Patients Candidates For Bariatric Surgery Research Articles

Prevalence of obstructive sleep apnea in obese patients candidates for bariatric surgery and predictive questionnaires

Introduction and objectivesObstructive sleep apnea (OSA) is a prevalent condition among electable to bariatric surgery obese patients, often remaining underdiagnosed, thereby increasing surgical risk. The main purpose was to determine prevalence of OSA among candidates for bariatric surgery and to assess the rate of underdiagnosis of this condition. Additionally, the study aimed to evaluate the specific performance of three sleep questionnaires and scales (Excessive Daytime Sleepiness Scale (EDSS), Epworth Sleepiness Scale (ESS), and STOP-Bang) in these patients. MethodsA longitudinal, prospective, single-cohort study, with consecutive sampling including patients aged 18–65 years with obesity grade II (body mass index (BMI) ≥ 35 kg/m2) and hypertension, type 2 diabetes, metabolic syndrome or OSA or obesity grade III or IV (BMI ≥ 40 kg/m2) elective for bariatric surgery. Patients were evaluated at the Otorhinolaryngology department with an anamnesis regarding OSA including the administration of three sleep questionnaires (EDSS, ESS, and STOP-Bang), followed by cardiorespiratory polygraphy (CRP) for sleep evaluation. Results124 patients were included in this study. While 74.2% of the sample exhibited OSA on CRP, only 28.2% had a prior diagnosis. The STOP-Bang questionnaire demonstrated the highest sensitivity (93.3%) for detecting moderate to severe OSA, although with low specificity (33.8%). EDSS and ESS did not show a significant association with the presence of OSA. ConclusionsOSA screening is crucial in candidates for bariatric surgery due to its high prevalence and low diagnosis rate. The STOP-Bang questionnaire may serve as a useful tool for identifying patients at risk of moderate to severe OSA and optimizing sleep assessments. However, further research is necessary to validate its utility in this specific population.

Selecting the Best Gastric Anatomical Place for Biopsy to Detect Helicobacter Pylori in Iranian Morbid Obese Patients.

Obesity and Helicobacter pylori (H. pylori) infection are public health problems in the world and Iran. This study aimed to indicate the anatomical place with the most accurate results for H. pylori. According to gastric mapping, this study will be able to evaluate the prevalence of H. pylori based on the pathology of gastric mapping and the accuracy of the antral rapid urease test (RUT) based on endoscopic findings. In this cross-sectional study, upper digestive endoscopy and gastric pathology were studied in 196 obese patients candidates for bariatric surgery. Statistical analyses were performed using a t-test and Chi-square/fisher's exact test to compare the groups. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and odds ratio (OR) were used to compare RUT and pathological H. pylori test of each of the six areas of the stomach. We set a positive test of the pathology of 6 regions of the stomach as our gold standard (in this study). The most common area of the stomach for pathological findings of H. pylori were incisura (116, 59.2%), greater curvature of the antrum (115, 58.3%), lesser curvature of the antrum (113, 57.7%), lesser curvature of the corpus (112, 57.1%), greater curvature of the corpus (111, 56.6%) and cardia (103, 52.6%). The prevalence of H. pylori was 58.2% (114 cases) and 61.2% (120 cases) with RUT and gastric pathology, respectively. Mild, moderate, and severe infection of H. pylori in cardia (58, 29.6%), greater and lesser curvature of the antrum (61, 31.1%), and greater curvature of the antrum (37, 18.9%) had the highest percentages of incidence comparing to other sites of the stomach, respectively. The most sensitive area for pathologic biopsy was incisura (96.6%, 95% confidence interval: 91.7, 98.7). According to the highest sensitivity, PLR, NPV, and pathological findings of H. pylori in accordance with the lowest NLR in the incisura compared with other parts of the stomach, it is highly recommended to take the biopsy from the incisura instead of other anatomical places of stomach for detecting H. pylori specifically if our strategy is taking only one biopsy.

