Background Bariatric Surgery Research Articles

Laparoscopic sleeve gastrectomy versus laparoscopic single anastomosis gastric bypass: short-term outcome

Objective To compare laparoscopic sleeve gastrectomy (LSG) and laparoscopic single anastomosis gastric bypass (LSAGB) for morbidly obese patients. Both procedures were compared regarding % of excess weight loss (%EWL), resolution of comorbidities, hospital stay, morbidity, mortality, and bariatric analysis and reporting outcome system (BAROS) on short-term basis. Background Bariatric surgery has been proved to be a successful treatment option, leading to long-term weight loss with improvement of obesity-related comorbidities. The LSG is now one of the most popular bariatric procedures worldwide, whereas the LSAGB is now rising worldwide. Patients and methods This prospective study involved 40 patients blindly divided into two groups: 20 of them underwent LSG and 20 of them underwent LSAGB. Written informed consent was obtained from all patients for the procedures and possible complications and conversion. The study was approved by the local ethical committee. All the patients had a 1-year period of follow-up postoperatively and were evaluated for % EWL, resolution of comorbidities, hospital stay, morbidity, mortality, and BAROS. Results A total of 40 obese patients were blindly divided into two groups: LSG included 20 patients, comprising three males and 17 females, with mean BMI of 43.7 kg/m2. Among them, four had type 2 diabetes mellitus (T2DM), three had hypertension (HTN), five had osteoarthritis, two had obstructive sleep apnea (OSA), five had dyslipidemia, and one had polycystic ovary. LSAGB group included 20 patients, comprising four males and 16 females, having a mean BMI of 45.1 kg/m2. Of them, 25 had T2DM, four had HTN, three osteoarthritis, one OSA, eight dyslipidemia, and two polycystic ovary. The mean operative time was 66 min in LSG, whereas it was 72.6 min in LSAGB. The mean duration of hospital stay was 2.5 days in LSG, whereas it was 3.5 days in LSAGB. Mean %EWL was 33.4% at 1 month and 77.22% at 12 months in LSG and was 20.13% at 1 month and 80.4% at 12 months in LSAGB. Overall, two patients with T2DM had complete and two had partial resolution in LSG, whereas three patients with T2DM in LSAGB. Moreover, two patients had complete resolution regarding HTN in LSG and all of them in LSAGB. There was resolution of osteoarthritis, OSA, and polycystic ovary in all patients in both groups. Bleeding was seen in one case in LSG. Wound infection was recorded in one case in LSG and in two cases in LSAGB. Postoperative nausea and vomiting was seen in three cases in LSG and in one cases in LSAGB. Symptomatic cholelithiasis was seen in seven patients in LSG group, and two patients needed surgery, whereas in LSAGB, five patients had symptomatic cholelithiasis, and three patients needed surgery. A total of eight patients had dumping symptoms only in LSAGB. According to BAROS, it was revealed that in LSG, 12 of the patients evaluated the quality of life as ‘excellent’ and two as ‘very good,’ whereas in LSAGB, 14 of the patients evaluated the quality of life as ‘excellent’ and three as ‘very good.’ Conclusion LSG has proved to be a safe and effective bariatric surgery with a rate of success that is similar to the LSAGB. LSAGB appears to reduce obesity-related comorbidities with low complication rate. Both procedures offer a good quality of life according to BAROS.

Post-bariatric surgery nutritional follow-up in primary care: a population-based cohort study.

BackgroundBariatric surgery is the most effective treatment for severe obesity. However, without recommended follow-up it has long-term risks.AimTo investigate whether nutritional and weight monitoring in primary care meets current clinical guidance, after patients are discharged from specialist bariatric care.Design and settingRetrospective cohort study in primary care practices contributing to IQVIA Medical Research Data in the UK (1 January 2000 to 17 January 2018).MethodParticipants were adults who had had bariatric surgery with a minimum of 3 years’ follow-up post-surgery, as this study focused on patients discharged from specialist care (at 2 years post-surgery). Outcomes were the annual proportion of patients from 2 years post-surgery with a record of recommended nutritional screening blood tests, weight measurement, and prescription of nutritional supplements, and the proportions with nutritional deficiencies based on blood tests.ResultsA total of 3137 participants were included in the study, and median follow-up post-surgery was 5.7 (4.2–7.6) years. Between 45% and 59% of these patients had an annual weight measurement. The greatest proportions of patients with a record of annual nutritional blood tests were for tests routinely conducted in primary care, for example, recorded haemoglobin measurement varied between 44.9% (n = 629/1400) and 61.2% (n = 653/1067). Annual proportions of blood tests specific to bariatric surgery were low, for example, recorded copper measurement varied between 1.2% (n = 10/818) and 1.5% (n = 16/1067) where recommended. Results indicated that the most common deficiency was anaemia. Annual proportions of patients with prescriptions for recommended nutritional supplements were low.ConclusionThis study suggests that patients who have bariatric surgery are not receiving the recommended nutritional monitoring after discharge from specialist care. GPs and patients should be supported to engage with follow-up care. Future research should aim to understand the reasons underpinning these findings.

