Management Of Bariatric Surgery Research Articles

Perception of knowledge and attitude, of safety, effectiveness consequences, and management of bariatric surgery among the community in Jazan City

Objective: To investigate the attitude and knowledge of the Saudi community in Jazan City regarding obesity. Methods: A sample of 480 citizens participated in the study, which was conducted in 2023. The average age of the population was 30 years. Consenting participants completed an anonymous online questionnaire requesting information on their demographics, obesity risk factors, and opinions on bariatric surgery. Results: Most of the study participants (87.3%) were aged 18 - 40 years. Females represented 56.5% and 43.5% were males; 61.5% had a bachelor's degree (RS, 27.3% > 10,000 RS); 61.7% were single, and 38.3% were married. The mean height of the study population was 162.05 ± 9.825, with a mean weight of 69.12 ± 18.195 and a body mass index of 26.11 ± 6. The primary causes of obesity were lack of exercise and excessive eating. Furthermore, 64% had a positive family history of obesity; 72% had good knowledge, 28% had moderate knowledge, and

A case specific review of postoperative complications and management in bariatric surgery

A case specific review of postoperative complications and management in bariatric surgery

Prospects of bariatric surgery in management of patients with non-alcoholic fatty liver disease

The obesity epidemic in the world is accompanied by a significant increase in the number of cases of non-alcoholic fatty liver disease (NAFLD). One of the directions is bariatric surgery. The review article presents an analysis of the short-term and long-term effectiveness of the use of bariatric surgery methods in patients with NAFLD. Aspects of the influence of bariatric surgery on biochemical and histological parameters of liver fibrosis, changes in insulin resistance and lipid profile, intestinal microbiome involved in the homeostasis of the intestine-liver axis are noted. The role of gene polymorphisms in the progression of NAFLD, as well as protection from fibrotic changes in patients with postoperative period is presented.

Patients' and caregivers' perceptions of bariatric surgery: A France and United States comparative infodemiology study using social media data mining.

People are conversing about bariatric surgery on social media, but little is known about the main themes being discussed. To analyze discussions regarding bariatric surgery on social media platforms and to establish a cross-cultural comparison of posts geolocated in France and the United States. Posts were retrieved between January 2015 and April 2021 from general, publicly accessed sites and health-related forums geolocated in both countries. After processing and cleaning the data, posts of patients and caregivers about bariatric surgery were identified using a supervised machine learning algorithm. The analysis dataset contained a total of 10,800 posts from 4,947 web users in France and 51,804 posts from 40,278 web users in the United States. In France, post-operative follow-up (n = 3,251, 30.1% of posts), healthcare pathways (n = 2,171, 20.1% of the posts), and complementary and alternative weight loss therapies (n = 1,652, 15.3% of the posts) were among the most discussed topics. In the United States, the experience with bariatric surgery (n = 11,138, 21.5% of the posts) and the role of physical activity and diet in weight-loss programs before surgery (n = 9,325, 18% of the posts) were among the most discussed topics. Social media analysis provides a valuable toolset for clinicians to help them increase patient-centered care by integrating the patients' and caregivers' needs and concerns into the management of bariatric surgery.

Is Airway Management More Risky in Bariatric Surgery?

Airway problems may be experienced more often during anesthesia management in bariatric surgery. In this prospective study, we aimed to compare the incidence of difficult ventilation and intubation between bariatric surgery and other surgeries. This was a case-control study. Medical records of 156 patients over the age of 18 who were scheduled for bariatric (n=68) and nonbariatric surgery (n=88) under general anesthesia were evaluated. The percentage of ASA III, diabetes mellitus, and obstructive sleep apnea syndrome (75%, 33.8%, and 16.2%, respectively) was significantly higher in bariatric surgery patients compared to nonbariatric patients (14.8%, 10.2%, and 3.4%, respectively). No significant difference was found in mean thyromental distance and history of difficult intubation, restriction of cervical extension, beard presence, tooth loss, mallampati, Cormack-Lehane score, intubation score, difficult ventilation, difficult intubation and intubation device used. An increase in neck circumference (>50 cm) rather than body mass index was a more significant indicator in predicting difficult intubation and difficult ventilation. The incidences of difficult ventilation and difficult intubation were similar in bariatric and nonbariatric surgeries in circumstances where the necessary equipment and experienced anesthesiologists are available.