Effect of 8 Weeks milk thistle powder (silymarin extract) supplementation on fatty liver disease in patients candidates for bariatric surgery

IntroductionNonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and is becoming the most frequent indication of liver transplantation. At present, since no Food and Drug Association (FDA) approved medication exists for NAFLD patients, bariatric surgery is indicated for the significant improvement in obesity-related comorbidities, such as NAFLD. However, alternative therapy is emerging to manage NAFLD. Problematically, many patients taking herbal remedies, such as Silymarin (milk thistle), with little/no understanding of its purported properties. MethodsFifty-two morbidly-obese (47.84 ± 6.48 kg m−2) patient candidates (mean age: 38.90 ± 10.28 years; n = 41 women and 11 men) for bariatric surgery with NAFLD were randomly assigned to determine the efficacy of eight weeks of Silymarin supplementation (140 mg four times daily for a total of 560 mg) on the aspartate transaminase (AST)/alanine transaminase (ALT) (AST/ALT) ratio, Fibrosis-4 (Fib-4) score, NAFLD score, sonographic grading, and fibroscan stages of NAFLD. ResultsSignificant (p ≤ 0.05) improvements were found in AST/ALT ratio, BMI and sonographic grading. No significant change was found for fibroscan staging, Fib-4, and NAFLD scores. ConclusionSilymarin improved ultrasound fatty liver grading and liver enzymes morbidly-obese patient candidates for bariatric surgery with NAFLD after only eight weeks, without any adverse effects.

Adherence to the mediterranean diet and metabolic syndrome: Potential relationship in patients candidates for bariatric surgery

Adherence to the mediterranean diet and metabolic syndrome: Potential relationship in patients candidates for bariatric surgery

Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair.

To analyze the safety of laparoscopic ventral hernia delayed repair in bariatric patients with a composite mesh. This retrospective single-center observational trial analyzed all bariatric/obese patients with concomitant ventral hernia who underwent laparoscopic abdominal hernia repair before bariatric surgery (group A) and laparoscopic delayed repair after weight loss obtained by the bariatric procedure (group B). Group A (30 patients) had a mean BMI of 37.8 ± 5.7kg/m2 (range: 34.0-74.2kg/m2); group B (170 patients) had a mean BMI of 24.6 ± 4.5kg/m2 (range 19.0-29.8kg/m2) (p < 0.05). Mean operative time: group A, 51.7 ± 26.6min (range 30-120); group B 38.9 ± 21.5min (range 25-110) (p < 0.05). Average length of stay: group A, 2.0 ± 2.7days (range 1-5) versus group B, 2.8 ± 1.9days (range 1-4) (p > 0.5). Recurrent hernia group A 1/30 (3.3%) versus recurrent hernia group B 4/170 (2.3%) (p > 0.5). Bulging: group A, 3/30 (10.0%) versus group B, 0/170 (0%) (p = 0.23). The present study demonstrates the safety of performing LDR in patient candidates for bariatric surgery in cases of a large abdominal hernia (W2-W3) with a low risk of incarceration or an asymptomatic abdominal hernia. In the case of a small abdominal hernia (W1) or strongly symptomatic abdominal hernia, repair before bariatric surgery, along with subsequent bariatric surgery and any revision of the abdominal wall surgery with weight loss, is preferable.

PO-01-077 The effects of testosterone treatment on fat tissue dysfunction and nonalcoholic fatty liver disease in obese men undergoing bariatric surgery

Substitution treatment of hypogonadism in clinical and experimental models has shown beneficial effects on insulin sensitivity and accumulation of visceral and liver fat. Aim of the study was to analyze the effects of testosterone replacement therapy on benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) clinical parameters, adipose tissue dysfunction and nonalcoholic fatty liver disease (NAFLD) in obese patients candidates for bariatric surgery. Patients were divided into three groups: eugonadal, untreated hypogonadal and symptomatic hypogonadal treated for 6-8 months with testosterone. BPH/LUTS parameters were assessed by IPSS (International Prostate Symptom Score) and prostate ultrasound. Preadipocyte cells (hPADs) isolated from adipose tissue biopsies were used to evaluate insulin sensitivity, adipogenic potential and mitochondrial function. NAFLD was evaluated by triglycerides (TG) assay and histological examination of liver biopsies. Clinically, notwithstanding a prostate volume increase, testosterone treatment improved the IPSS score and hyperemia. Liver TG levels correlated positively with both steatosis and NAS scores, and resulted significantly higher in hypogonadal patients when compared to eugonadal patients, with testosterone treatment significantly reducing TG levels. In the liver, testosterone treatment induced an increased mRNA expression of lipid metabolism markers, whereas in visceral adipose tissue it induced an increased mRNA expression of lipid catabolism and mitochondrial biofunctionality markers. In hPADs testosterone treatment induced an increased mRNA expression of brown adipogenesis and mitochondrial biofunctionality markers. Testosterone treatment normalized hPADs ability to respond to increasing concentrations of insulin. Accordingly, glucose uptake AUCs showed a positive correlation with testosterone levels. Hypogonadal hPADs mitochondria displayed a lower average length and a superoxide generation increase, compared to eugonadal, with testosterone treatment normalizing both parameters.