Effectiveness of ursodeoxycholic acid treatment in the prevention of gallstone formation after laparoscopic sleeve gastrectomy

Background Bariatric surgery is a critical risk factor for cholelithiasis. This study aimed to investigate the role of treatment with ursodeoxycholic acid (UDCA) in the prevention of gallstone formation after laparoscopic sleeve gastrectomy (SG) in morbidly obese patients. Methods Patients who underwent SG for morbid obesity from January 2016 to September 2016 were evaluated. Patients without hepatobiliary disorders were included. Patients were divided into two groups based on whether they did (Group I) or did not receive treatment with UDCA (Group II). Indication for UDCA treatment was symptomatic alkaline reflux. Demographic characteristics, comorbid diseases, preoperative blood parameters, early and late period weight loss rates, and gallstone development were monitored and compared between the groups. Results Ninety-six of 155 patients met the inclusion criteria. Group I and II included 49 and 47 patients, respectively. The mean age was 39.1 ± 10.8 (range 18–69) years and the mean follow-up period was 20.75 ± 6.6 (range 12–34) months. Gallstone formation was significantly lower in Group I compared to Group II [5 patients (10.2%) vs. 21 patients (44.6%), p<.001]. Moreover, the absence of UDCA treatment was independently and significantly associated with gallstone formation (hazard ratio: 3.08; 95% confidence interval: 1.73–5.50; p<.001) in multivariate analyses. There was no difference in weight loss rates between the two groups at the early or late periods. Conclusions Treatment with UDCA seems to be effective in the prevention of gallstone formation after sleeve gastrectomy. Furthermore, early and late period weight loss rates were not found to have significant effects on the risk of cholelithiasis.

Patient involvement to inform the design of a clinical trial in postbariatric hypoglycaemia

BackgroundBariatric surgery may lead to symptomatic postprandial hypoglycaemia as a major side effect without established therapy so far. We aimed to develop an evidence-based study design of a clinical trial that tests treatment options and can provide useful patient-relevant evidence.MethodsWe searched systematically for guidance of core outcome sets to determine the most relevant types of outcomes and duration of such a trial. Our search comprised literature databases, a database of core outcome sets and self-help organizations. We then developed a simple online questionnaire based on interviews with German-speaking patients with postprandial hypoglycaemia after bariatric surgery. We recruited participants by reaching out to all German speaking endocrinologists in Switzerland and large Swiss bariatric centres. We asked for preferences regarding outcome types and acceptable duration of being included in a corresponding clinical trial.ResultsThe literature search did not identify evidence-based guidance for informing our study design. Experience of clinical and research routine as well as patient interviews helped in identifying potential outcomes and the design of an online questionnaire. Therein, a total of 29 persons started the questionnaire and 22 answered questions related to the primary outcome. Of these, 17 (77.3%) deemed quality of life more relevant as primary outcome than the rate of hypoglycaemic episodes. A trial length of four weeks or longer was regarded as acceptable for 19 of 21 respondents to this question (91.4%) and of six months or longer for 12 respondents (56%).ConclusionsIn situations with no other guidance, a simple questionnaire may help to inform trial design decisions. This study identifies a patient preference for “quality of life” as a primary outcome and supports the evidence-based conception of a patient-centred clinical trial in postbariatric hypoglycaemia.

Bariatric patient's body composition: An option to BMI?

