Management Of Bariatric Patients Research Articles

Where Are My Patients? Lost and Found in Bariatric Surgery.

Follow-up is a cornerstone of the success of bariatric surgery. However, adherence to monitoring decreases over time. The reasons for non-compliance with follow-up still remain unclear. This is a retrospective, single-center, cohort study, including all patients undergoing bariatric surgery between 2014 and 2017. Patients lost to follow-up were called back and questioned about the reasons of non-adherence. Patients followed and lost to follow-up were compared in terms of weight loss. Overall, 29.7% of patients were lost to follow-up. After a callback, we obtained information on 89.9% of patients. The first reason of non-attendance was considering follow-up as unnecessary (29.5%). Almost a quarter of patients (24%) discontinued follow-up due to geographic distance, while 23.3%, 18.6%, and 14.0% of patients explained the lack of follow-up due to family, professional, or health problems. Only 7.0% declared to renounce to follow-up because of poor weight loss. Percentage of excess weight loss at 3 and 5years after surgery was respectively 73.6% and 81.2% in attendant patients, and 70.7% and 68.4% in non-adherent patients (p = ns). Despite a greater weight loss in the group of patients regularly followed, the difference with patients lost to follow-up remained not significant in multivariate analysis. Follow-up is of crucial importance in the management of bariatric patients. Follow-up disruption is associated to individual patient choice and external constraints. In order to improve the quality of long-term care, care providers will probably need to adapt to these constraints, diversifying the offer of care.

WEIGHT LOSS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE MULTIDISCIPLINARY APPROACH OF MAGGIORE DELLA CARITA’ AOU, NOVARA

Bariatric surgery is currently considered the most effective treatment to obtain a substantial weight loss sustained on the long term in morbid obesity. We present data regarding the recent bariatric experience of candidates enrolled between July 2016 and 2018 at “Maggiore Della Carita” Novara hospital. According to international and national guidelines1-2, surgery inclusion criteria were: age 8-65 years old; BMI ≥40 kg/m2 or ≥35 kg/m2 with at least one obesity-related comorbidity; multi-disciplinary team pre-surgical evaluation of the medical and psychological conditions that could interfere with health, weight loss outcome, or follow-up compliance 3. Among 98 candidates, 40 (41%) subjects underwent a bariatric procedure; 90% (36) underwent laparoscopic sleeve gastrectomy (LSG). No serious adverse events (SAE) were observed after surgery up to 12 months. The mean baseline BMI was 44.4 kg/m2 (±5.2), with a decrease of 9.7 kg/m2 (±3.5) and 13.3 kg/m2 (±5.5) at 6 and 12 months, respectively. The Percent Excess Weight Loss (%EWL) and Percent Total Body Weight Loss (%TBWL) were 47.8 (±17.7), 61.2 (±27.6) and 21.9 (±7.5), 27.6 (±10) at 6 and 12 months, respectively. Moreover, mean serum glucose levels reduced from 110.6 (±35.5) mg/dL at baseline to 90.4 mg/dL (±14.8) and 88.3 mg/dL (±12.7) after 6 and 12 months. Detailed data are shown in the table 4. Our multidisciplinary experience in bariatric patient management demonstrates that a proper pre-surgical selection of candidates and a regular follow up are effective in obtaining a substantial weight loss, preventing SAE, and ensuring long-term compliance in order to avoid weight regain and malnutrition. 1-SICOB

Obesity Management Task Force of the European Association for the Study of Obesity Released “Practical Recommendations for the Post-Bariatric Surgery Medical Management”

Bariatric patients may face specific clinical problems after surgery, and multidisciplinary long-term follow-up is usually provided in specialized centers. However, physicians, obstetricians, dieticians, nurses, clinical pharmacists, midwives, and physical therapists not specifically trained in bariatric medicine may encounter post-bariatric patients with specific problems in their professional activity. This creates a growing need for dissemination of first level knowledge in the management of bariatric patients. Therefore, the Obesity Management Task Force (OMTF) of the European Association for the Study of Obesity (EASO) decided to produce and disseminate a document containing practical recommendations for the management of post-bariatric patients. The list of practical recommendations included in the EASO/OMTF document is reported in this brief communication.

The impact of preoperative investigations on the management of bariatric patients; results of a cohort of more than 1200 cases

BackgroundDespite the increasing use of bariatric surgery as the most effective treatment of morbid obesity, there is still no consensus on its preoperative diagnostic workup. The aim of this study was to identify the pathologies of the endoscopic and radiologic investigations before performing bariatric surgery and to evaluate their impact on the patient management. MethodsRetrospective analysis of prospectively collected data of 1225 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass (n = 834) or sleeve gastrectomy (n = 391) at our institution. An abdominal ultrasound was performed in 1188 patients, 1190 patients underwent upper gastrointestinal (GI) endoscopy, 1178 patients underwent upper GI series, and 610 patients underwent esophageal manometry. SettingPrivate hospital, Switzerland. ResultsGallstones were detected in 222 (21.0%) patients, and a synchronous cholecystectomy was performed in 220 (18.0%) patients. The upper GI series indicated hiatal hernias in 325 (27.6%) patients. The most common findings of the upper GI endoscopy were type-C gastritis (224 patients, 18.8%), reflux esophagitis (229 patients, 19.2%), Helicobacter pylori–positive gastritis (158, 13.3%), and hiatal hernia (55 patients, 4.6%). Additionally, we detected 1 Barrett’s high-grade dysplasia, 2 Barrett’s carcinomas, and 1 stomach cancer in asymptomatic patients, who were scheduled to have a sleeve gastrectomy. Esophageal motility disorders were detected in 104 (17.0%) individuals, who underwent esophageal manometry. ConclusionsWe recommend performing abdominal sonography and upper GI endoscopy before bariatric surgery as they reveal findings, which influence the therapeutic approach. Upper GI series and esophageal manometry help to define patients not suitable for sleeve gastrectomy.