Food Addiction is Associated with Higher Neuroticism, Lower Conscientiousness, Higher Impulsivity, but Lower Extraversion in Obese Patient Candidates for Bariatric Surgery

ABSTRACTBackground: The “food addiction” phenotype identifies a subpopulation of individuals experiencing substance-dependence symptoms toward specific foods. In the current debate on whether the “food addiction” phenotype should be considered as an addictive disorder, assessment of the personality traits associated with this phenotype would provide arguments for or against the “food addiction” phenotype and its inclusion in the “substance-related and addictive disorder” category. Objectives: To assess the personality characteristics associated with the “food addiction” phenotype in obesity surgery candidates (i.e., big five personality dimensions, alexithymia and impulsivity). Methods: We assessed food addiction (Yale Food Addiction Scale), personality dimensions (Big Fig Inventory), impulsivity (Barratt Impulsiveness Scale-11th version) and alexithymia (Toronto Alexithymia Scale-20 items) in 188 bariatric surgery candidates recruited between July 2013 and November 2015 in the Nutrition Department of the University Hospital of Tours. We used chi-squared tests and Student's tests or Mann-Whitney-U-tests to determine the factors associated with food addiction. Results: Prevalence of current food addiction was 16.5%. Patients with (vs. without) food addiction had lower conscientiousness (p = .047), higher neuroticism and lower extraversion (ps < 0.001), but there was no difference in terms of agreeableness (p = 0.42) or openness (p = 0.16). They were more frequently single (p = .021) and reported higher alexithymia (ps < .001) and higher impulsivity sub-scores (ps<.05). Conclusions/Importance: Food addiction shares personality traits with substance-related disorders (regarding neuroticism, conscientiousness, impulsivity, alexithymia), and one distinctive trait (low extraversion). This study provides additional data that enrich the discussion on whether the “food addiction” phenotype should be included or not in the “substance-related and addictive disorder” category.

P.6.f.008 - Relation between food addiction and nutritional status in patients candidates for bariatric surgery

To investigate the hypothesis that misreporting observed in dietary assessments would be associated with nutrition knowledge and health consciousness, we compared the degree of misreporting between 99 female dietitians and 117 nondietitians who worked at welfare facilities in Japan. Sodium, potassium, and protein intake were assessed by two 24-hour urine collections, 4-day semiweighed dietary records, and 2 validated diet history questionnaires. Intake of these 3 nutrients measured by each method was compared. The ratio of self-reported intake to biomarker-based intake was used as an index of reporting accuracy and compared between dietitians and nondietitians. Correlation coefficients between biomarker-based and self-reported intakes were also compared between dietary assessment methods within the same group, as well as between the 2 groups. The dietitians tended to underreport sodium and protein intake more severely than the nondietitians and overreported potassium intake more obviously. However, the degree of misreporting did not significantly differ between the 2 groups. The correlation coefficients between biomarker-based and self-reported intakes were significantly lower with the 2 diet history questionnaires than with the diet record, particularly in the dietitians. In conclusion, misreporting was strongly suspected to be more severe among the dietitians, and the validity of the diet history questionnaires differed between the 2 groups and this result suggests that misreporting might be associated with higher nutrition knowledge and health consciousness.

Prevalence of musculoskeletal symptoms in obese patients candidates for bariatric surgery and its impact on health related quality of life.