Bariatric surgery is one of the best treatments for obesity. This indication includes an evaluation of body mass index (BMI) that does not consider the body composition of an individual. To determine the body composition of bariatric surgery candidates. Patients treated at a tertiary care centre for obesity were evaluated. Body composition was measured by bioelectrical impedance analysis (BIA). All measures of BIA and surgical indication were analysed. We evaluated 407 subjects, 87 (21.4%) men, with a mean age of 36 years. In men with indications for bariatric surgery, the mean±SD body fat percentage (%BF) was 45.1±5.39%, and the mean±SD visceral fat area was 243.6±33.79cm2. In women with indications for bariatric surgery, the mean±SD %BF was 50.7±3.3%, and the mean±SD visceral fat area was 241.7±24.77cm2. This study showed different body compositions between men and women and parameters of %BF and visceral fat area evaluated by BIA.

Risk of anemia in morbidly obese patients after bariatric surgery in Taiwan.

BACKGROUNDBariatric surgery is one of most effective long-term treatments for morbid obesity. However, post-bariatric surgery anemia is identified as a common adverse effect and remains a challenge nowadays.AIMTo estimate the risk of post-bariatric surgery anemia and to stratify the association between age, gender, and types of surgery.METHODSThis study is a population-based cohort study. We conducted this nationwide study using claims data from National Health Insurance Research Database in Taiwan. There were 4373 morbidly obese patients in this study cohort.RESULTSAmong patients who were diagnosed with morbid obesity, 2864 received bariatric surgery. All obesity-associated comorbidities decreased in the surgical group. Increasing risk of post-bariatric surgery anemia among obese patients was found by Cox proportional hazards regression [adjusted hazard ratio (HR): 2.36]. Also, we found significantly increasing cumulative incidence rate of anemia among patients receiving bariatric surgery by log-rank test. After adjusting for age and gender, the increasing incidence of post-bariatric surgery anemia was found among women (adjusted HR: 2.48), patients in the 20–29-year-old group (adjusted HR: 3.83), and patients in the 30-64-year-old group (adjusted HR: 2.37). Moreover, malabsorptive and restrictive procedures had significantly higher adjusted HRs, 3.18 and 1.55, respectively.CONCLUSIONBariatric surgery give rise to anemia risk among obese patients, specifically in women, young- and middle-aged patients, and patients undergoing malabsorptive procedures in our population-based cohort study in Taiwan.

Dietary macro- and micro-nutrients intake adequacy at 6th and 12th month post-bariatric surgery

BackgroundBariatric surgery (BS) is considered as an effective solution to control morbid obesity. Food restrictions resulting from the operation may decrease dietary nutrient intakes, particularly during the first year after BS. This study mainly aimed to assess the adequacy of dietary nutrient intakes at 6th and 12th month after BS.MethodOf the severely obese participants in the Tehran obesity treatment study in 2015–2016, 58 patients undergoing Roux-En-Y gastric bypass (N = 16) or sleeve gastrectomy (N = 42) were selected from Tehran Obesity Treatment Center. To assess the patients’ dietary intake, a three-day, 24-h dietary recall was obtained on three unscheduled days (two non-consecutive weekdays and one weekend day) at 6th and 12th month after BS. To evaluate the adequacy of nutrient intake, the patients’ intakes were compared to the current dietary reference intakes (DRIs), including estimated average requirements (EAR) or Adequate Intakes (AI).ResultsThe mean age of the participants (71% women) undergoing BS was 37 ± 8 years. Anthropometric parameters significantly decreased at the 12th month after BS. The percentage of energy from carbohydrate intake increased significantly between the 6th and 12th month after BS (P = 0.04). The mean ± SD of protein intake was lower than the recommended dosage with a dramatic decrease from 45 ± 30 to 31 ± 15 (g/day) between the two intervals (P = 0.001). The mean intake of saturated fatty acid (SFA) decreased dramatically (P < 0.001) from 6 to 12 month; however, the median intake of n3-polyunsaturated fatty acid (n3-PUFA) intake increased (P = 0.02). None of the participants showed nutrient intake adequacy in terms of biotin, fat soluble vitamins, pantothenic acid, potassium, and zinc. Moreover, less than 10% of the participants showed nutrient intake adequacy in terms of folate, magnesium, manganese, and calcium according to DRIs during the both intervals after BS.ConclusionBariatric surgery can reduce dietary intakes, which is more obvious 12 months after the surgery. Out of 21 micronutrients, nearly all could not met the EAR and were received < 50%, also had significant reduction from the 6th to12th month after surgery.

