Outcomes Of Gastric Bypass Surgery Research Articles

Outcome of Gastric Bypass Surgery on Patients with Polycystic Ovary Syndrome: A Review.

Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, is associated with obesity. The most effective method to achieve and maintain long-term weight loss is by the Roux-en-Y gastric bypass (RYGB). In this review, an overview about metabolic and PCOS-specific outcomes after RYGB in obese PCOS women is provided. The RYGB leads to an adequate excess weight loss and reduction in BMI in this patient population. Testosterone levels decline significantly at 6- and 12-months follow-up, as does the incidence of hirsutism and cycle irregularities. Data about fertility are scarce in this patient population. In conclusion, RYGB surgery seems to be an efficient treatment option for obese PCOS patients and leads to weight loss and improvements in metabolic parameters as well as in an improvement of PCOS-specific characteristics. However, larger prospective studies are warranted, which include all PCOS-specific outcome data in one patient population at the same time.

Weight loss before bariatric surgery and its impact on poor versus excellent outcomes at 2years.

To identify preoperative factors that influence the outcomes of gastric bypass surgery, in terms of excess weight loss at 24months. This retrospective study included two groups of patients who underwent laparoscopic gastric bypass surgery. Group A (poor outcomes) had ≤ 50%EWL or BMI ≥ 30kg/m2; group B (excellent outcomes) had ≥ 80%EWL at 24months. A comparative analysis of demography, anthropometry, comorbidities, and metabolic status was performed. A linear regression model was used to evaluate %EWL association; the number of preoperative and postoperative consultations were also compared. A total of 202 patients completed follow-up; 71 (35.1%) and 78 (38%) had poor and excellent outcomes (%EWL 44.1 ± 9.4% vs. 92 ± 10.9%), respectively. Mean age was 40.4 ± 8.9years. Patients with poor outcomes had higher weight and BMI, lesser preoperative %EWL, higher dyslipidemia and diabetes rates with longer periods of evolution, and increased HbA1c% levels. In the linear regression analysis, preoperative %EWL and initial and preoperative BMI were statistically significant determinants of %EWL at 24months Diabetes remission was 46.2% (group A) vs. 66.6% (group B). Group A had higher non-attendance rates after surgery. The factors independently associated with greater %EWL at 24months between groups were higher preoperative %EWL, and lower initial and preoperative BMI.

Evaluation the mid-term outcomes of gastric bypass surgery in severe obese patients: A 2-years follow-up study in Iran

Rationale: Roux-en-Y Gastric Bypass (RYGB) has been established as an effective bariatric technique for treating morbid obese patients, but there are questions about long-term results. Our aim is to assess the benefits of RYGB in the first 2 years after surgery.

The Neuroendocrine and Metabolic Outcomes of Bariatric Surgery Depend on Presurgical Control over Eating

Background: The outcomes of bariatric surgery are very irregular and mostly unpredictable. The search for variables of predictive value is encouraged to help preventing therapeutic failures. Objective: We aimed to confirm the hypothesis that preexisting eating behaviors could predict neuroendocrine and metabolic outcomes of gastric bypass surgery in morbidly obese subjects. Methods: Twenty-one morbidly obese patients from the Bariatric Surgery Program of our hospital were selected according to the specific inclusion and exclusion criteria for this study. The subjects filled out a validated questionnaire to quantify the “loss-of-control” (LC) dimension of food craving and provided serum samples at the onset of the study and 1 year after gastric bypass surgery. Hematological, metabolic, and hormonal variables were studied by conventional clinical tests and enzyme immunoassays and checked for correlations with LC both before and after surgery. Results: Those patients that had exhibited worse eating control at the beginning of the study experienced a better metabolic response 1 year after surgery in terms of reduction of serum insulin, HOMA1-IR, HOMA2-IR, and vitamin D₁; all these variables were inversely correlated with presurgical LC. Serum brain-derived neurotrophic factor (BDNF) levels showed the same tendency; in fact, BDNF significantly decreased only in those patients with worse eating control. Conclusions: Problematic eating behaviors may predict a better response of insulin resistance and a specific reduction of serum BDNF in morbidly obese patients after gastric bypass surgery.