Nutrological Management in Bariatric Surgery: A Narrative Review


 Nutrology based on the analysis of benefits and harms generated by the ingestion of nutrients and assessing individual organic needs promotes the maintenance of health and the reduction of disease risk, as well as the treatment of manifestations of deficiency or excess. Obesity is defined by a body mass index greater than 30 kg/m². Its manifestation is the sum of genetic and environmental factors, this through sedentary lifestyle and caloric intake greater than energy consumption. There are many ways to deal with obesity, from behavioral changes such as a balanced diet and physical exercises, pharmacological and even surgical measures of different modalities, with Roux-en-Y gastric bypass surgery being the most used technique in Brazil. The most common postoperative nutritional deficiencies are iron, protein, calcium, folate, thiamine, zinc, copper, and vitamins D, B12, A, C, and K. In this case, we present the importance of nutrology in monitoring patients after bariatric surgery. This research made use of a bibliographic survey, giving priority to articles dated from the last 5 years, using the databases Lilacs, Medline, bireme, where articles, dissertations, and theses were consulted, in search of the following keywords, obesity, bariatric surgery, and nutritional deficiency, post-bariatric feeding.

Clinical evidence of the cost effectiveness of bariatric surgery in management of type 2 diabetes mellitus and obesity to prevent associated co-morbidity

Clinical evidence of the cost effectiveness of bariatric surgery in management of type 2 diabetes mellitus and obesity to prevent associated co-morbidity

Development and validation of machine learning models to predict gastrointestinal leak and venous thromboembolism after weight loss surgery: an analysis of the MBSAQIP database.

Postoperative gastrointestinal leak and venous thromboembolism (VTE) are devastating complications of bariatric surgery. The performance of currently available predictive models for these complications remains wanting, while machine learning has shown promise to improve on traditional modeling approaches. The purpose of this study was to compare the ability of two machine learning strategies, artificial neural networks (ANNs), and gradient boosting machines (XGBs) to conventional models using logistic regression (LR) in predicting leak and VTE after bariatric surgery. ANN, XGB, and LR prediction models for leak and VTE among adults undergoing initial elective weight loss surgery were trained and validated using preoperative data from 2015 to 2017 from Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Data were randomly split into training, validation, and testing populations. Model performance was measured by the area under the receiver operating characteristic curve (AUC) on the testing data for each model. The study cohort contained 436,807 patients. The incidences of leak and VTE were 0.70% and 0.46%. ANN (AUC 0.75, 95% CI 0.73-0.78) was the best-performing model for predicting leak, followed by XGB (AUC 0.70, 95% CI 0.68-0.72) and then LR (AUC 0.63, 95% CI 0.61-0.65, p < 0.001 for all comparisons). In detecting VTE, ANN, and XGB, LR achieved similar AUCs of 0.65 (95% CI 0.63-0.68), 0.67 (95% CI 0.64-0.70), and 0.64 (95% CI 0.61-0.66), respectively; the performance difference between XGB and LR was statistically significant (p = 0.001). ANN and XGB outperformed traditional LR in predicting leak. These results suggest that ML has the potential to improve risk stratification for bariatric surgery, especially as techniques to extract more granular data from medical records improve. Further studies investigating the merits of machine learning to improve patient selection and risk management in bariatric surgery are warranted.

A Spanish Society joint SECO and SEEDO approach to the Post-operative management of the patients undergoing surgery for obesity.

Bariatric surgery is the method of choice for the management or treatment of obesity. Bariatric surgery brings about several physiological changes in the body and is associated with set of complications. The aim of this study is to provide guidelines on post bariatric surgery management based on consensus by the Spanish society for Obesity Surgery (Sociedad Española de Cirugía de la Obesidad) (SECO) and the Spanish Society for the Study of Obesity (Sociedad Española para el Estudio de la Obesidad) (SEEDO). The boards proposed seven experts from each society. The experts provided the evidence and a grade of recommendation on the selected topics based on systematic reviews/meta-analysis. A list of clinical practical recommendations levels of evidence and grades of these recommendations was derived from the consensus statements from the members of these societies. Seventeen topics related to post-operative management were reviewed after bariatric surgery. The experts came with 47 recommendations and statements. The mean number of persons voting at each statement was 54 (range 36-76). In this consensus, we have designed a set of guidelines to be followed while managing patients after bariatric surgery. Expertise and knowledge of the clinicians are required to convey suitable considerations to the post-bariatric patients. There should also be extensive follow-up plans for the bariatric surgery patients.