Changes of bone metabolism markers in obese individuals with laparoscopic sleeve gastrectomy

Background Bariatric surgery has proven to be a valuable treatment option for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a bariatric procedure owing to its safety, low complication rate, and excellent weight loss results. As calcium requires the action of stomach acid to become solubilized, so by eliminating all HCl-secreting parietal cells and pepsin-secreting chief cells in sleeve gastrectomy, calcium becomes unable to be absorbed. A decrease in whole body bone mineral content was seen at first 2 years after SG. If bone loss continues even at slow rate, these patients may have an increased risk for fractures later in life. Aim The aim was to evaluate vitamin D, parathyroid hormone (PTH), and calcium serum after SG and its effect on modulation of postoperative nutritional monitoring and supplementation. Patients and methods This prospective study was done on 50 morbidly obese patients (33 females and 17 males), with mean age of 31.8±7.6 years and mean BMI of 41.5±4.6, who underwent LSG operation. Serum calcium, PTH, and vitamin D were measured before and 6 months after LSG. Results There was a statistically significant reduction in calcium level from baseline to postoperatively (P Conclusion LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrient deficiencies, and greater weight loss does not require higher dosage of multivitamins.

Histologic and microbiological findings of the defunctionalized loop in sleeve gastrectomy with jejunal bypass.

Bariatric surgery produces anatomic changes in the digestive tract that can affect the intestinal microbiome and, in some cases, can cause small intestinal bacterial overgrowth. Since the inception of the sleeve gastrectomy with jejunal bypass (SGJB) in 2004, there has been discussion regarding the possible development of those complications associated with the now abandoned jejunoileal bypass (JIB) procedure. The primary endpoint was to characterize the bacteriologic and histopathologic findings in the defunctionalized jejunal loop after the SGJB procedure and to analyze the liver profile. The secondary endpoint was to report SGJB conversions or reversions and to review the differences between SGJB and JIB. Academic medical center. We conducted a prospective study of patients who underwent laparoscopy for any reason, having previously had an SGJB. A 5-cm segment at the proximal end of the excluded limb was resected. Luminal liquid and tissue samples were taken from this segment for aerobic and anaerobic cultures, and pathologic examination of the bowel wall was performed to evaluate trophism and signs of chronic inflammation. Other variables were liver function and pre- and postoperative status. Finally, we retrospectively reviewed the causes of revisional surgery in the prospective database. Eleven patients underwent laparoscopy. The median time after SGJB was 14 months (range, 10-144 months). There were no complications from the procedure. Eight (72.7%) of the procedures were cholecystectomies. None of the patients showed histologic alterations or signs of chronic infection. The liquid and tissue cultures were negative. The liver tests and the laparoscopic morphology of the liver were normal in all patients, except in 1 with previously documented liver cirrhosis. The number of SGJB revisions was 19 of 1074 (1.8 %), and all of them were converted to Roux-en-Y gastric bypass for severe gastroesophageal reflux. In this study, we were unable to demonstrate the presence of symptoms or histologic alterations that would suggest that patients undergoing SGJB develop small intestinal bacterial overgrowth in the short- and medium-term follow-up, unlike those who have undergone JIB. The study constitutes an initial step toward establishing what happens to the defunctionalized jejunal limb as a result of this surgical technique.

Google Trends as a resource for bariatric education: what do patients want to know?

Bariatric surgery (BaS) is the safest, most effective, and most durable therapy for obesity but is performed in less than 1% of the affected United States (US) population. It is challenging to determine from traditional surveys if this phenomenon is the result of poor access to care or lack of interest among Internet users. The aim of this study was to use Google Trends (GT) as a tool to analyze the US general population interest in BaS. Academic Hospital, United States. GT was used to access data searched for the term bariatric surgery. The gathered information included data from 2008 through 2018 in English within the US. Search frequency, time intervals, locations, frequent topics of interest, and related searches were analyzed. GT reports search frequency on means, and a value of 100 represented peak popularity. The number of Google searches related to the term bariatric surgery has gradually increased over time, from a mean of 67% in 2008 to a 94% interest in 2017. Regarding interest by subregion in 2017, the state of Michigan lead the frequency of searches, followed by Indiana, Delaware, West Virginia, and Tennessee. Top searched terms by frequency were the following: patient eligibility for BaS, what is BaS, what are the complications of BaS, financial costs of BaS, and what insurance companies cover BaS. It appears that traditional Web sites only address a few. GT complements the understanding of interest in BaS. Using these trends can improve an Internet user's education, and tailor specific official Web sites for the public's generalinterest.

