Mean Postoperative Body Mass Index Research Articles

Evolution of body mass index and complications rate in severely or morbidly obese patients undergoing total knee arthroplasty

IntroductionAssociations between obesity and knee osteoarthritis or complications after total knee arthroplasty (TKA) are well established. The procedure can significantly improve knee function, favoring weight loss, despite the risk of surgical complications. The main objective of the present study was to assess change in body mass index (BMI) after TKA in patients with severe or morbid obesity (BMI≥35kg/m2). The secondary endpoint was the rate of surgical revision. The hypotheses were that there is no significant change in BMI after TKA and that there is a significant rate of revision. MethodsThis retrospective descriptive study was conducted for the period June 2009 to December 2019. Thirty-three patients (48 knees) were included: 27 women, 6 men; mean age, 66.5 years (range, 55–80). Preoperatively, 11 patients had BMI 35–39.9kg/m2 and 22 BMI≥40 (including 11 with BMI≥45kg/m2). The preoperative axis was in varus for 35 patients (73%, including 54%≥10°) and in valgus for 13 (27% including 33%≥10°). Radiological and clinical evaluation was carried out at 3 months and 1 year postoperatively. At≥2 years, change in BMI and EQ5D functional score were established by telephone survey; >5% change in BMI was considered significant. ResultsMean follow-up was 6.9±2.3 years (range, 2.9–10.5). Twenty-five patients (38 knees) were included for analysis. Mean postoperative BMI was 41±5kg/m2, with a mean decrease of 1.2±3.6kg/m2. At the last follow-up, BMI had increased in 8 patients (32%), including 3 by >5% (12%), and decreased in 16 (64%), including 7 by >5% (28%). The higher the baseline BMI, the greater the decrease: for BMI [35–39.9], –0.81 (range, –6.8; +4.3); for BMI [40–44.5],–1 (range, –9; +5.22); and for BMI>45, –1.54 (range, –3.97; +1.3). EQ5D averaged 0.75 at last follow-up. The higher the preoperative BMI, the more satisfactory the postoperative EQ5D: EQ5D for BMI [35–39.9]=0.71 (range, 0.36; 1); for BMI [40–44.5]=0.75 (range, 0.45; 1); and for BMI>45=0.80 (range, 0.48; 1). Four early surgical site infections (10.5%) and 2 isolated changes of the tibial component for early loosening (5.2%) required surgical revision. ConclusionPatients with severe or morbid obesity had a low tendency to lose weight after TKA, but this does not appear to us to be clinically relevant: the functional results were good. Nevertheless, this series showed a significant rate of revision (15%). TKA was feasible in patients with BMI≥35kg/m2, but requires appropriate patient information. Level of evidenceIV.

Surgical Management Algorithm for Intrathoracic Sleeve Migration: A Retrospective Series and Literature Review.

Background: With the increase in utilization of laparoscopic sleeve gastrectomy (LSG), intrathoracic sleeve migration (ITSM) has introduced a novel challenge for bariatric surgeons. Despite being an underreported complication, effective and safe solutions for ITSM are being sought. The aim of this study is to present our center's experience as well as a comprehensive review of the literature on ITSM. Accordingly, we propose an algorithm for the surgical management of ITSM. Methods: We conducted a retrospective chart review of 4000 patients who underwent LSG at our center. ITSM was clinically suspected with gastroesophageal reflux disease (GERD) symptoms and/or epigastric pain resistant to proton pump inhibitors. Diagnosis of ITSM was confirmed in all patients by three-dimensional computed tomography (3D-CT) volumetry. Several corrective procedures were offered based on the findings of the 3D-CT volumetry, esophagogastroduodenoscopy, and the diaphragmatic pillars' condition: cruroplasty with gastropexy, one anastomosis gastric bypass (OAGB), or Roux-en-Y gastric bypass (RYGB) with or without re-sleeve gastrectomy, omentopexy, or ligamentum teres augmentation. We conducted a literature review of ITSM using several databases. Results: Fifteen patients were diagnosed with postoperative ITSM. The most common presenting complaint was severely worsened GERD symptoms not responding to medical treatment. The mean time interval between the primary operation and diagnosis of ITSM was 38.8 ± 29.1 months. Three patients had re-sleeve gastrectomy and gastropexy, 5 patients had OAGB, and 7 patients had RYGB. The mean postoperative body mass index was 31.2 ± 4.9 kg/m2. No case of recurrent ITSM was detected during follow-up. Our electronic database search yielded 19 studies to be included in our review, which included 201 patients. Conclusion: A high index of suspicion is required to diagnose ITSM. CT volumetry with 3D reconstruction may be the most sensitive diagnostic modality. ITSM management should depend on the results of the diagnostic workup and the condition of the diaphragmatic pillars during surgery.