Perioperative management in bariatric surgery using eras

Purpose of review. The aim of the work is to collect in a single whole the disparate information devoted to certain aspects of ERAS methods application for the creation of the project of Ukrainian-language recommendations on optimization of perioperative period in the bariatric patients.&#x0D; Recent findings. Bariatric surgery today is a gold standard in the long-term treatment of morbid obesity and associated comorbid conditions such as metabolic syndrome, type 2 diabetes, and others. Laparoscopic longitudinal resection of the stomach (LPRS) and gastric bypass graft (LSH) are the most common bariatric interventions in the world. But despite the fact that the global epidemic of obesity for several decades has had an impact on perioperative tactics of the management of barrier patients, there is currently a relative lack of management in the treatment of this group of patients.&#x0D; They still feel pain and are traditionally injecting opioids for early postoperative analgesia, suffering from nausea and vomiting, which significantly delay the onset of enteral nutrition and prolong the duration of hospitalization. Consequently, postoperative pain, PONV and malnutrition, rather than factors associated with the operation, often lead to prolonged hospitalization and elimination of which benefits the healthcare system and patients by returning them home earlier.&#x0D; Protocols of Enhanced Recovery After Surgery (ERAS), introduced in medical practice Prof. Kehlet in the nineties of the last century, widely used in various fields of surgeons. The most studied application of these protocols in colorectal, thoracic surgery and operative urology.&#x0D; There are recent studies and meta-analyzes that have demonstrated the feasibility of introducing ERAS into bariatric surgery. In 2016, recommendations were published on the implementation of ERAS components in bariatric surgery. The ERABS protocol has been implemented in many Western European bariatric centers and includes the best practice of preoperative preparation and standardization of perioperative and post-operative care that will provide rapid recovery and improve treatment outcome. But it remains unclear whether all components of the classical protocol, namely, epidural anesthesia, are necessary for successful implementation in bariatric surgery.&#x0D; Conclusions. ERAS protocols are successfully used in obese patients after bariatric surgery, and the principles of multimodal analgesia minimize the need for opioids. The principles of ERAS have already proved themselves in many clinics and should be reflected in the National Clinical Recommendations for Bariatric Surgery.

Anesthetic Management in Bariatric Surgery: A Case Report

Anesthetic Management in Bariatric Surgery: A Case Report

Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery.

New persistent opioid use following surgery is a common iatrogenic complication, developing in roughly 6% of patients after elective surgery. Despite increased awareness of misuse and associated morbidity, opioids remain the cornerstone of pain management in bariatric surgery. The potential impact of new persistent opioid use on long-term postoperative outcomes is unknown. We sought to determine the relationship between new persistent opioid use and 1-year postoperative outcomes for patients undergoing bariatric surgery. Using data from the MBSC registry, we identified patients undergoing primary bariatric surgery between 2006 and 2016. Using previously validated patient-reported survey methodology, we evaluated patient opioid use preoperatively and at 1year following surgery. New persistent use was defined as a previously opioid-naïve patient who self-reported opioid use 1year after surgery. We used multivariable logistic regression models to evaluate the association between new persistent opioid use, risk-adjusted weight loss, and psychologic outcomes (psychological wellbeing, body image, and depression). 27,799 patients underwent primary bariatric surgery between 2006 and 2016. Among opioid-naïve patients, the rate of new persistent opioid use was 6.3%. At 1-year after surgery, patients with new persistent opioid user lost significantly less excess body weight compared to those without new persistent use (57.6% vs. 60.3%; p < 0.0001). Patients with new persistent opioid use had significantly worse psychological wellbeing (35.0 vs. 33.1; p < 0.0001), body image (19.9 vs. 18.0; p < 0.0001), and depression scores (2.4 vs. 5.0; p < 0.0001). New persistent opioid users also reported less overall satisfaction with their bariatric surgery (75.1% vs. 85.7%; p < 0.0001). New persistent opioid use is common following bariatric surgery and associated with significantly worse physiologic and psychologic outcomes. More effective screening and postoperative surveillance tools are needed to identify these patients, who likely require more aggressive counseling and treatment to maximize the benefits of bariatric surgery.