Two-year outcomes of sleeve gastrectomy versus gastric bypass: first report based on Tehran obesity treatment study (TOTS)

BackgroundBariatric surgery is an effective treatment for obesity and its associated comorbidities. This is the first comprehensive report of a prospective cohort study, comparing sleeve gastrectomy (SG) with gastric bypass (GB) regarding their effectiveness and safety.MethodsThe prospectively collected data of patients, who presented to a specialized bariatric center and underwent a primary bariatric procedure, were compared in terms of weight loss, remission of obesity-associated comorbidities, complication rate, and quality of life improvement at 6-, 12-, and 24-month follow-ups.ResultsOf 3287 patients (78.6% female) analyzed, 67% (n = 2202) and 33% (n = 1085) underwent SG and GB, respectively. Effective outcomes were reported in both groups regarding the body composition indices. Type 2 diabetes mellitus (T2DM) remission rate at the end of follow-up was 53.3% and 63.8% in the SG and GB groups, respectively. Following the propensity score-adjusted analysis, the T2DM remission rate was not significantly different between the groups. Conversely, the remission rate of hypertension in the 24-month follow-up (39.1% vs. 54.7%) and the remission rate of dyslipidemia in all follow-ups were lower in the SG group, compared to the GB group. Moreover, both procedures caused substantial improvements in various domains of quality of life. The surgery duration, early complication rate, and nutritional deficiencies were lower in the SG group, compared to the GB group.ConclusionBoth surgical procedures were effective in the control of obesity and remission of its comorbidities. However, since SG was associated with a lower rate of complications, it seems that SG should be considered as a suitable procedure for obese patients, especially those with a healthier metabolic profile.

Plasma progranulin levels in obese patients before and after Roux-en-Y gastric bariatric surgery: a longitudinal study.

Bariatric surgery stands out as the most effective long-term intervention for sustainable weight loss and metabolic improvement in patients with severe obesity. Progranulin was recently identified as an adipokine related to obesity and inflammation, revealing a metabolic function and proinflammatory properties. To evaluate plasma progranulin levels before and after 6 months of bariatric surgery in Roux-en-Y gastric bypass (RYGB). Tertiary referral hospital, southern Brazil. This was a prospective longitudinal study, including 23 obese patients who underwent RYGB. Demographic and clinical characteristics, body composition, and resting energy expenditure were evaluated. Plasma progranulin was determined with enzyme-linked immunosorbent assays in a peripheral blood sample collected before and 6 months after the surgical procedure. The participants were mostly women (78.3%), with a mean age of 42.3 ± 10.8 years and baseline body mass index of 48.8 ± 10.4 kg/m2. Regarding the anthropometric parameters, there were differences in the pre- and post-RYGB values, with reduction of weight, body mass index, body fat percentage, and cervical and abdominal circumferences. All laboratory parameters improved, such as lipid profile and fasting glycemia, and resting energy expenditure values decreased significantly. Plasma progranulin levels decreased from 47.6 ± 13.5 ng/mL before RYGB to 40.4 ± 9.9 ng/mL after 6 months of surgery (P = .005). The reduction of progranulin did not correlate with body composition or laboratory data. Plasma progranulin levels significantly reduced 6 months after RYGB, but it could not be explained by changes in anthropometry, body composition, or glycemic or lipid profile.

The Effects of Bariatric Surgery on Renal, Neurological, and Ophthalmic Complications in Patients with Type 2 Diabetes: the Taiwan Diabesity Study

BackgroundBariatric surgery has been shown to improve glycemic control in patients with type 2 diabetes. However, less is known whether it can also reduce diabetic renal, neurological, and ophthalmic complications.MethodsThis prospective multicenter cohort study compared renal, ophthalmic, and neurological complications between 49 patients with obesity/overweight receiving bariatric surgery and 338 patients receiving standard medical treatment after follow-up for 2 years. Patients received neurological examinations including toe tuning fork vibration test, ankle tendon reflex test, 10-g monofilament test, and ophthalmic examinations including visual acuity measurement and fundus examinations. Multiple regressions, propensity score weighting, and matching were employed to adjust for baseline differences.ResultsAfter 2 years of follow-up, patients with type 2 diabetes receiving bariatric surgery had greater reduction in BMI, HbA1c, and urine albumin–creatinine ratio, greater improvement in estimated glomerular filtration rate, and greater increase in tuning fork test score of right and left toes compared with the medical group. However, there is no improvement in 10 g-monofilament test, visual acuity, diabetic non-proliferative retinopathy, and proliferative retinopathy. Similar results were obtained using multiple regression adjustment, propensity-score weighting, or comparing age-, sex-, and BMI-matched subjects.ConclusionsAfter 2-year follow-up, patients with obesity/overweight and type 2 diabetes receiving bariatric surgery have increased glomerular filtration rate, reduced albuminuria, and improved tuning folk vibration sensation.