Revision of Roux-en-Y-Gastric bypass – Our experience in Indian patients

Background: The indications for revision bariatric surgery include inadequate weight loss, weight regain, failure to resolve comorbidities, and complications associated with primary surgery. Objectives: The objective is to evaluate the outcome of revision of Roux-en-Y gastric bypass (RYGB) and compare the efficacy of different revision procedures for weight regain, resolution of comorbidities, and complications, if any. Methods: Revision cases performed between May 2017 and April 2021 were included. The analysis of collected data was carried out for weight loss, resolution of comorbidities, and adverse outcomes. Results: Twenty three revision procedures were performed. Two patients were lost to follow-up. The overall complication and reoperation rates were 14.29% and 4.76%, respectively. The follow-up duration was at 6, 12, and 36 months. Twenty-one (91.3%) patients completed 6-month, 18 (78.3%) 12-month, and nine (39.1%) completed 36-month follow-up. The mean postoperative body-mass index at 6, 12, 36 months were 33.07+/−4.15, 33.11+/−4.05, 34.5 ± 8.81, respectively. The mean %excess weight loss (EWL) at 6, 12, 36 months were 39.47+/−13.76, 43.70+/−13.70, 41.14+/−8.48%, respectively. The patients were divided into three groups. Group A - lengthening of biliopancreatic limb (BPL) by 100 cm (n = 6); Group B - placement of ring with a diameter of 7.5 cm in addition to BPL lengthening (n = 12); and Group C - pouch trimming with BPL lengthening by 100 cm (n = 3). %EWL at 6 months was 31.86, 47.69, and 53.49, in Groups A, B, and C, respectively. Similar trends in %EWL were observed in three groups at 12 and 36 months. Conclusion: Revision bariatric surgeries are complex procedures. In our study, banded RYGB with BPL lengthening had better outcomes, though a statistical significance could not be established due to the small sample size and retrospective nature of the study.

Good to excellent Quality of Life in patients suffering from severe obesity post bariatric surgery - A single-center retrospective study report using BAROS Questionnaire.

Context:Despite the positive outcomes reported in terms of weight loss and resolution of co-morbidities, the impact of bariatric surgery on patient-reported outcomes of quality of life (QoL) still remains scarce, particularly in the Indian population. The present study was conducted to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) procedures in patients with severe obesity over a period of 2 years in terms of weight loss, resolution of comorbidities, safety and changes in QoL using the Bariatric analysis and reporting outcome system (BAROS).Subjects and Methods:The data of 100 patients who underwent RYGB and LSG between March 2014 and December 2017 were analyzed. The study endpoints such as QoL, major and minor complication rates, co-morbidity resolutions and the percentage of excess weight loss (%EWL) were measured using the Moorehead-Ardelt BAROS questionnaire II.Results:At a follow-up point of 2 years, patients achieved a mean %EWL of 79.2 (±28.9) % and the mean postoperative body mass index decreased to 31.7 (±6.22) kg/m2. No major complications were reported to have occurred. Excellent global BAROS outcome was obtained in 20% of patients, very good in 47%, good in 29%, fair 2% and failure in 2% patients 24 months post-surgery. The mean BAROS score was 5.8 ± 1.73, and a ‘good’ to ‘excellent’ QoL outcome was observed in 96% of patients.Conclusion:RYGB and LSG are safe and effective bariatric procedures. These procedures provided substantial results in good to excellent health-related QoL, weight loss and medical conditions.

Bridged one-anastomosis gastric bypass: technique and preliminary results.

