Gastric Bypass Surgery Patients Research Articles

Long-term changes in lung function after Roux-en-Y gastric bypass in patients with severe obesity.

Obesity can decrease the lung function. The proposed mechanisms of reduced lung function in persons with obesity have been altered mechanical properties in the lung and chest wall, airway narrowing and increased respiratory resistance. The aim of this current study was to analyse the long-term results after gastric bypass surgery in patients with reduced lung function. The bariatric surgery observation study invited patients to a follow up 10 years after gastric bypass surgery. We compared the spirometry results before surgery to the spirometry 10 years after surgery. Thirty percent of 198 participants had reduced lung function before surgery. There was no significant relation between body mass index before surgery and lung function. Seventy-three percent of the participants with reduced lung function had normal lung function 10 years after surgery. There was no significant relation between the degree of weight loss and the improvement in lung function. Most participants with reduced lung function had normal lung function 10 years after gastric bypass surgery. There was no significant correlation between weight loss and improvement in lung function.

Central Noradrenergic Neurotransmission and Weight Loss 6 Months After Gastric Bypass Surgery in Patients with Severe Obesity

PurposeRoux-en-Y gastric bypass (RYGB) surgery is currently the most efficient treatment to achieve long-term weight loss in individuals with severe obesity. This is largely attributed to marked reductions in food intake mediated in part by changes in gut-brain communication. Here, we investigated for the first time whether weight loss after RYGB is associated with alterations in central noradrenaline (NA) neurotransmission.Materials and MethodsWe longitudinally studied 10 individuals with severe obesity (8 females; age 43.9 ± 13.1 years; body mass index (BMI) 46.5 ± 4.8 kg/m2) using (S,S)-[11C]O-methylreboxetine and positron emission tomography to estimate NA transporter (NAT) availability before and 6 months after surgery. NAT distribution volume ratios (DVR) were calculated by volume-of-interest analysis and the two-parameter multilinear reference tissue model (reference region: occipital cortex).ResultsThe participants responded to RYGB surgery with a reduction in BMI of 12.0 ± 3.5 kg/m2 (p < 0.001) from baseline. This was paralleled by a significant reduction in DVR in the dorsolateral prefrontal cortex (pre-surgery 1.12 ± 0.04 vs. post-surgery 1.07 ± 0.04; p = 0.019) and a general tendency towards reduced DVR throughout the brain. Furthermore, we found a strong positive correlation between pre-surgery DVR in hypothalamus and the change in BMI (r = 0.78; p = 0.01).ConclusionReductions in BMI after RYGB surgery are associated with NAT availability in brain regions responsible for decision-making and homeostasis. However, these results need further validation in larger cohorts, to assess whether brain NAT availability could prognosticate the outcome of RYGB on BMI.Graphical abstract

The Effect of Oral Propranolol on Intraoperative Bleeding in Minimally Invasive Gastric Bypass Surgery in Patients Admitted to Rasoul Akram Hospital: A Randomized Clinical Trial

Surgical treatment of patients with morbid obesity is now the most successful way to return to active life and overcome its effects. Complications during surgery, but still are varied and plentiful. One of the most important of these effects is increased bleeding during surgery and may require further surgery is surgery duration. The use of propranolol in other operations under the impact of which is helpful in reducing blood loss in surgery Bariatric still not been investigated. The purpose of this study is the use of propranolol in reducing gastric bypass surgery is bleeding.

Quality of life after gastric bypass surgery in patients with type 2 diabetes: patients\u2019 experiences during 2\xa0years of follow-up

BackgroundTo examine the effects of gastric bypass surgery on health-related quality of life (HRQoL) in obese patients with type 2 diabetes, and to investigate their experiences of life adjustments using quantitative and qualitative methods.MethodsThirteen patients with type 2 diabetes and obesity, (body mass index, BMI > 30 kg/m2), participating in a randomized clinical trial, completed this sub-study. HRQoL was evaluated before, and at 6 months and 2 years after gastric bypass surgery, using the RAND- 36-item health survey. At 2 years, interviews for in-depth analysis of HRQoL changes were performed.ResultsSignificant improvement was observed from baseline to 6 months for 2 of the eight health concepts, general health, and emotional well-being. At 2 years, improvements were also seen in physical functioning, energy/fatigue, as well as sustained improvements in general health and emotional well-being. Multiple regression analyses showed mostly non-significant associations between the magnitude of decrease in weight, BMI, and HbA1c during follow-up and improvement in HRQoL. The analyses from qualitative interviews supported a common latent theme “Finding a balance between the experience of the new body weight and self-confidence”.ConclusionsThe improved HRQoL after gastric bypass surgery in obese patients with type 2 diabetes was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness.Trial registration ClinicalTrials.gov Identifier NCT02729246. Date of registration 6 April 2016 – Retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02729246?term=bariglykos&draw=2&rank=1