This study was designed to identify the major musculoskeletal symptoms of individuals with obesity, to assess their health-related quality of life, and to evaluate the correlation between the musculoskeletal symptoms and the individuals' health-related quality of life. Cross-sectional study. "Nordic Musculoskeletal Questionnaire" and "The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)". In total, 41 subjects were evaluated, of which 90.15% were female. The mean age of the subjects was 40.78 ± 9.85 years and their mean body-mass index was 46.87 ± 8.08. All subjects reported musculoskeletal pain in at least one anatomical region and 80.49% had pain in three or more regions. The activity limitations due to pain were reported by 75.61% of them. The most affected regions by pain were the ankles and/or feet, lower back, knees and wrists/hands/fingers. The most associated regions with activity limitations due to pain were the ankles and/or feet, knees and lower back. The presence of pain showed a negative correlation with the domains physical functioning (PF), role-physical (RP) and body pain (BP). The activity limitations showed a negative correlation with the domains PF, BP, social functioning (SF) and role-emotional (RE). Our data showed a high prevalence of musculoskeletal pain and limitation in activities due to pain in obese subjects. The musculoskeletal symptoms had negative correlations with physical and mental components of the health-related quality of life, highlighting the importance of ensuring that patients with obesity have access to interdisciplinary care, for the prevention and rehabilitation of musculoskeletal disorders.

Factores psicológicos y/o psiquiátricos presentes en pacientes desertores de protocolo de preparación para cirugía bariátrica

Resumen Introducción. La obesidad severa es la enfermedad crónica con mayor prevalencia en el mundo, afectando la calidad de vida de los pacientes. Aunque existe una variedad de tratamientos para ella, las tasas de abandono de los mismos se encuentran entre el 40-80%. Objetivo. Identificar los factores psicológicos y/o psiquiátricos que presentaron en la evaluación inicial los pacientes con obesidad severa que desertaron del protocolo de preparación para la cirugía bariátrica y establecer diferencias con los pacientes que no desertaron. Método. Se llevó a cabo un estudio analítico observacional de casos (desertores) y controles (no desertores), retrospectivo, transversal, con una muestra de 286 expedientes de pacientes candidatos a cirugía bariátrica del Hospital General Dr. Manuel Gea González en la Ciudad de México, con IMC de 44.77 ± 7.47 kg/m2 y una edad de 37.45 ± 9.94 años y que fueron seleccionados por muestreo no probabilístico por conveniencia. Resultados. Se encontraron diferencias significativas: género (los hombres desertan más), los pacientes desertores mostraron una mayor prevalencia en el trastorno por estrés postraumático, trastorno por déficit de atención e hiperactividad, trastorno por atracón, aislamiento, deterioro de las funciones cognitivas y mayor disfunción familiar y social que los no desertores. Un análisis multivariado sobre los mismos factores demostró que el ser hombre, tener poco apoyo social, presentar trastorno por atracón y tener un mayor número de faltas a sus citas durante el tratamiento, son factores contribuyentes para la deserción. Discusión y conclusión. Existen variables psicológicas/psiquiátricas que podrían establecerse como factores de riesgo en la deserción y como consecuencia incrementar la posibilidad de afectar el bienestar físico y emocional del paciente.

Validation de la version française de la Binge Eating Scale : étude de sa structure factorielle, de sa consistance interne et de sa validité de construit en population clinique et non clinique

ObjectiveThe Binge Eating Scale is a widely used scale to assess binge eating disorder in obese patients. Until now, this scale has not been validated on a French population, and no psychometrically sound tool assesses binge eating disorder in the French. This study aimed to test the psychometric properties of a French version of the Binge Eating Scale by establishing its factor structure, internal consistency, and construct validity in both a non-clinical population and a clinical population (obese patients who are candidates for bariatric surgery). MethodsA total of 553 non-clinical subjects and 63 morbidly obese patients who were candidates for bariatric surgery were assessed with the BES and the Bulimic Investigatory Test, Edinburgh or BITE (which assesses both binge eating behaviours and use of inappropriate compensatory behaviours). We tested the factor structure of the instrument, its internal consistency, its construct validity with measures of binge eating, and its construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In 47 out of the 63 obese patients, we assessed binge eating disorder (SCID). ResultsIn the non-clinical population, the BES had a one-factor structure (which accounted for 61% of the variance), excellent internal consistency (α=0.93), and high construct validity with measures of binge eating. In this population, construct validity with measures of inappropriate compensatory behaviours was confirmed in overweight and obese subjects (P=0.42), but not in underweight and optimal weight subjects (P<0.001). In obese patients candidates for bariatric surgery, we demonstrated that the BES had a one-factor structure (which accounted for 46% of the variance), had high internal consistency (α=0.88) and high construct validity with measures of binge eating and good construct validity with measures of inappropriate compensatory behaviours to avoid weight gain. In the subpopulation of 47 obese patients, sensitivity, specificity, positive predictive value and negative predictive value were respectively 75%, 88.4%, 37.5% and 97.4% (BES threshold=18). DiscussionIn this study, we validated a psychometrically sound French version of the Binge Eating Scale, both in a non-clinical and a clinical sample. The psychometric properties of the French version of the BES are comparable to its original version with a one-factor structure. The BES is a useful tool to assess binge eating disorder in obese patients (e.g., bariatric surgery candidates), but might not differentiate between binge eating disorder and bulimia nervosa in underweight and optimal weight subjects.