One-anastomosis gastric bypass (OAGB) is an established bariatric procedure performed worldwide. We developed a modification of OAGB leaving a bridge at the cranial 2cm of the fundus as a gastro-gastric fistula to allow for endoscopic access to the bypassed stomach. We present the preliminary results of 44 patients who underwent this technique in our hospital. We analyzed, retrospectively, data collected prospectively on 44 patients who underwent our bridged one-anastomosis gastric bypass (BOAGB) procedure between September, 2018 and November, 2020. The mean age of the patients was 45.2 ± 9.3years (range 20-66years). The mean preoperative body mass index (BMI), weight, and HbA1c values were 41.5 ± 6.4kg/m2 (range 35-59), 116 ± 22.7kg, and 8.2 ± 2.1%, respectively. After a median follow-up period of 18months (11-26months), the mean postoperative BMI was 28.4 ± 3.2kg/m2 (range 21-38), the mean total weight loss was 35.8 ± 13.5kg (range 20-80kg), and the mean percentage of excess weight loss (%EWL) and the percentage of total weight loss (%TWL) were 79.8 ± 16.1% (range 47-109) and 30.6 ± 6.9% (range 19-48), respectively. The mean postoperative HbA1c level was 6.3 ± 0.9%. There were two early complications (stenosis and bleeding) and one late complication (marginal ulcer). Patients who underwent BOAGB lost weight similarly to those who underwent OABG as reported in the literature, without an apparent increase in complications related to the technique. Randomized studies with longer term follow-up are needed.

A Randomized Trial of Deep Brain Stimulation to the Subcallosal Cingulate and Nucleus Accumbens in Patients with Treatment-Refractory, Chronic, and Severe Anorexia Nervosa: Initial Results at 6 Months of Follow Up

Background: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN). Methods: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on comorbidities (affective or anxiety disorders, respectively) and type of AN. The primary outcome measure was body mass index (BMI). Results: Overall, we found no significant difference (p = 0.84) between mean preoperative and postoperative (month 6) BMI. A BMI reference value (BMI-RV) was calculated. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02). After 6 months of DBS, five participants showed an increase of ≥10% in the BMI-RV. Quality of life was improved (p = 0.03). Three cases presented cutaneous complications. Conclusion: DBS may be effective for some patients with severe AN. Cutaneous complications were observed. Longer term data are needed.

Ongoing Inconsistencies in Weight Loss Reporting Following Bariatric Surgery: a Systematic Review.

Weight loss is the primary outcome following bariatric surgery; however, its documentation within current literature is heterogeneous and poorly defined, limiting meaningful comparison between studies. Randomized controlled trials from 2012 to 2016 were identified using the Medline database through "Gastric bypass OR sleeve gastrectomy AND weight" search terms. A total of 73 studies with 5948 patients were included. Reporting of preoperative weight was done primarily using mean body mass index (BMI) (87.7%) and mean weight (65.8%). Postoperative weight reporting was more variable, with the most frequently reported measure being mean postoperative BMI (71.2%). Overall, nearly one third of all bariatric literature contained discrepancies that precluded meaningful meta-analysis. Reporting of weight loss following bariatric surgery is becoming increasingly diverse for both pre- and post-operative outcomes. Ongoing heterogeneity will continue to act as a barrier to meaningful comparison of bariatric outcomes until standardized reporting practices become adopted.

Our Early Experience with Laparoscopic Sleeve Gastrectomy in Adolescents

Background: Laparoscopic sleeve gastrectomy (LSG) is a very effective bariatric procedure indicated in the treatment of morbid obesity. Methods: Between July 2015 to November 2017, 58 adolescents with morbid obesity (42 female and 16 male) underwent LSG. The mean preoperative weight was 126.4 ± 26.7 (range 90-210) Kg. The mean body mass index (BMI) was 45.1 ± 7.9 (range 36.2-59.5) Kg/m2. Results: The mean operative time was 35 (range 33-68) minutes. The mean length of hospital stay was 1.2 (range 1-3) days. There were no intraoperative complications. The %EWL (excess body weight loss) was 50.2% ± 19.3% and 73.3% ± 20.1% at six months and 1 year respectively. The mean postoperative BMI was 33.8 ± 6.8 Kg/m2 and 27.6 ± 5.1 Kg/m2 at six months and 1 year respectively. The overall complication rate was 10.3% (6 patients). Two patients (3.4%) had postoperative bleeding and managed conservatively. Three patients (5.2%) suffered from port site infection. One of them had persistent vomiting and upper abdominal pain for 3 days after operation. Vomiting and pain improved after drainage of an abscess at the site of the 15 mm trocar. The other two improved with antibiotics. Finally, one patient was readmitted 4 days after surgery for persistent severe nausea, vomiting, and dehydration. This patient resolved with inpatient medical treatment. There were no postoperative mortalities. Conclusion: LSG can be regarded as a simple, safe, effective bariatric procedure in adolescents.