Long-term Effects of Gastric Bypass Surgery in Patients with Obstructive Sleep Apnea

Background: Obstructive sleep apnea is a common disorder involving, intermittent mechanical obstruction of the upper airway during sleep. Obesity is the most powerful risk factor for obstructive sleep apnea. Objective: This study aimed to investigate the long-term effect of Roux-en-Y gastric bypass bariatric surgery on patients with obstructive sleep apnea. Methods: This study included patients were referred for bariatric surgery (Roux-en-Y gastric bypass) to control symptoms and complications of obesity during a 5-year period. An overnight sleep study was performed for each patient before and after the bariatric surgery, to study its effect on different obstructive sleep apnea-related variables. Results: This study included 179 patients (mean age 35.9 ± 10.7 years). The mean duration from preoperative assessment to postoperative assessment was 2.4 ± 2.2 years. The mean change in body mass index and weight showed a decrease of 16.0 ± 16.0 kg/m2 and48.7 ± 25.9 kg, respectively. The apnea hypopnea index decreased by a mean of 22.6 ± 26.3 events/hour. Conclusion: We concluded that a decrease in the body mass index by 1 kg/m2 could predict a decrease in the apnea hypopnea index by 0.46 events/hour. Moreover, after mean follow-up duration of 2.4 years, 84.3% of mild and 83.3% of moderate obstructive sleep apnea patients became normal postoperatively.

Cholecystectomy increases the risk of dumping syndrome and postbariatric hypoglycemia after bariatric surgery.

Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Bile acids (BA) have been implicated in their pathogenesis because both bariatric surgery and cholecystectomy (CCx) are known to modulate human BA metabolism. Our investigation aimed to compare the prevalence of self-reported complaints of DS and PBH in postbariatric patients with and without CCx. A large peripheral hospital in the Netherlands. All patients who underwent bariatric surgery in 2008-2011 received standardized questionnaires on DS/PBH complaints. The relative risk (RR) of CCx was calculated as the risk of perceived DS and PBH in patients with and without CCx. Of 590 participants, 146 (25%) had CCx before assessment of DS/PBH complaints. Participants were mostly female (82%) with median age of 46 years (interquartile range, 39-53). The RR for DS after CCx was higher in patients with body mass index <30 kg/m2 at the study (RR, 1.59; 95% CI, 1.04-2.42; P = .007) and in primary Roux-and-Y gastric bypass surgery patients (RR, 1.63; 95% CI, 1.10-2.42; P = .018). Detailed analysis of the latter group associated women, age younger than 50 years, without diabetes and (most prominently) with excess weight loss ≥70% (RR, 2.73; 95% CI, 1.57-4.77; P = .0004) with greater risk of DS. The RR for PBH was higher after CCx in sleeve gastrectomy patients (RR, 4.5; 95% CI, 1.00-20.3; P = .036). High suspicion of DS and PBH after CCx is increased after bariatric surgery in certain subgroups, suggesting involvement of altered BA metabolism in their pathophysiology.

