupture rate was significantly high but decreased after March 2002 because of changing of junction between port and catheter. Mean excess weight loss (35.2+/-27.7%) was not different in group whether the patients were reoperated or not. Band and port related morbidity is an important aspect of bariatric surgery. We have to pay attention to material evolution and to our follow up for calibration. Some new recent technical advancement could improve the management of these patients.