Midterm results of revisional bariatric surgery postsleeve gastrectomy: resleeve versus bypass.

Bariatric surgery has been shown to produce the most predictable weight loss results, with laparoscopic sleeve gastrectomy (SG) being the most performed procedure as of 2014. However, inadequate weight loss may present the need for a revisional procedure. The aim of this study is to compare the efficacy of laparoscopic resleeve gastrectomy (LRSG) and laparoscopic Roux-en-Y gastric bypass in attaining successful weight loss. Public hospital following SG. A retrospective analysis was performed on all patients who underwent SG from 2008-2019. A list was obtained of those who underwent revisional bariatric surgery after initial SG, and their demographic characteristics were analyzed. A total of 2858 patients underwent SG, of whom 84 patients (3%) underwent either a revisional laparoscopic Roux-en-Y gastric bypass (rLRYGB) or LRSG. A total of 82% of the patients were female. The mean weight and body mass index (BMI) before SG for the LRSG and rLRYGB patients were 136.7 kg and 49.9 kg/m2 and 133.9 kg and 50.5 kg/m2, respectively. The mean BMI showed a drop from 42.0 to 31.7 (P < .001) 1 year post revisional surgery for the LRSG group and 42.7 to 34.5 (P < .001) for the rLRYGB group, correlating to an excess weight loss (EWL) of 61.7% and 48.1%, respectively. At 5 years post revisional surgery, LRSG patients showed an increase in BMI to 33.8 (EWL = 45.3%), while those who underwent rLRYGB showed a decrease to 34.3 (EWL = 49.2%). Completeness of follow-up at 1, 3, and 5 years for rLRYGB and LRSG were 67%, 35%, and 24% and 45%, 21%, and 18%, respectively. Revisional bariatric surgery is a safe and effective method for the management of failed primary SG. LRSG patients tended to do better earlier on; however, it leveled off with those who underwent rLRYGB by 5 years.

Effects of gastric sleeve surgery on the serum levels of GH, IGF-1 and IGF-binding protein 2 in healthy obese patients

BackgroundBariatric surgery is an effective treatment for severe obesity. It also ameliorates diabetes independently of weight loss through mechanisms that are not fully understood. In this study, we investigated the levels of GH, IGF-1 and IGF-binding protein 2 (IGFBP-2) after gastric sleeve surgery in healthy obese individuals.MethodThis study was conducted in 33 obese (BMI > 38.3) healthy male subjects aged 25 to 50 years undergoing sleeve gastrectomy. GH, IGF-1 and IGFBP-2 levels were evaluated by ELISA at baseline and 6–12 months after surgery. Other parameters, such as glucose, BMI, insulin, HOMA-IR and lipid profile, were also investigated.ResultsSystemic GH (12.32 vs. 50.97 pg/mL, p < 0.001) and IGFBP-2 levels (51.86 vs. 68.81 pg/mL, p < 0.001) were elevated after bariatric surgery. There was no change in IGF-1 level from before to after surgery. BMI (52.18 vs. 40.11, p = 0.001), insulin (19.35 vs. 8.80 mIU/L, p < 0.001) and HOMA-IR index (6.48 to 2.52, p < 0.001) were reduced after surgery. Lipid profile analysis revealed that total cholesterol (4.26 vs. 5.12 mmol/L, p < 0.001) and high-density lipoprotein (HDL) (0.90 to 1.55 mmol/L, p < 0.001) were increased, while triglycerides were decreased, after surgery (1.62 vs. 1.05 mmol/L p < 0.001). GH, IGF-1, and IGFBP-2 were not correlated with insulin or lipid parameters.ConclusionsOur study suggests that improved circulating GH and IGFBP-2 levels may mediate the beneficial effects of gastric sleeve surgery in improving insulin sensitivity and reducing insulin demand.

The association of uncoupling proteins 1, 2, and 3 with weight loss variability after bariatric surgery: a systematic review.