Sustained Improvements in Glucose Metabolism Late After Roux-En-Y Gastric Bypass Surgery in Patients with and Without Preoperative Diabetes

To describe glucose metabolism in the late, weight stable phase after Roux-en-Y Gastric Bypass (RYGB) in patients with and without preoperative type 2 diabetes we invited 55 RYGB-operated persons from two existing cohorts to participate in a late follow-up study. 44 (24 with normal glucose tolerance (NGT)/20 with type 2 diabetes (T2D) before surgery) accepted the invitation (median follow-up 2.7 [Range 2.2–5.0 years]). Subjects were examined during an oral glucose stimulus and results compared to preoperative and 1-year (1 y) post RYGB results. Glucose tolerance, insulin resistance, beta-cell function and incretin hormone secretion were evaluated. 1 y weight loss was maintained late after surgery. Glycemic control, insulin resistance, beta-cell function and GLP-1 remained improved late after surgery in both groups. In NGT subjects, nadir glucose decreased 1 y after RYGB, but did not change further. In T2D patients, relative change in weight from 1 y to late after RYGB correlated with relative change in fasting glucose and HbA1c, whereas relative changes in glucose-stimulated insulin release correlated inversely with relative changes in postprandial glucose excursions. In NGT subjects, relative changes in postprandial nadir glucose correlated with changes in beta-cell glucose sensitivity. Thus, effects of RYGB on weight and glucose metabolism are maintained late after surgery in patients with and without preoperative T2D. Weight loss and improved beta-cell function both contribute to maintenance of long-term glycemic control in patients with type 2 diabetes, and increased glucose stimulated insulin secretion may contribute to postprandial hypoglycemia in NGT subjects.

A149 - Gastric bypass surgery in patients with psychiatric diagnoses – risk of reoperation and length of hospital stay

A149 - Gastric bypass surgery in patients with psychiatric diagnoses – risk of reoperation and length of hospital stay

Efficacy of Intravenous Acetaminophen in Length of Stay and Postoperative Pain Control in Laparoscopic Roux-en-Y Gastric Bypass Surgery Patients.

Background: Opiate-based pain medications may incur adverse effects following bariatric surgery. The aim of this study was to evaluate the efficacy of intravenous Acetaminophen (IVAPAP) on length of stay (LOS) after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery.Methods: This was a prospective, double-blind, randomized controlled trial conducted from October 2011 to March 2014 at a 416-bed teaching hospital. Eighty-nine total patients were included (control group, n = 45; treatment group, n = 44). Patients were administered either 1000 mg of IVAPAP or placebo every 6 h beginning preoperatively and continuing for four doses. LOS, total narcotic consumption, pain and nausea scores, time to return of flatus (ROF), and postoperative rescue pain medication used were measured during the first 24 h after surgery.Results: LOS was significantly decreased in the treatment group compared with control (2.72 days vs. 3.18 days; p = 0.03). There was significant reduction in time to ROF (1.87 days vs. 2.24 days; p = 0.04). Pain was significantly decreased in the first 2 postoperative hours in the treatment group (p = 0.02). Total opioid consumption, postoperative nausea scores, and use of rescue pain medications were not affected.Conclusions: The use of IVAPAP significantly decreases LOS following LRYGB, improves acute postoperative pain control, and mediates quicker return of bowel function.

Early Changes in Glucose Homeostasis after Gastric Bypass Surgery in Patients with T2DM—Role of Adipose Tissue Mechanisms?