Scaling it down: new in vitro tools to get the balance right.

Treatments for diabetes and obesity based on enteroendocrine hormones are a focus of research interest, partly due to the successes of glucagon-like peptide-1 (GLP-1) mimetic peptides in the treatment of diabetes and the correlation of altered enteroendocrine profiles with the positive metabolic outcomes of gastric bypass surgery. It is thought that simultaneous stimulation of more than one receptor might mimic the superior efficacy of the latter and dual or triple-agonist peptides are under investigation. An important step in developing multiple agonists is to establish the relative pharmacological potency and efficacy of new molecules at its different target receptors, and to optimise the balance of activities to achieve the desired treatment outcome. In a recent issue of the Biochemical Journal, Naylor et al. described how they used CRISPR technology to modulate endogenous receptor density in insulinoma cells to get the balance right for a dual incretin peptide engaging both GLP-1- and glucose-dependent insulinotropic polypeptide-receptors.

“When the honeymoon is over, the real work begins:” Gastric bypass patients' weight loss trajectories and dietary change experiences

To understand gastric bypass patients' experiences with managing food and eating for long-term weight management, this study examined patients' self-reported dietary changes and weight loss patterns. Thirteen women and three men between 15 months and 10 years post-gastric bypass surgery were recruited in Upstate New York. They completed two qualitative, in-depth interviews about their weight loss and dietary experiences. Using verbatim transcripts, researchers created timelines for each participant that summarized weight changes and the associated dietary behaviors. Constant comparative analysis of the timelines and transcripts identified a common, initial rapid weight loss period followed by weight stabilization, after which participants' weight loss patterns diverged into three possible long-term trajectories (Maintaining, Regained/Losing, and Regained) and one short-term trajectory (Losing). Dietary management over the periods of weight loss involved six components: physical needs, hunger and fullness, relationship with food, strategy use, habit formation, and awareness of eating. In the “honeymoon period” weight loss was “easy” because “surgery does the work” in limiting appetite, portion sizes, and interest in foods. As weight stabilized, “the work begins” as participants became capable of eating a greater quantity and a wider variety of foods. Differences in weight loss trajectories were associated with participants' abilities to maintain changes in relationship with food, dietary strategies and habits, and awareness of eating behaviors. Viewing weight loss outcomes of gastric bypass surgery as trajectories that develop as the result of dietary transitions and changes in dietary management suggests that patients need to be counseled on a variety of cognitive and behavioral strategies.

Relationships between type 2 diabetes remission after gastric bypass and different weight loss metrics: arguments against excess weight loss in metabolic surgery