Weight Loss Following Left Gastric Artery Embolization in a Human Population without Malignancy: A Retrospective Review

Objective: Recent evidence suggests embolization of the left gastric artery, which provides the predominant arterial supply to the gastric fundus, may affect energy homeostasis through alterations in ghrelin production. The purpose of this study is to evaluate post-procedural weight loss following left gastric artery embolization (performed for reasons other than for weight loss) in patients without malignancy. Materials and Methods: A retrospective review of patients who underwent arterial embolization for acute upper gastrointestinal hemorrhage between January 2002 and January 2014 was conducted. A study group of 10 patients who underwent left gastric artery embolization and control group of 22 patients who underwent embolization of a different mesenteric or visceral arterial branch for non-tumoral acute gastrointestinal bleeding were collected. Their electronic medical records were reviewed and data points for height, weight, and body mass index were collected at 1-, 4-, 8-, and 12-month post-procedural time points. Exclusion criteria included age less than 18 years and documented history of malignancy. Results: The left gastric artery embolization group had a significantly greater reduction in body mass index compared with the control group at 1 month (-9.8% vs. -4.0%, p=0.042) and 4 months (-11.7% vs. +0.1%, p=0.033). No significant change was demonstrated at 8 months (-8.6% vs. -1.7%, p=0.32) and 1 year (-5% vs. +2.6%, p=0.42) compared with controls. Conclusion: Left gastric artery embolization provides early post-procedural weight loss that may persist for at least 1 year. Further studies will better elucidate the role of gastric artery embolization in the management of bariatric patients.

Bariatric surgery in patients with liver cirrhosis

BackgroundData regarding the management of bariatric patients with cirrhosis are scarce, and there is no strong evidence that supports a specific approach for this group of patients. The aim of this study was to review our experience with cirrhotic patients undergoing bariatric surgery. MethodsA prospectively maintained database was reviewed to assess the outcomes of bariatric surgery for patients with known cirrhosis and for patients with cirrhosis discovered at surgery (unknown cirrhosis). ResultsFrom April 2004 to September 2011, 23 patients (12 with known cirrhosis and 11 with unknown cirrhosis) met inclusion criteria. There were 14 females and 9 males with a mean age of 51.5±8.3 and a mean body mass index of 48.2±8.6 kg/m2. Child-Pugh classes were A (n = 22) and B (n = 1). Patients had a high frequency of diabetes (83%), dyslipidemia (61%), and hypertension (83%). Procedures performed were laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 14), laparoscopic sleeve gastrectomy (LSG) (n = 8), and laparoscopic adjustable gastric banding (n = 1). Two patients underwent LSG successfully after transjugular intrahepatic portosystemic shunt. Mean length of hospital stay was 4.3±2.7 days. Complications developed in 8 patients. One patient died of unknown cause 9 months after surgery. No patients had liver decompensation after surgery. The patients lost 67.4%±30.9% of their excess weight at 12 months follow-up and 67.7%±24.8% at 37 months follow-up. ConclusionLRYGB and LSG can be performed without prohibitive complication rates in carefully selected patients with cirrhosis. In our experience, bariatric patients with cirrhosis achieved excellent weight loss and improvement in obesity-related co-morbidities.

Managing patients who are overweight

The weight and size of the UK population is increasing, and many healthcare assistants and assistant practitioners look after patients who are obese or of bariatric proportions. Some bariatric patients require assistance with mobility and daily living activities, but care must be provided in an effective and safe manner. This second article on bariatrics outlines the treatment and management of bariatric patients within a hospital, clinic or community setting.

Bariatric Surgery: Beyond Informed Consent

Abstract The safety and efficacy of bariatric surgery in the management of obesity have been demonstrated in recent years. Bariatric surgical procedures have become less invasive and require less time in the hospital. Similarly, changes in payer rules increased the popularity of bariatric procedures among many overweight and obese patients for whom nonsurgical interventions have failed. However, the increased diversity of patients seeking bariatric surgery heightens concerns about informed consent and how much of the indications, risks, complications, and commitment to lifelong weight-loss management patients truly understand prior to making this life-changing decision. This article explores the relationships among informed consent, patient decision making, and healthcare literacy in the management of bariatric patients before, during, and after surgery. It discusses alternative strategies for providing information that facilitates informed consent and decision making and supports the patient throughout t...

Current Issues and Challenges in the Management of Bariatric Patients

Morbid obesity is an increasingly common healthcare problem, and providers and patients currently face numerous challenges in dealing with this problem effectively. Issues addressed in this article include the effect of stigma, the need for more evidence regarding effective management options, and the declining insurance coverage for bariatric surgery. The role of bariatric surgery in effective management of morbid obesity is discussed, along with the effect on and possible reasons for declining coverage. A comparison between benefits and coverage for bariatric surgery and angioplasty/stent placement is included.