Gastric bypass (GBP) surgery can effectively prevent or treat type 2 diabetes (T2D). Adipose tissue (AT) mechanisms may be important, but causality is not shown. We studied the relationship between early changes in whole-body and AT metabolism in obese T2D patients. Methods: Eight T2D patients with BMI 30-45 (M/F 3/5, age 49 ± 10) underwent GBP following 4 week low calorie diet. Assessments: OGTT, AT biopsies to measure gene expression in AT and in adipocytes size, glucose uptake (GU), lipolysis and insulin action. Results: At 4 and 24 weeks post-GBP, all subjects but one stopped diabetes medication. The Matsuda index increased compared to baseline, while HOMA-IR, fasting glucose, HbA1c and insulin levels decreased (p &amp;lt;0.01 for all). In adipocytes, basal, isoprenaline-stimulated or insulin-inhibited lipolysis rates and basal or insulin-stimulated GU did not change significantly. Mean adipocyte size was reduced, more at 4 than 24 weeks. At 4 week, expression of genes involved in fatty acid oxidation, CPT1b; cell proliferation, E2F1; and adiponectin were increased, whereas leptin was reduced (p&amp;lt;0.for all). Conclusion: Glycemic control and insulin sensitivity clearly improved 4 weeks after GBP, but adipocyte insulin sensitivity in vitro did not improve despite a reduction in adipocyte size. Thus the mechanisms for rapid improvement of T2D after GBP may occur mainly in other tissues than adipose.Clinical and metabolic characteristicsBaseline4-wks post surgery24-wks post surgeryAdipocyte in-vitro dataBaseline4-wks post surgery24-wks post surgeryBMI (kg/m2)37.3 ± 4A32.9 ± 3.3B28.3 ± 3.5CAdipocyte diameter (µm)110 ± 5.3A72.3 ± 10.3B92.5 ± 5.4CWeight (kg)105.5 ±14.5A93.4 ± 11.4B80.1 ± 11.1CGlucose uptake (fL/cell/sec)Waist hip ratio (cm)0.99 ± 0.07a0.97 ± 0.07a0.93 ± 0.07bbasal19.5 ± 4.316.6 ± 6.720.3 ± 3.8Body fat (%)41.2 ± 8.9A38.6 ± 8.9B30.7 ± 10.4C25 µU/ml Insulin23.1 ± 6.319.2 ± 7.629.8 ± 6.7HbA1c (mmol/mol)48 ± 6a39 ± 7b37 ± 4b1000 µU/ml Insulin31.4 ± 4.725.7 ± 10.739.4 ± 6.9Fasting glucose (mmol/L)7.4 ± 0.9A5.8 ± 0.6B5.4 ± 04CLipolysis (nmol gly-cerol/10E5 cells/h)HOMA-IR6.63 ± 0.5A2.59 ± 1.3B1.32 ± 0.5C0.5 µM Iso58.4 ± 16.253.2 ± 9.351.3 ± 12.9Matsuda index1.38 ± 0.3A2.77 ± 0.9B4.90 ± 2.1C0.5 µM Iso + 1µU/ml insulin33.1 ± 6.527.3 ± 6.941.7 ± 10.7Modified QUICKI0.29 ± 0.01A0.33 ± 0.3B0.38 ± 0.03C0.5 µM Iso + 100 µU/ml insulin26.4 ± 4.321.6 ± 5.433.1 ± 9.1Data are means ± SD. Body fat % measured by bioimpedance. Different letters indicated significant differences between the visits; lower case letter: p &amp;lt; 0,; upper case letter: p &amp;lt; 0,01. Iso, isoprenaline. Disclosure P. Katsogiannos: None. G.J. Boersma: None. P.G. Kamble: None. M.J. Pereira: None. P. Lundkvist: None. A. Karlsson: None. M. Sundbom: None. J.W. Eriksson: Employee; Spouse/Partner; Amgen Inc.. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca. Consultant; Self; Novo Nordisk A/S, Merck Sharp &amp; Dohme Corp.. Research Support; Self; Bristol-Myers Squibb Company.

Increased circulating magnesium concentrations after Roux-en-Y gastric bypass surgery in patients with type 2 diabetes

BackgroundLow circulating magnesium concentrations predict cardiovascular and all-cause mortality in patients with type 2 diabetes (T2D). Epidemiologic and clinical studies have indicated lower extra- and intracellular magnesium concentrations in patients with diabetes. ObjectiveWe aimed to describe alterations, if any, in circulating magnesium concentrations after laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) in patients with obesity and T2D. SettingOutpatient clinic of obesity and central hospital. MethodsRetrospective analysis of 1-year outcome of plasma magnesium (p-Mg) and glucometabolic status in all consecutive patients who underwent primary LRYGBP and who completed the follow-up visits, including biochemical test panels 6 and 12 months after surgery. ResultsLRYGBP and complete follow-up visits were performed in 51 patients with T2D and 86 patients without T2D. All patients were given similar dietary advice and multivitamin and mineral supplementation after surgery. Before RYGB, the patients with T2D showed lower p-Mg compared with patients without T2D (.79 ± .06 mM and .82 ± .05 mM, respectively, P<.01). P-Mg was inversely correlated to fasting blood glucose and glycosylated hemoglobin levels. After surgery, mean p-Mg increased by 5.2% in the group with T2D compared with 1.4% in the patients without T2D (P<.01), ending at an equal level of .83 mM. The alterations in p-Mg were inversely related to the changes in fasting glucose and glycosylated hemoglobin concentrations. ConclusionThe lowered p-Mg associated with impaired glucometabolic status in patients with T2D was increased after LRYGBP, reaching similar concentrations as in patients without T2D.