BackgroundPercentage excess weight loss (%EWL) outcome of bariatric surgery is distorted by deviations in baseline body mass index (BMI). It has been reported that this can lead to false conclusions, most likely because bariatric weight loss in fact is baseline-BMI independent. ObjectivesIf the metabolic effect of bariatric surgery is baseline-BMI independent as well, could %EWL also lead to false conclusions on metabolic surgery? SettingBariatric Center of Excellence, general hospital, Netherlands. MethodsRetrospective analysis of 1-year outcome of all consecutive primary gastric bypass patients with type 2 diabetes (T2DM). Metabolic outcome (glycated hemoglobin [HbA1c], T2DM medication) was compared with bariatric outcome (weight loss) using 3 different metrics: %EWL, the most popular weight loss metric among bariatric surgeons; percentage (total) weight loss (%WL), most commonly used by nonsurgical professionals; and percentage alterable weight loss (%AWL), the only metric rendering weight loss outcome independent of baseline BMI. Metabolic success (HbA1c≤6.0%, T2DM remission) was compared with different definitions of bariatric success (≥50 %EWL, BMI<35 kg/m2, %AWL percentiles; Mann-Whitney test; P< .05). ResultsUntil May 2014, 2001 patients underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), of whom 449 had T2DM with baseline BMI 43.3 kg/m2, mean 1.6 number of T2DM medication and HbA1c 7.5%. At 1 year 95% follow-up, with BMI 30.5 kg/m2, 52.1% T2DM remission, 86.9% HbA1c<7.0%, and 63.6% without T2DM medication. No significant differences in T2DM outcome and weight loss were found with different baseline BMI, except for %EWL (P<.001). Weight loss was significantly better with better T2DM outcome, but for %EWL contradictory relationships were found in baseline-BMI subgroups. T2DM outcome was not less successful for patients with<50 %EWL. ConclusionIn T2DM patients, weight loss after gastric bypass does not depend on BMI, HbA1c, or T2DM medication at baseline. The popular %EWL metric and the 50 %EWL success criterion are problematic in comparing bariatric and metabolic outcome of gastric bypass surgery. They should be abandoned. The %WL metric is the best and most commonly used alternative, whereas %AWL is ideal for selected logistics in bariatric research. Weight loss percentiles are best suited for defining bariatric success in metabolic surgery.

Effect of Gastric Bypass Surgery on Endothelial function and Heart Rate Variability

The obesity epidemic in the US has reached 155 million people. Obesity is associated with increased incidence of cardiovascular (CV) and metabolic diseases. The use of gastric bypass surgery has been shown to decrease excess body weight and reduce CV risk. Although, more than 100,000 procedures were performed during the past decade, it is unclear how it contributes to endothelial and autonomic function. The purpose of this study was to examine the outcomes of gastric bypass surgery on endothelial function and heart rate variability (HRV).We assessed 12 gastric bypass patient's peripheral arterial and endothelial function along with HRV using EndoPAT device, pre and 1 week post‐surgery.The mean of augmentation index (AI) was lower (p&lt;0.05) 1 week post‐surgery (1.7±8.0 to ‐7.2±4.1) with an increase in mean of AI pulse (178±12 to 193±46, p&lt;0.05). LF/HF ratio was increased (1.03±0.26 to 1.34±0.28, p&lt;0.05) after gastric bypass surgery suggesting that it may contribute to improved autonomic modulation of CV function. In contrast, no changes were found in endothelial function. These findings show that gastric bypass surgery improves the parasympathetic to sympathetic input on the heart and peripheral arterial stiffness despite no change in endothelial function.

The Relationship of Pre-Operative Stress Level to Sustained Outcome in Gastric Bypass Surgery

Purpose: Previous research has shown that pre-operative health status can serve as a moderator in enhancing the accuracy of certain variables for predicting sustained weight loss after gastric bypass surgery. The present study investigated the role of pre-operative stress level as a moderator in identifying useful pre-operative predictors of sustained weight loss. Materials and Methods: Follow-up data at a mean of 3.2 years post-operatively were available for 111 patients who had undergone pre-operative assessment on 227 variables including four psychological assessment instruments. These measures were studied for their success in predicting sustained weight loss separately for patients who were under low and high pre-operative stress. Results: As anticipated, several types of variables (support, coping skills, good adjustment, and good cognitive functioning) predicted success for both groups. In addition, for low-stress patients, social drinking and self-efficacy variables (strong expectations of a broad range of positive changes), and a broader range of personal support variables were the best predictors. For high-stress patients, the best predictors included the presence of a troubled intimate relationship, lack of attention to personal health matters, an active history of smoking, and the possible need for psychiatric medication. Overall, the results show some consistency with the basic postulates of selfdetermination theory. Conclusion: The findings provide further support for the view that the investigation of pre-intervention variables can provide useful information in enhancing the predictive accuracy of the success of major life interventions in medical and other settings.