Morbidly Obese Patients Awaiting Liver Transplantation—Sleeve Gastrectomy: Safety and Efficacy From a Liver Transplant Unit Experience

BackgroundThe prevalence of obesity has increased dramatically, even in the population awaiting a liver transplantation. Despite their associated complications, we cannot consider morbid obesity any longer as an absolute contraindication to liver transplantation. Dietary approaches alone are usually completely ineffective. Bariatric surgery is the gold-standard treatment for morbid obesity and can be performed before, during, or after transplantation. Materials and methodsAt our Liver Transplantation Unit, a single surgeon performed a sleeve gastrectomy in 8 patients with liver cirrhosis due to nonalcoholic steatohepatitis, alcohol, or HCV. The Child score was A in 6 patients and B in the remaining 2 patients. Two of our patients had portal hypertension with mild esophageal varices. The procedure was performed laparoscopically in 7 cases (87.5%); in the other case, it was performed by open approach due to portal hypertension and according to patient preferences. ResultsPatients showed no postoperative morbidity or mortality. The mean postoperative body mass index of our patients was 37.4, 33.3, and 30.3 kg/m2 at 3, 6, and 12 months after surgery, respectively. The mean percentage excess weight loss of our patients was 42.9%, 62.2%, and 76.3% at 3, 6, and 12 months. Two of the patients have already undergone a successful liver transplant. ConclusionBariatric surgery in selected patients with compensated cirrhosis and without significative portal hypertension is reasonable. There are not clear guidelines on the use of bariatric surgery in patients with cirrhosis. In our experience, the sleeve gastrectomy is safe and effective in the treatment of patients with compensated cirrhosis; in a short time, the sleeve gastrectomy can improve candidacy in morbidly obese patients awaiting transplantation.

Effect of Sleeve Gastrectomy on Platelet Counts and Mean Platelet Volumes

Obesity is a chronic metabolic disorder associated with cardiovascular disease, characterized by a chronic proinflammatory and prothrombotic state. The size and hemostatic potential of circulating platelets (PLTs) differ, with larger PLTs containing more granules and producing greater amounts of vasoactive and prothrombotic factors. This study aimed to investigate the effect of laparoscopic sleeve gastrectomy (LSG) on PLT count and mean platelet volume (MPV) in morbidly obese patients. Two hundred five patients (females, n = 143; males, n = 62) who attended monitoring visits in the period prior to LSG and for 6months after surgery were included in this study. Routine physical examination findings and laboratory parameters recorded preoperatively were compared with the same parameters in the postoperative 6th month. The mean age of the patients was 37.36 ± 10.93years. The mean preoperative body mass index (BMI) of the patients was 47.65kg/m2, whereas the mean postoperative BMI at 6months was 31.49kg/m2. Prior to LSG, the mean PLT count was 314.16 ± 76.40 × 109/L. At the postoperative 6th month, the mean PLT count was significantly reduced (263.17 ± 65.67 × 109/L, p < 0.001). In the preoperative period, the MPV was 10.12 ± 0.88fL. In the postoperative period, it was significantly increased (10.41 ± 1.23fL, p > 0.001). Both preoperatively and postoperatively, PLT counts were significantly higher in females than in males. After LSG, the MPV increased in both females and males. The results demonstrated that PLT counts decreased and MPV levels increased significantly after LSG and that the decrease in PLT counts was independent of changes in BMI.

Laparoscopic Sleeve Gastrectomy Changes in the Last Decade: Differences in Morbidity and Weight Loss.

Aim is to report the learning curve and standardization process of Laparoscopic Sleeve Gastrectomy (LSG), describing the evolution in surgical technique and patient management in the authors' experiences. One hundred twenty-seven patients were divided in three Groups (A, B, and C), based on bougie size and technical details, and included 36, 46, and 45 patients, respectively. Mean operative time in Groups A, B, and C was 201.5, 150.8, and 172 minutes, respectively. Conversion to open surgery occurred in 1 Group A case. Eleven postoperative complications (8.6%) were observed (1 Group A, 8 Group B, 2 and Group C). Mean hospital stay in Groups A, B, and C, was 7.1, 6.9, and 3.1 days, respectively. At a mean follow-up of 69.7 months (Group A), 33.3 months (Group B), and 14.8 months (Group C), mean postoperative body mass index is 32.6, 28.1, and 31.5 kg/m2, respectively. Percentage estimated body mass index loss (%EBMIL) was 74.8% for Group A, 85.7% for Group B, and 68.1% for Group C. LSG is a safe and effective procedure. In the postoperative course, meticulous alertness to early warning signs of sepsis and aggressive patient management are mandatory to prevent mortality. The use of a larger bougie size was associated with weight regain.