Persistent Endocrine-Disrupting Chemicals and Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is the most prominent chronic liver disease in Western countries, affecting approximately 25% of the population worldwide. Sex-specific differences in the development of NAFLD are apparent. While obesity and insulin resistance are major contributors to the increasing prevalence of NAFLD, a growing body of literature suggests that exposure to persistent endocrine-disrupting chemicals (pEDCs) may also play a role. This review summarizes recent (2011 and later) scientific literature investigating exposures to pEDCs, specifically persistent organic pollutants (POPs), and NAFLD, with a focus on sex-specific associations. The overwhelming majority of studies were conducted in single-sex animal models and provide biological evidence that exposures to 2,3,7,8-tetrachlorodibenzo-p-dioxin polychlorinated biphenyls, and other POPs or POP mixtures are negatively associated with liver health. There were four cross-sectional epidemiological studies in humans that reported associations for several POPs, including polychlorinated biphenyls and perfluorinated chemicals, with elevated liver enzymes. Only one of these studies, using a sample of gastric bypass surgery patients, examined sex-specific associations of POPs and liver enzymes, finding adverse associations among women only. The noticeable lack of studies investigating how differences (i.e., biochemical, physiological, and behavioral) between men and women may influence associations of pEDCs and NAFLD represents a large research gap in environmental health. Sexual dimorphism in metabolic processes throughout the body, including the liver, is established but often overlooked in the designs and analyses of studies. Other factors identified in this review that may also act to modulate associations of environmental chemicals and NAFLD are reproductive status and dietary nutrient intakes, which also remain understudied in the literature. Despite knowledge of sexual dimorphism in the actions of pEDCs, as well as in metabolic processes related to NAFLD development, few experimental or epidemiological studies have investigated sex-dependent associations. Future studies, especially those in humans, should be designed to address this research need. Consideration of other factors, such as reproductive status, dietary intakes, and mixtures of chemicals with varying endocrine-disrupting capabilities, should be explored.

Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long-Term Risks of Congestive Heart Failure.

BackgroundObesity and its association with reduced life expectancy are well established, with cardiovascular disease as one of the major causes of fatality. Metabolic surgery is a powerful intervention for severe obesity, resulting in improvement in comorbid diseases and in cardiovascular risk factors. This study investigates the relationship between metabolic surgery and long‐term cardiovascular events.Methods and ResultsA cohort of Roux‐en‐Y gastric bypass surgery (RYGB) patients was tightly matched by age, body mass index, sex, Framingham Risk Score, smoking history, use of antihypertension medication, diabetes mellitus status, and calendar year with a concurrent cohort of nonoperated control patients. The primary study end points of major cardiovascular events (myocardial infarction, stroke, and congestive heart failure) were evaluated using Cox regression. Secondary end points of longitudinal cardiovascular risk factors were evaluated using repeated‐measures regression. The RYGB and matched controls (N=1724 in each cohort) were followed for up to 12 years after surgery (overall median of 6.3 years). Kaplan–Meier analysis revealed a statistically significant reduction in incident major composite cardiovascular events (P=0.017) and congestive heart failure (0.0077) for the RYGB cohort. Adjusted Cox regression models confirmed the reductions in severe composite cardiovascular events in the RYGB cohort (hazard ratio=0.58, 95% CI=0.42–0.82). Improvements of cardiovascular risk factors (eg, 10‐year cardiovascular risk score, total cholesterol, high‐density lipoprotein, systolic blood pressure, and diabetes mellitus) were observed within the RYGB cohort after surgery.ConclusionsGastric bypass is associated with a reduced risk of major cardiovascular events and the development of congestive heart failure.