Bariatric surgery is currently the most effective treatment for patients with severe obesity. Uncoupling proteins (UCP) 1, 2, and 3 play key roles in the regulation of energy balance and weight. Previous studies have suggested that changes in UCP1-3 genes could influence weight loss after bariatric surgery. However, it is still unclear if these UCPs are indeed involved in weight loss variability after surgery. Therefore, we performed a systematic review aiming to summarize the results of studies on this subject. A literature search was performed for all studies that evaluated associations of UCP1-3 expressions and their polymorphisms with obesity-related outcomes after bariatric surgery. Twenty-six studies were eligible for inclusion in this systematic review. Among them, 18 evaluated UCP1-3 expressions while 8 studies investigated the association between UCP1-3 polymorphisms and weight loss after bariatric surgery. In general, UCP2 and UCP3 expressions in adipose tissue and skeletal muscle seem to be affected by metabolic changes of bariatric surgery, which might be influenced by the surgery type. Data on UCP1 expression in adipose tissue is still inconclusive. Only few studies investigated the association between polymorphisms in UCP1-3 genes and weight loss after bariatric surgery, with contradictory results. Available studies suggest that changes caused by bariatric surgery could influence UCP2 and UCP3 expressions in adipose tissue and muscles, consequently affecting weight loss. However, because of the reduced number of studies, further studies are needed to confirm whether these UCPs and their polymorphisms are indeed involved in weight loss after bariatric surgery.

Relationship between bariatric surgery and dental erosion: asystematicreview.

Bariatric surgery can have several oral repercussions, including tooth erosion due to decreased salivary flow associated with the action of acidic pH and behavioral modifications in the diet that lead to the dissolution of mineralized dental tissues. This systematic review aimed to evaluate whether bariatric surgery presented a greater risk of dental erosion. Dentistry School, Pernambuco University, Camaragibe, Pernambuco, Brazil. This review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) and registered at the International Prospective Registry of Systematic Reviews (CRD42019124960). A search was performed in the PubMed/MEDLINE, Web of Science, and Cochrane Library databases using the following descriptors: "dental erosion OR tooth wear OR oral health OR dental wear OR tooth erosion OR salivary flow AND bariatric surgery OR gastrectomy OR obesity surgery". The review included 553 articles (after exclusion of duplicates) submitted for title and abstract reading, of which 24 were selected for full text analysis. Five articles fulfilling the eligibility criteria were included in the qualitative and quantitative analysis review. Because of high heterogeneity of the studies, meta-analysis could not be performed. Based on the review, we concluded that patients undergoing bariatric surgery had a higher incidence of dental erosion. All studies presented a high degree of dental erosion in patients submitted to bariatric surgery (P < .05).

Intraoperative lidocaine infusion and 24-hour postoperative opioid consumption in obese patients undergoing laparoscopic bariatric surgery.

Bariatric surgery is the most effective long-term treatment for obesity. Opioid-sparing anesthesia and multimodal analgesia such as lidocaine infusion have been recommended in these patients to reduce opioid-related complications. However, evidence supporting its use for bariatric surgery population is limited. To investigate whether intraoperative lidocaine infusion is associated with decreasing opioid consumption in laparoscopic bariatric surgery. A university hospital, California, USA. In this retrospective cohort study, outcomes among consecutive obese patients undergoing laparoscopic bariatric surgery between January 2016 to December 2018 were evaluated to determine the impact of adjunctive intraoperative lidocaine infusion on 24-hour postoperative opioid consumption. Secondary outcomes, including opioid consumption during hospitalization, length of stay, and postoperative complications were determined. Post hoc analyses were performed exploring possible dose effects and drug-drug interactions. Univariable and multivariable analyses were performed to identify factors associated with opioid consumption. Among 345 patients, 54 (15.7%) received intraoperative lidocaine infusion (L+) whereas 291 (84.3%) did not receive intraoperative lidocaine infusion (L-). Both L+ and L- groups shared similar demographic characteristics. The 24-hour postoperative opioid consumption was 17.6% lower in L+ (95% confidence interval -28.4 to -5.2, P = .007), but nonsignificantly lower in themultivariate model (12.8%, 95% confidence interval -24.4 to .5, P = .06). Opioid consumption during hospitalization, length of stay, and other clinically significant outcomes did not differ. However,subgroup analysis restricted to opioid-naïve patients indicated significantly reduced opioid consumption in the L+ group. Post hoc analysis suggested interaction between lidocaine and ketaminein decreasing 24-hour postoperative opioid consumption. Intraoperative lidocaine infusion was not significantly associated with decreasing 24-hour postoperative opioid consumption in obese patients undergoing laparoscopic bariatric surgery.