Five‐year outcome of bariatric surgery in a patient with melanocortin‐4 receptor mutation

Monogenic obesity is characterized by mutations in genes involved in the central regulation of food intake. Melanocortin-4 receptor (MC4R) mutations are the most frequent monogenic cause of severe early onset human obesity. Although bariatric surgery is the most effective therapy for idiopathic morbid obesity in adults, little is known about its effectiveness in patients with monogenic obesity syndromes. We report 5-year outcome of gastric bypass surgery in a young man with severe super-obesity associated with MC4R mutation. A 22-year-old man with a weight of 221.6 kg and body mass index of 76.7 kg m(-2) associated with a heterozygous MC4R mutation was referred to our centre for bariatric surgery. He underwent Roux-en-Y gastric bypass (RYGB) surgery and achieved weight loss of 76% of excess weight over a follow-up period of 58 months. Heterozygous MC4R mutations have been associated with dominantly inherited obesity in various ethnic groups, and non-surgical interventions are rarely effective in the long term. One previous report of bariatric surgery in a patient with complete MC4R deficiency reported poor weight loss after gastric banding. We speculate that patients with MC4R mutations achieve superior weight loss outcomes from procedures such as RYGB that produce neurohormonal changes rather than gastric restriction alone due to beneficial effects on appetite and satiety regulation.

The Relationship of Pre-Operative Health Status to Sustained Outcome in Gastric Bypass Surgery

The task of sustaining initial weight loss after gastric bypass surgery has been identified as the area of greatest concern in this intervention. The present study investigated the role of good vs. poor pre-operative health as a moderator variable in identifying useful pre-operative predictors of continued weight loss. Follow-up data at a mean of 12.8 months and again at 3.2 years post-operatively were available for 79 patients on 227 interview variables and four psychological assessment instruments. These measures were studied for their success in predicting continued weight loss over the 1–3-year period separately for patients who were in good and in poor general pre-operative health. Previous findings showed that the overall mean simple weight loss to 12.8 months was 45.61 kg, but additional weight loss to 3.2 years was only 0.28 kg. The good and poor pre-operative health groups differed little on these figures. However, the significant predictors of continued weight loss for good-health patients (high anxiety and distress, low self-esteem, poor eating habits, strong expectations of life improvement, and good achievement and coping skills) were quite different from those for poor-health patients (good psychological health and happiness, strong personal support and life satisfaction, good eating habits, and little knowledge about their health). Thus, pre-operative health status served as a powerful moderator in predicting continued weight loss from pre-operative characteristics. These findings offer a means of making more accurate predictions as to which patients are the best candidates for surgery, and also suggest that different psychological and other interventions should be selected according to pre-operative health status.

The metabolic outcome of gastric bypass surgery: A systematic review

The metabolic outcome of gastric bypass surgery: A systematic review

P-106 Effects of socioeconomic status on outcomes of gastric bypass surgery in hispanic patients

Some studies have found that outcomes of bariatric surgery may not be different between Medicaid and private insurance patients when severity of obesity and comorbidities are taken into account. No studies have looked at these outcomes specifically in a Hispanic population. This study aims to determine preoperative characteristics, outcomes and follow-up Medicaid and private insurance/self pay patients following gastric bypass (GBP) in Hispanic patients.

Predicting Outcome of Gastric Bypass Surgery Utilizing Personality Scale Elevations, Psychosocial Factors, and Diagnostic Group Membership

Researchers have traditionally relied upon various presurgical biopsychosocial measures to predict weight loss success following bariatric surgery. The present study proposed a diagnostic grouping system to predict postsurgical outcome. It was hypothesized that psychosocial and Minnesota Multiphasic Personality Inventory (MMPI)/Millon Clinical Multiaxial Inventory (MCMI) psychometric variables could be used to identify gastric bypass surgery candidates requiring additional preoperative and postoperative services. Of 143 candidates for surgical treatment of morbid obesity, 120 women and 23 men underwent psychological evaluation prior to approval for gastric bypass. Each was placed into one of four diagnostic groups based upon results of personality measures and a preoperative semistructured interview. Results support the K scale of the MMPI-2 as a significant predictor of postsurgical outcome; MCMI scores on the schizoid, schizotypal, and compulsive scales appeared to be better overall predictors of outcome.