Hormone Substitution after Gastric Bypass Surgery in Patients with Hypopituitarism Secondary to Craniopharyngioma

Craniopharyngiomas (CPs) are benign brain tumors presenting frequently in childhood and are treated by surgery with or without radiotherapy. About 50% of cured patients suffer from eating disorders and obesity due to hypothalamic damage, as well as hypopituitarism, necessitating subsequent hormone substitution therapy. Gastric bypass surgery has been reported to be an efficient treatment strategy for morbid hypothalamic obesity. However, so far it is unknown whether oral hormone substitution is affected by impaired intestinal drug absorption, potentially leading to severe hypopituitarism or pituitary crisis. Four morbidly obese CP patients with panhypopituitarism treated by gastric bypass surgery were included in this retrospective analysis. Dosages of hormone substitution therapy, blood concentrations of hormones, potential complications of impaired drug absorption, and anthropometric characteristics were investigated pre- and postoperatively after 6 to 14 months and 13 to 65 months. In all CP patients (3 female/1 male; baseline body mass index, 49 ± 7 kg/m(2)), gastric bypass resulted in distinct weight loss (-35 ± 27 kg). In follow-up examinations, mean daily dosage of thyroid hormone (levothyroxinebaseline 156 ± 44 μg/day versus levothyroxinefollow-up 150 ± 30 μg/day), hydrocortisone (hydrocortisonebaseline 29 ± 12 mg/day versus hydrocortisonefollow-up 26 ± 2 mg/day), growth-hormone (somatotropinbaseline 0.9 ± 0.5 mg/day versus somatotropinfollow-up 1.0 ± 0.4 mg/day), and desmopressin (desmopressinbaseline 222 ± 96 μg/day versus desmopressinfollow-up 222 ± 96 μg/day) substitution was unchanged. No patient developed adrenal insufficiency. Oral thyroid/hydrocortisone absorption testing performed in 1 patient indicated sufficient gastrointestinal drug absorption after bariatric surgery. Our preliminary results suggest that oral hormone substitution therapy is not impaired following gastric bypass operation in CP patients with morbid obesity, indicating that it might be a safe and effective treatment strategy.

Comparative analysis of laparoscopic sleeve gatrectomy and laparoscopic gastric bypass surgery in patients with type 2 diabetes mellitus and impaired glucose tolerance

Comparative analysis of laparoscopic sleeve gatrectomy and laparoscopic gastric bypass surgery in patients with type 2 diabetes mellitus and impaired glucose tolerance

Adherence to Psychiatric Follow-up Predicts 1-Year BMI Loss in Gastric Bypass Surgery Patients.

The objective of this study was to investigate the effects of adherence to postoperative recommended psychiatric follow-up on weight loss in morbid obesity patients with psychiatric disorders 1 year after gastric bypass. Three hundred eighteen morbidly obese patients were retrospectively reviewed. They were divided into four groups according to preoperative psychiatric evaluations and adherence to psychiatric follow-up 1 year after their bypass surgery. The first group included patients who did not meet the referral criteria (NMRC). The second group consisted of patients who did not meet the psychiatric diagnostic criteria (NMDC). The third group was patients who met criteria for a psychiatric disorder and were nonadherent (NA) to psychiatric follow-up. The fourth group consisted of patients who met criteria for a psychiatric disorder and were adherent (A) to psychiatric follow-up. The A group exhibited higher % change in BMI than the NA and NMRC groups at 1 year after bypass surgery. Regression analyses to examine the effects of the grouping variable on % change in BMI were performed by controlling the effects of age, gender, educational level, and preoperative BMI. The regression coefficient for the grouping variable was 0.175 (p = .003) at the 6-month and 0.133 (p = .027) at the 1-year % change in BMI. Our preliminary data suggest that adherence to postoperative psychiatric follow-up is associated with greater postoperative weight loss. However, evidence from studies with a longer follow-up is required to justify this therapeutic approach.

Roux-en-Y Gastric Bypass Surgery in Patients with Polycystic Ovary Syndrome and Metabolic Syndrome.