Comparison of intravenous ibuprofen and acetaminophen for postoperative multimodal pain management in bariatric surgery: A randomized controlled trial

Study objectiveMultimodal analgesic strategies are recommended to decrease opioid requirements and opioid-induced respiratory complications in patients undergoing laparoscopic bariatric surgery. Recent studies have demonstrated that intravenous ibuprofen decreases opioid consumption compared with placebo. The primary aim of this study was to compare the effect of intravenous ibuprofen and intravenous acetaminophen on opioid consumption. We also aimed to compare postoperative pain levels and side effects of the drugs. DesignRandomized, double-blinded study. SettingUniversity hospital. PatientsEighty patients, aged 18–65 years, (ASA physical status II-III) undergoing laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass surgery were included in this study. InterventionsPatients were randomized to receive 800 mg ibuprofen or 1 g acetaminophen intravenously every 6 h for the first 24 h following surgery; in addition, patient-controlled analgesia with morphine was administered. MeasurementsPostoperative morphine consumption in the first 24 h, visual analog scale (VAS) pain scores at rest and with movement, and opioid related side effects were assessed. In addition, time to passage of flatus, surgical complications, lengths of intensive care unit and hospital stay, and laboratory parameters were recorded. Main resultsThe mean morphine consumption was 23.94 ± 13.89 mg in iv ibuprofen group and 30.23 ± 13.76 mg in the acetaminophen group [mean difference: -6.28 (95% CI, −12.70, 0.12); P = 0.055]. The use of intravenous ibuprofen was associated with reduction in pain at rest (AUC, 1- to 24-h, P < 0.001 and 12- to 24-h, P = 0.021) and pain with movement (AUC, 1–24, 6–24, and 12–24 h, P < 0.001). Intravenous ibuprofen was well tolerated with no serious side effects except dizziness. ConclusionsIntravenous ibuprofen did not significantly reduce opioid consumption compared to intravenous acetaminophen; however, it reduced the severity of pain. Intravenous ibuprofen may be a good alternative to intravenous acetaminophen as part of a multimodal postoperative analgesia in patients undergoing bariatric surgery.

Efficacy of Goal-Directed Fluid Therapy via Pleth Variability Index During Laparoscopic Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients.

There is no well-recognized guideline for intraoperative fluid management in bariatric surgery. Goal-directed fluid therapy (GDFT) is a new concept of perioperative fluid management which was shown to improve patients' prognoses. Dynamic indicators may better predict fluid response compared to static indicators. In this study, we aimed to assess effects of administering GDFT protocol via Pleth Variability Index (PVI) in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) surgery. The study included 60 patients who underwent elective laparoscopic RYGB surgery. Subjects were randomized to two groups as being managed with either standard fluid regimen (control group) or PVI (PVI group) during intraoperative period. After induction of general anesthesia, control group received 500ml crystalloid bolus followed by 4-8ml/kg/h infusion. Fluid management of the control group was guided by central venous pressure and mean arterial pressure. PVI group received 500ml crystalloid bolus followed by 2ml/kg/h infusion. If PVI had been >14%, 250ml colloid was administered. Norepinephrine was given by infusion to keep mean arterial pressure >65mmHg, if needed. Perioperative lactate levels, hemodynamic parameters, and renal functions were recorded. In PVI group, volume of crystalloid and total fluid infusion during intraoperative period was significantly lower than the control group (p<0.05). The groups did not significantly differ in terms of lactate or creatinine levels before or after the surgery (p>0.05). There is no need to administer extra volume of fluid to obese patients undergoing laparoscopic bariatric surgery. Use of dynamic indicators like PVI helps to decrease intraoperative volume of infused fluids with no effects on either intraoperative or postoperative lactate levels in laparoscopic bariatric interventions.

Preoperative Medical Weight Management in Bariatric Surgery: a Review and Reconsideration

Bariatric surgery is the most robust treatment for extreme obesity. The impact ofpreoperative medical weight management sessions designed, in theory, with the primary goal of promoting preoperative weight loss, is unclear. This paper reviews studies that have investigated the relationship between preoperative weight loss and bariatric surgical outcomes, both with respect to postoperative weight loss and complications. We conclude that the most robust of preoperative interventions has not been implemented or evaluated in a manner which would conclusively assess the value of this element of care. We offer a reconsideration of the role of preoperative medical weight management and provide recommendations for future research in this area.