Reported nutrient intake over 7 years after Roux-en-Y gastric bypass in the Longitudinal Assessment of Bariatric Surgery-3 (LABS-3) psychosocial study.

Bariatric surgery is the most effective therapy for severe obesity. It reduces gastric capacity and may modify regulation of appetite, satiety, insulin, and other physiologic processes, resulting in weight loss. Long-term data on postsurgical nutrient intake are lacking. The Longitudinal Assessment of Bariatric Surgery-3 psychosocial study. Reported dietary intake was assessed in a subset of participants (n = 72) of the Longitudinal Assessment of Bariatric Surgery-3 psychosocial study who underwent Roux-en-Y gastric bypass surgery. Two 24-hour diet recalls at presurgery and annual assessments over 7 years were obtained. Reported diets were evaluated for energy, macro- and micronutrient intake, and assessed for adequacy by comparison to the dietary reference intakes. After surgery, reported intake of total energy, and all macronutrients were significantly reduced. At least a quarter of participants reported protein intake below the recommended dietary allowance. Over half of participants reported intake of several vitamins (C, D, A, E, thiamin, folate) and minerals (zinc, calcium) below recommended levels over 7 years. Compared with presurgery, reported energy intake was reduced over 7 years. This study was registered at ClinicalTrials.gov as NCT02495142. The reduction in energy resulted in intakes below the dietary reference intakes formany micronutrients among the majority of participants and below the recommended dietary allowance for protein in a substantial subgroup. These data support continued long-term nutrition education, monitoring, and supplementation.

The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study

BackgroundBariatric surgery improves insulin sensitivity and secretion in patients with type 2 diabetes, but the effect on patients with prediabetes or even normal glucose tolerance deserves further consideration.MethodsCohort study including patients operated with laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) between November 2012 and June 2017 at the Örebro University Hospital (n = 813) with follow-up of 742 patients 2 years after surgery. Fasting insulin, glucose, glycosylated hemoglobin (HbA1c), and homeostatic model assessment of insulin resistance (HOMA-IR) were analyzed at baseline and 2 years after surgery for patients with overt type 2 diabetes, prediabetes, or non-diabetes.ResultsFasting insulin levels improved for all groups (diabetics baseline 25.5 mIU/L, IQR 17.5–38.0, 2 years 7.6 mIU/L, IQR 5.4–11.1, p < 0.001; prediabetics baseline 25.0 mIU/L, IQR 17.5–35.0, 2 years 6.7mIU/L, IQR 5.3–8.8, p < 0.001; non-diabetics baseline 20.0 mIU/L, IQR 14.0–30.0, 2 years 6.4 mIU/L, IQR 5.0–8.5, p < 0.001). HbA1c improved in all groups (diabetics baseline 56 mmol/mol, IQR 49–74 [7.3%, IQP 6.6–8.9], 2 years 38 mmol/mol, IQR 36–47 [5.6%, IQR 5.4–6.4], p < 0.001; prediabetics baseline 40 mmol/mol, IQR 39–42 [5.8%, IQR5.7–6.0], 2 years 36 mmol/mol, IQR 34–38 [5.5%, IQR 5.3–5.6], p < 0.001; non-diabetics baseline 35 mmol/mol, IQR 33–37 [5.4%, IQR 5.2–5.5]; 2 years 34 mmol/mol, IQR 31–36 [5.3%, IQR 5.0–5.4], p < 0.001). HOMA-IR improved in all groups (diabetics baseline 9.3 mmol/mol, IQR 5.4–12.9, 2 years 1.9 mmol/mol, IQR 1.4–2.7, p < 0.001; prediabetics baseline 7.0 mmol/mol, IQR 4.3–9.9, 2 years 1.6 mmol/mol, IQR 1.2–2.1, p < 0.001; non-diabetics 4.9 mmol/mol, IQR 3.4–7.3, 2 years 1.4 mmol/mol, IQR 1.1–1.9, p < 0.001).ConclusionInsulin homeostasis and glucometabolic control improve in all patients after LRYGB, not only in diabetics but also in prediabetics and non-diabetic obese patients, and this improvement is sustained 2 years after surgery.