Does clinical improvement of symptomatic degenerative lumbar disease impact obesity?

OBJECTIVE Obesity and low-back pain associated with degenerative spondylosis or spondylolisthesis are common comorbid conditions. Many patients report that the pain and disability associated with degenerative lumbar disease are key factors in their inability to lose weight. The aim of this retrospective study was to determine if there is an association between improved functional status and weight loss following a successful transforaminal lumbar interbody fusion (TLIF) procedure. METHODS A retrospective cohort study of patients who underwent single-level TLIF was performed. Inclusion criteria were preoperative body mass index (BMI) greater than 30 kg/m2, achievement of minimum clinically important difference in the Oswestry Disability Index (ODI, defined as improvement of 15 points), and minimum 1-year postoperative followup BMI. Preoperative and postoperative BMI, ODI, and visual analog scale (VAS) scores were compared. A subgroup analysis of patients who achieved substantial clinical benefit (SCB, defined as a net improvement of 18.8 points on the ODI) was also performed. RESULTS A total of 56 patients met the inclusion criteria. The mean age of the study population was 55.6 ± 13.7 years. The mean preoperative BMI was 34.8 ± 4.6 kg/m2, the mean preoperative ODI was 66.2 ± 10.1, and the mean preoperative VAS score was 7.1 ± 1.7. The mean change in ODI was -33.1 ± 13.5 (p < 0.01) and the mean change in the VAS score was -4.1 ± 2.1 (p < 0.01). The mean change in BMI was +0.15 ± 2.1 kg/m2 (range -4.2 to +6.5 kg/m2; p = 0.6). SCB was achieved in 46 patients on the ODI. The mean preoperative BMI for patients with SCB was 34.8 ± 4.8 kg/m2, and the mean postoperative BMI was 34.7 ± 5.0 kg/m2. The mean change in BMI was -0.03 ± 1.9 kg/m2 (p = 0.9). CONCLUSIONS Despite successful surgical intervention via TLIF with achievement of improved function and pain, obese patients did not have significant change in weight postoperatively.

Do patients lose weight after total knee replacement?

ObjectiveSeveral studies show that patients undergoing total knee arthroplasty (TKA) tend to maintain or gain weight after the procedure, which would result in increased wear of the prosthesis and new surgical interventions in a smaller period of time in comparison with patients with adequate body mass index (BMI). The aim of this study was to investigate the effect of TKA surgery on these patients’ BMI. MethodsInitially the records were analyzed, chosen at random from 91 patients undergoing TKA during the period from August 2011 to July 2013. Patients were stratified by BMI as normal weight (BMI between 20 and 25), overweight (BMI between 25 and 30), and obesity (BMI>30). They were re-evaluated in a minimum period of 18 months. ResultsThe mean age of the sample population was 68.1 years; 69.1 for men and 67.2 for women. The mean preoperative BMI was 27.24kg/m2. Among the study participants, in the preoperative period, 17 patients had normal weight, 65 were overweight, and nine were obese. Postoperative analysis showed weight loss in 41 patients (46%), and weight gain in 50 patients (54%). The mean postoperative BMI was 27.16kg/m2, in general, experiencing a slight decline in the mean BMI of 0.08kg/m2. ConclusionPatients who underwent TKA did not achieve significant reduction in BMI after surgery.

Impact of preoperative body mass index on the final outcome after laparoscopic sleeve gastrectomy for morbid obesity.

Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric surgery due to its excellent results and limited morbidity. Our study aims to assess the efficacy of LSG in terms of loss of weight and co-morbidity improvement and to evaluate the impact of preoperative body mass index (BMI) on the final outcome. The data of 173 patients who underwent LSG were analyzed. Laparoscopic sleeve gastrectomy was indicated only for patients with BMI >40. Mean postoperative BMI, co-morbidity improvement, operative data and complications, length of hospital stay and excess weight loss were evaluated and recorded. This study included 151 females and 22 males with a mean age of 37.6 years. Patients were divided into two groups according to their BMI (group I <50, group II >50). Mean preoperative BMI was 53.8 kg/m2. Mean operative time was 120 minutes. Mean duration of hospital stay was 3.2 days. Mean postoperative BMI decreased to 47.3 kg/m2 at 1 year. Excess weight loss was 43.1% at 6 months, 71.1% at 1 year, and 87.5% at 5 years. Group I showed a significantly shorter length of hospital stay, more improvement of laboratory parameters and more reduction in BMI as compared to group II. There was one mortality and six cases had gastric staple line leakage. Laparoscopic sleeve gastrectomy is an efficient treatment to achieve significant weight loss that is maintained up to 5 years of follow up, also it improves some of the obesity related co-morbidities. This beneficial impact of LSG appears to be significantly higher in patients with BMI <50.

Laparoscopic sleeve gastrectomy using a synthetic bioabsorbable staple line reinforcement material: Post-operative complications and 6 year outcomes.

BackgroundGastric leak after laparoscopic sleeve gastrectomy (LSG) is a serious complication. Currently, the literature lacks long-term outcomes in LSG and leak rates after reinforcement of the staple line. The aims are two-fold: to present leak rates from using staple line reinforcement and six year outcomes of LSG in relation to resolution of obesity-related comorbidities and long-term weight loss.Materials and methodsThis is a single-institution, retrospectively reviewed study of 204 patient case files. Data from all patients undergoing LSG between December 2007 and May 2013 was collected.ResultsThe total complication rate was 6.9% (14/204), with no recorded staple line leaks. The mean postoperative Body Mass Index (BMI) at 1 year, 2 years, 3 years, 4 years, 5 years, and 6 years was 39.3 ± 8, 38.7 ± 8, 40.4 ± 9, 40.5 ± 10, 43.0 ± 10, and 42.4 ± 7, respectively. The mean % excess weight loss at 1 year, 3 years, and 6 years was 48.4 ± 19, 51.7 ± 28, and 41.0 ± 21, respectively. There were no significant differences between follow-ups at year 1 and 3 (p > 0.05), and between year 3 and 6 (p > 0.05) for the mean % excess weight loss. The resolution rates for all patients were 74%, 61%, 79%, and 90% for hypertension, hypercholesterolemia, diabetes mellitus type 2 and obstructive sleep apnea, respectively.ConclusionThe synthetic bioabsorbable reinforcement material shows no staple line leaks making it safe to use. LSG as a procedure had a high resolution of obesity-related comorbidities as well as sustainable long-term weight loss.

Os pacientes emagrecem após artroplastia total de joelho?

ObjectiveSeveral studies show that patients undergoing total knee arthroplasty (TKA) tend to maintain or gain weight after the procedure, which would result in increased wear of the prosthesis and new surgical interventions in a smaller period of time in comparison with patients with adequate body mass index (BMI). The aim of this study was to investigate the effect of TKA surgery on these patients’ BMI. MethodsInitially the records were analyzed, chosen at random from 91 patients undergoing TKA during the period from August 2011 to July 2013. Patients were stratified by BMI as normal weight (BMI between 20‐25), overweight (BMI between 25‐30), and obesity (BMI>30). They were re‐evaluated in a minimum period of 18 months. ResultsThe mean age of the sample population was 68.1 years; 69.1 for men and 67.2 for women. The mean preoperative BMI was 27.24kg/m2. Among the study participants, in the preoperative period, 17 patients had normal weight, 65 were overweight, and nine were obese. Postoperative analysis showed weight loss in 41 patients (46%), and weight gain in 50 patients (54%). The mean postoperative BMI was 27.16kg/m2, in general, experiencing a slight decline in the mean BMI of 0.08kg/m2. ConclusionPatients who underwent TKA did not achieve significant reduction in BMI after surgery.

Early Laparoscopic Sleeve Gastrectomy Outcomes in Terms of Weight Loss.