Perception of Knowledge, Attitude, Practice of Safety, Effectiveness, Consequences and Management of Bariatric Surgery among Community in Jeddah City

Background: obesity is associated with increased mortality and morbidity. The use of bariatric surgery has recently increased dramatically in order to lose weight fast; however, the heavy consequences and the long-term weight loss induced by bariatric surgery has favorable effects on life span remains unclear. Aim of Study: this study was aimed to explore knowledge and beliefs about safety, effectiveness and consequences of bariatric surgeries among community population in Jeddah city and to evaluate the role of demographic factors in shaping those beliefs, and assess possible associations between demographic characteristics with lose weight preventive behavior. Patients and methods: this study was done in 2016 and carried out among a sample of 474 citizens, of them 70.1% women and 29.9% men. The mean age of citizens was 35.77. To assess citizens’ demographic factors, risk factors of obesity and beliefs about bariatric surgeries, consenting citizens responded to an anonymous online questionnaire. The data was entered and analyzed using SPSS version 20. Data were entered into the Statistical Package for Social Sciences (SPSS, version 20) and descriptive analysis conducted. Results: the results of the current study show that among the respondents, (24.5%) were obese, (13.7%) severely obese and (9.3%) were morbid obese. The majority of them believed that the lack of exercise is the cause of their obesity (45.7%), (71% ) of the respondents think that genetics play a role in obesity, (69.3%) of respondents have someone in their family who suffers from obesity and (61.6%) were not keen to exercise. The majority of respondents (77.4%) think that weight loss procedures contribute to weight loss, however (69.8%) are not of favor towards weight loss procedures to get rid of obesity, (63.4%) of them have not undergone any surgery, and (86.6%) of the respondents do not think of surgeries as their first choice to lose weight without exercise or diet, also (71.0%) think that weight loss procedures and its complications may lead to death.The majority of the respondents (74%) have inadequate beliefs about bariatric surgery and (50.8%) of the respondents have good knowledge on prevention behavior of obesity.

Complication management in bariatric surgery

Complication management in bariatric surgery

Peri- and post-operative management in bariatric surgery

Owing to the worldwide obesity epidemic there is an increased demand for bariatric surgery, which has proven effective in reducing obesity-related morbidity and mortality. As a prerequisite for successful treatment, careful pre-operative evaluation and life-long post-operative care within an interdisciplinary setting is mandatory. The scope of this review is to summarize current knowledge on peri-operative complications, post-operative nutritional deficiencies and treatment options after bariatric surgery. Among the most common complications related to surgery are vomiting and bleeding, as well as chronic nutritional deficiency. The major macronutrient deficiency is protein malnutrition leading to oedema and other related consequences. Micronutrients, which comprise water- and fat-soluble vitamins, essential minerals and trace elements, need to be substituted in most patients. Many patients already suffer from nutritional deficiencies prior to bariatric surgery, which, if not corrected, can cause the patient to deteriorate. Recognition of nutritional deficiencies is important to avoid short- and long-term adverse effects. Depending on the bariatric procedure, the requirement of supplementation and the follow-up schedule might be different. In this regard, studies on optimizing post-operative supplementation strategies, as well as those on avoiding chronic complications, are greatly encouraged.

Comparative analysis of LSG versus LRYGBP bariatric surgery in management of morbid obesity and type 2 diabetes mellitus in terms of percentage weight loss and T2DM resolution

Background: Obesity is a major health problem worldwide and in India also & is a major risk factor associated with significant morbidity and mortality due to comorbid conditions. Surgery is the only effective modality for significant and sustained weight loss & in resolution of associated diabetes, hypertension, sleep apnea and osteoarthritis. Laparoscopic Bariatric surgery is a unique field, this proven surgical approach provide marked improvement in quality of life with quick recovery. Methods: Retrospective data analysis of 145 laparoscopic bariatrics surgery 123 LSG & 22 RYGBP done in patients of morbid obesity alone or with T2DM , HT was analyzed in the study Over a period of three years with mean follow up period of 1-2 years. Patients were evaluated in terms of resolution of percentage weight loss & T2DM. Results: In Present study 145 cases of bariatric surgery (mainly SG & RYGB) were included. Significant weight control of around 40-60 kgs was observed. BMI reduction shift from 29-77 to 21.1-46.6kg/m2 was recorded. In all diabetes pt, post op reduction in HbA1c <6 (<6 normal value) 40% pt & near normal range in 35 % proves significant resolution in status of T2DM. Finally LSG & RYGBP showed almost similar result in % weight reduction & glycemic control. Conclusions: Thus I conclude bariatric LSG / LRYGBP are a definite choice for patient of only morbid obesity & morbid Obesity with T2DM & give adequate resolution of problem & adds to quality of life of patient with cosmetic & therapeutic benefits

Erratum to: post‐operative behavioural management in bariatric surgery: a systematic review and meta‐analysis of randomized controlled trials

Erratum to: post‐operative behavioural management in bariatric surgery: a systematic review and meta‐analysis of randomized controlled trials