Adolescent paraplegia, morbid obesity, and pickwickian syndrome: outcome of gastric bypass surgery

Loss of mobility, such as what occurs as a consequence of spinal cord injury or malformation, is a risk factor for excess weight gain and can confound weight management efforts. Despite well-documented outcomes of bariatric surgery in ambulatory patients, little information is available regarding weight loss surgery in adult or adolescent paraplegic patients. A 15-year-old adolescent boy with a body mass index of 60 kg/m 2 and complete paraplegia caused by spina bifida developed metabolic dysfunction, severe obstructive sleep apnea, and hypoxemia syndrome. In an effort to avoid a tracheostomy for worsening pickwickian syndrome, he was referred for weight loss surgery. Laparoscopic Roux-en-Y gastric bypass surgery was safely performed and resulted in loss of 55% of body weight (83.8% excess weight loss) for 2 years. Risk factors for cardiovascular disease markedly improved, and polysomnography demonstrated complete reversal of sleep apnea with substantial subjective improvement in daytime breathlessness and quality of life. Body composition analysis demonstrated preferential reduction in body fat mass compared with lean mass, without detrimental effect on bone mineral density. This case illustrates that paraplegia does not necessarily impair either weight loss efficacy or comorbidity resolution after Roux-en-Y gastric bypass surgery.

Body mass index as a predictor of 1-year outcome in gastric bypass surgery.

The aim of this study was to determine if presurgery (T1), post-surgery (T2), or the change in body mass index (BMI) between these time points are useful predictors for predicting longer-term (T3) outcome in gastric bypass surgery. The sample consisted of 72 gastric bypass surgery patients with an average age of 40.5. The mean presurgery BMI was 54.7 (SD = 8.6). T2 assessments (BMI, depressed mood, binge eating status) occurred on average 21 weeks (SD = 19) after surgery and T3 assessments occurred on average 63 weeks (SD = 34) after surgery. Three separate hierarchical linear regressions were performed to assess the predictive value of (1) BMI at T1, (2) BMI at T2, and (3) change in BMI from T1 to T2 on the dependent variable, BMI at T3, when age, sex, ethnicity, education status, age of overweight, binge eating status, depressed mood, and number of weeks after surgery were controlled for. When these demographic and psychological variables were controlled for, lower BMI at T1 and lower BMI at T2 predicted lower BMI at T3. However, change in BMI from T1 to T2, did not significantly predict BMI at T3 (p < .001). Higher presurgery BMI and post-surgery BMI predict poorer 1-year follow-up BMI in gastric bypass surgery, and these measures can be used as easy "rules of thumb" for predicting longer term outcome.

Regional Variations in Gastric Bypass Surgery: Results from the 2005 Nationwide Inpatient Sample

The purpose of this study is to use nationally representative data to examine regional variations in the use and outcomes of gastric bypass surgery. Using data from the Nationwide Inpatient Sample (NIS), we identified adults undergoing gastric bypass surgery (n = 92,910) in 2005. Following descriptive analyses, multiple logistic regression models were constructed to examine regional variations in the likelihood of laparoscopic vs. open approaches and in the likelihood of complications while controlling for patient and hospital characteristics. After indirectly adjusting for age and sex, the gastric bypass rates per 100,000 were as follows: Northeast, 70; Midwest, 39; South, 37; and West, 61. After adjusting for both patient and hospital characteristics, the odds of receiving laparoscopic surgery for patients living in the West were 1.79 times the mean [95% confidence interval (CI): 1.67-1.92], while the odds of receiving laparoscopic surgery for patients in the Midwest were 0.66 of the mean (95% CI: 0.62-0.70) and those of the Northeast were 0.88 of the mean (95% CI: 0.83-0.94). When adjusting for both patient and hospital characteristics, the odds of one or more postoperative complications among patients living in the South were greater than the mean (OR: 1.14, 95% CI: 1.02-1.26). Findings from this study suggest that gastric bypass surgery is more common in the Northeast and West. There is a greater likelihood of gastric bypass being performed laparoscopically in the West; it is less likely to be performed in the Northeast and Midwest. Postoperative complications are more likely to occur in the South.