To investigate the outcomes of laparoscopic sleeve gastrectomy (LSG) in terms of weight loss. Descriptive cohort study. Department of Surgery, Shifa International Hospital, Islamabad, from January 2009 to January 2015. A total of 100 consecutive patients were included in the study through retrospective chart review. A5-port technique was utilized with the gastric sleeve being created using endostapler. Postoperatively, patients gradually progressed from clear liquid diet and oral rehydration salts to nutritional supplements over three days. By two weeks postoperatively, patients had progressed to a solid diet. SPSS was used for data entry and analysis. Body mass index (BMI) and weight in kg were determined. From 100 patients, 17 were lost to follow-up less than a week into the postoperative period. Of the remaining, average age of the patients was 34.7 ±11.3 years at the time of surgery. The majority of patients were females (72%). Mean preoperative and postoperative BMI was 45.3 ±10.4 kg/m2 and 35.0 ±10 kg/m2, respectively. Of the 83 patients, 62 were followed-up for longer than 1 month (average 419 days). For patients in this category, mean reduction in BMI was 10.3 ±6.5 kg/m2 with average weight loss of 34.3 ±18.2 kg. There were no mortalities associated with LSG. Laparoscopic sleeve gastrectomy is a safe and effective intervention in young Pakistani females with encouraging outcomes at a mean follow-up of over one year.

Weight Changes After Reduction Mammaplasty in Adolescents

PurposeThe ability to exercise more easily and weight loss are often cited benefits of reduction mammaplasty. However, measured weight outcomes after this common procedure are lacking. The purpose of this study was to measure body mass index (BMI) changes in an otherwise healthy adolescent sample after bilateral breast reduction. MethodsWe retrospectively reviewed the records of patients aged 12–21 years who underwent reduction mammaplasty at our institution between 2007 and 2013, with a minimum postoperative follow-up time of 1 year. Charts were reviewed for preoperative and postoperative height and weight, amount of breast tissue resected, and medical comorbidities. No formal nutritional support or weight loss program was instituted before or after surgery. ResultsEighty patients meeting eligibility criteria were identified. The mean follow-up time was 2.0 ± 1.0 years. Mean postoperative BMI did not differ significantly from mean preoperative BMI (27.8 ± 7.1 kg/m2 vs. 27.3 ± 6.4 kg/m2). However, among overweight and obese patients, a significant gain in preoperative to postoperative BMI was observed, on average (p = .019). Twelve (22.2%) of these patients increased their BMI by at least 10% after reduction mammaplasty. Although approximately one third (37%) of overweight/obese patients decreased their BMI, only 5.6% decreased BMI by at least 10%. ConclusionsWe found no significant difference between mean preoperative and postoperative BMI among patients who underwent reduction mammaplasty. Our results suggest that although reduction mammaplasty may facilitate exercise and help some patients lose weight, meaningful postoperative weight loss without additional support is rare.

Do patients lose weight after total hip arthroplasty?

ObjectiveTo investigate the effect of total hip arthroplasty (THA) on body mass index (BMI), from before to after the operation. Methods100 patients who underwent THA were retrospectively analyzed. They were stratified according to BMI, as proposed by the World Health Organization (WHO). ResultsThere were 48 male patients and 52 female patients. Their mean age was 63.8±13.5 years. The mean follow-up was 24.6±0.6 months. The men had a mean preoperative BMI of 28.4±3.6kg/m2 and the women, 27.5±5.0kg/m2. The mean postoperative BMI was 28.9±0.7kg/m2 for the men and 27.8±0.7kg/m2 for the women. There was a general mean increase in BMI of 0.4kg/m2. The BMI increased both in patients with normal weight and in those who were overweight, but it decreased slightly in patients who were obese. BMI remained unchanged in the majority of the patients (73%). ConclusionThe improvement in mobility achieved through THA did not promote any reduction in anthropometric measurements in the majority of the patients.

Os pacientes emagrecem após artroplastia total do quadril?

ObjectiveTo investigate the effect of total hip arthroplasty (THA) on body mass index (BMI), from before to after the operation. Methods100 patients who underwent THA were retrospectively analyzed. They were stratified according to BMI, as proposed by the World Health Organization (WHO). ResultsThere were 48 male patients and 52 female patients. Their mean age was 63.8±13.5 years. The mean follow‐up was 24.6±0.6 months. The men had a mean preoperative BMI of 28.4±3.6kg/m2 and the women, 27.5±5.0kg/m2. The mean postoperative BMI was 28.9±0.7kg/m2 for the men and 27.8±0.7kg/m2 for the women. There was a general mean increase in BMI of 0.4kg/m2. The BMI increased both in patients with normal weight and in those who were overweight, but it decreased slightly in patients who were obese. BMI remained unchanged in the majority of the patients (73%). ConclusionThe improvement in mobility achieved through THA did not promote any reduction in anthropometric measurements in the majority of the patients.