We aimed to evaluate the impact of Roux-en-Y gastric bypass (RYGB) surgery on metabolic syndrome-related variables in obese women with polycystic ovarian syndrome (PCOS). Thirteen obese women with PCOS (Rotterdam criteria) who met the International Diabetes Federation criteria for metabolic syndrome and who qualified for RYGB were enrolled. Clinical examinations included ovarian ultrasonography and measurement of waist, hip, body mass index and blood pressure. Venous blood samples were taken at the visit before surgery to measure triglyceride, high-density lipoprotein, low-density lipoprotein, fasting glucose, glycated haemoglobin (HbA1c), serum progesterone, allopregnanolone, total testosterone and sex hormone-binding globulin (SHBG) levels. Six months after surgery, patients underwent the same examinations and provided blood samples to analyse the same variables. At 6 months after surgery, the metabolic syndrome-related variables improved in all patients, except in six patients with anovulatory menstrual cycles who still satisfied the criteria for metabolic syndrome. The metabolic variables normalised and serum progesterone and allopregnanolone levels increased in seven patients with ovulatory cycles. Testosterone and SHBG normalised in all patients at 6 months after surgery. Serum HDL and diastolic blood pressure did not change after surgery. Correlations were found among testosterone, progesterone, allopregnanolone, lipoproteins, triglyceride, fasting glucose and HbA1c levels, which was interpreted as progesterone and its metabolite allopregnanolone may contribute to metabolic abnormalities. In PCOS patients, normalisation of metabolic dysfunction may be incomplete by 6 months after RYGB surgery, and the start of ovulatory menstrual cycles may indicate normalisation of metabolic dysfunction.

No evidence of impaired oral hormone substitution after gastric bypass surgery in patients with morbid hypothalamic obesity and hypopituitarism secondary to craniopharyngioma

No evidence of impaired oral hormone substitution after gastric bypass surgery in patients with morbid hypothalamic obesity and hypopituitarism secondary to craniopharyngioma

Rapid Change in Afterload After Gastric By‐Pass Surgery

Obesity is associated with increased arterial dysfunction, an independent risk factor linking obesity to an elevated risk of cardiovascular (CV) mortality. Interventions are needed to alleviate the burden of obesity on the CV system. Gastric bypass surgery (GBS) is an intervention associated with rapid weight loss and a reduction in future CV events. We aim to show the immediate effects of GBS on CV function assessed by pulse wave analysis on 12 GBS patients. As expected weight decreased (pre: 132±6 to post: 125±5 Kg, p&lt;0.01) 1‐week post GBS this coincided with a reduction in waist circumference (pre: 122±5 to post: 112±3 cm, p&lt;0.05). Central systolic blood pressure (pre: 112±4 to post: 105±2 mmHg, p=0.08), augmentation index (pre:16±3 to post:8±3 ,p=0.06), an indirect measure of stiffness, and central augmentation pressure (pre: 5±1 to post: 3±1 mmHg, p=0.06) tended to decrease 1‐week post GBS. These changes were independent of a change in brachial BP. These measures suggest GBS and postoperative care reduce arterial load leading to a decrease in cardiac afterload. The reduction in afterload allows for shorter ejection duration (pre: 326±8 post: 302±11 ms, p&lt;0.05) and higher contractile rates (dP/dt pre: 672±54 post: 737±46, p&lt;0.01) leading to a decrease of the oxygen demand in the myocardium (PTIs pre: 2346±120 post: 2194±107 area/min, p&lt;0.05) and more efficient cardiac work. GBS quickly improves central arterial function alleviating some of the cardiac workload.

The effect of gabapentin on reducing pain after laparoscopic gastric bypass surgery in patients with morbid obesity: a randomized clinical trial.

Background:Pain after laparoscopic gastric bypass surgery (LGBP) is a major problem. Gabapentin is an anticonvulsant drug that can be effective in postoperative pain control.Objectives:This study examined the effect of preoperative administration of gabapentin on reducing pain after LGBP in patients with morbid obesity.Patients and Methods:This randomized clinical trial was performed in Hazrat Rasoul Akram Medical Center in Tehran. A total of 60 patients undergoing LGBP were randomly allocated into two groups; one group received 100 mg of oral gabapentin and the other group received placebo. Pain was evaluated at recovery time, and at the first, second, fourth and sixth hour of surgery by visual analog scale. The number and dose of opioid use after surgery and incidence of postoperative complications, such as nausea and vomiting, agitation, and headache, were also recorded.Results:The mean pain score in the group receiving gabapentin was significantly lower than the placebo group (P < 0.001). Indications and dose of opioid consumption between the two groups were not statistically significant. Incidence of nausea/vomiting (P = 0.028) as well as agitation (P = 0.037) was significantly lower in the gabapentin group.Conclusions:Administration of gabapentin before surgery can reduce pain after LGBP. Furthermore, it is not accompanied by significant short-term adverse effects.