Concurrent Validity of the Multidimensional Health Profile—Health Functioning Scales (MHP-H) in the Pre-operative Assessment of Applicants for Gastric Bypass Surgery

The concurrent validity of a brief screening test, the Multidimensional Health Profile-Health Functioning (MHP-H) was examined in conjunction with a much more lengthy pre-operative assessment procedure in 449 applicants for gastric bypass surgery (GBS). The MHP-H is a 69-item screening inventory that assesses five areas of health functioning: Adult Health History, Health Habits, Health Care Utilization, Health Beliefs and Attitudes, and Response to Illness. The more lengthy procedure included a comprehensive 273-item structured interview plus the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Basic Personality Inventory (BPI), and Beck Depression Inventory (BDI). The MHP-H showed significant correspondence with the more comprehensive assessment on measures of potential relevance to outcome in GBS, supporting the use of the MHP-H as a low-cost alternative to the more extensive procedure. The utility of the MHP-Psychosocial Functioning (MHP-P), a companion instrument to the MHP-H, was demonstrated in an earlier study.

Bariatric surgery for morbidly obese adolescents: Is there a rationale for early intervention?

Obesity is one of the most common metabolic disorders affecting the US population: 31% of adults and 16% of adolescents now meet the criteria for obesity. Similar to the rising prevalence of morbid obesity in adults, the prevalence of more severe obesity is also increasing in pediatric patients. The most effective treatment for morbid obesity is bariatric surgery, a procedure most commonly performed in the fifth and sixth decades of life. Although it is clear that rapid, profound weight loss can significantly improve multiple comorbid conditions in adults, including disordered carbohydrate metabolism, obstructive sleep apnea, and cardiovascular risk factors, it is not clear to what degree similar comorbidities are affected in adolescents undergoing surgical weight loss. In this paper, the indications, contraindications, and early surgical outcomes of gastric bypass surgery for morbidly obese adolescents are reviewed, and important directions for future research are discussed.

Long-Term Outcomes after Gastric Bypass

While a great deal has been published regarding the short- and medium-term outcomes of gastric bypass surgery, much less information is available regarding long-term follow-up. Such information would be valuable in changing attitudes towards this surgery. 342 severely obese patients underwent gastric bypass between June 1990 and April 2003 by a single surgeon. Careful preoperative documentation and follow-up have been maintained on a computerized database. Where necessary, recent followup information has been gained by mailed questionnaire and blood tests. Follow-up data from within the last 12 months is available for 88% of patients. Follow-up time ranges from 0-14 years, with a median of 48.6 months. Of those lost to follow-up, only 24 (7%) have <12 months follow-up. The series includes 261 females and 81 males. Preoperative BMI ranged from 28-99 (median 44). Before surgery, hypertension was present in 138, type 2 diabetes in 62, and dyslipidemia in 265. There was no 30-day peri-operative mortality. Three life-threatening complications occurred. BMI and % excess weight loss after 1, 2, 5 and 10 years were 28.7 and 89%, 28.3 and 87%, 31.2 and 70% and 31 and 75%, respectively. At most recent follow-up, 62% of those with hypertension before surgery were cured and 25% had improved. 85% of those with type 2 diabetes were cured and 10% had improved. No patients with impaired glucose tolerance had progressed to diabetes. 34% of those with dyslipidemia were cured and 38% had improved. The excellent outcomes, in terms of weight loss and improvement in co-morbidities, seen in both the short- and medium-term after gastric bypass, are well maintained into the longer-term.