Effectiveness and factors predicting success of therapeutic patient education in obese patients candidates for bariatric surgery

IntroductionObesity is an increasingly common chronic disease. Its biopsychosocial basis provides the rationale of multidisciplinary interventions, such as Therapeutic Patient Education (TPE, WHO 1998), which is effective for lifestyle change and awareness improvement, thus reducing the disease's prevalence and its health care-related financial burden. However, patients’ socio-demographic and psychopathological factors may influence TPE's effectiveness.Objectives/AimsWe aimed to assess the effectiveness of an 8-week TPE program in obese patients candidates for bariatric surgery and identify factors predicting its success.MethodsWe enrolled 159 patients with a BMI &gt; 35 Kg/m2 and obesity-related comorbidities (females = 71.3%; age range = 18-35 years) at the C.A.S.C.O. (EASO COMs) of our University Hospital. They filled out the Binge Eating Scale (BES), the Symptom Checklist-90-R (SCL-90-R), and the Short Form-36 Health Survey (SF-36). We used Tukey's multiple comparison test to assess Quality of Life (QoL) improvement after TPE and multivariate logistic regression to estimate the size of the association between TPE and the aforementioned factors.ResultsThe SF-36 showed a significant improvement (P &lt; 0.05) of physical and mental QoL post-TPE, especially in obese patients without binge eating disorder. The same applied to BES and SCL-90-R scores. The factors predicting TPE success were a short duration of obesity, a limited number of past diets, and low levels of anxiety/depression pre-TPE.ConclusionsIn obese patients candidates for bariatric surgery, TPE is useful to improve physical and mental QoL, eating behavior, and psychological status. Several factors are predictive of TPE success, allowing a personalization of the intervention to render it more effective.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ASSESSMENT OF BODY FAT IN OBESE PATIENTS PREOPERATIVELY FOR BARIATRIC SURGERY

ABSTRACTBackground: The study of body composition in patient candidates for bariatric surgery is directly related to the increase and distribution of body fat in the development of cardiovascular disease. Aim: To correlate anthropometric indicators and bioelectrical impedance in the assessment of body fat in female candidates for bariatric surgery. Methods: Cross-sectional, observational study of 88 women. The weight, height, body mass index and waist circumference data were evaluated in the anthropometric analysis. The body fat was determinate by bioelectrical impedance conducted according to the manufacturer´s recommended technique with a specific severe obesity formula. The patients were divided into two subgroups according to the average waist circumference and body mass index for better analysis of the results. Results:The group had a mean age of 39.7 years (±7.2), average weight of 125.6 kg (±16.2), mean body mass index of 48.7 kg/m2 (±6.4) and the mean waist circumference 137.6 cm (±12.4). Negative and significant relationship between BMI values waist circumference and resistance obtained by bioelectrical impedance ​​were found. By analyzing the two groups the mean BMI and waist circumference, a significant relationship was observed, ie, the higher the degree of obesity less resistance was obtained by bioelectrical impedance. The higher is the obesity the lower is value found for resistance. Conclusion: The increase of anthropometric indicators (BMI and waist circumference) determined reduction in resistance and reactance obtained by bioelectrical impedance analysis in obese women candidates to bariatric surgery.

PRE-OPERATIVE IRON DEFICIENCY IN BARIATRIC SURGERY: DIAGNOSIS AND TREATMENT

chronic inflammation induced by obesity alters iron homeostasis leading to mild /moderate iron deficiency and anaemia. Between 14% and 43% of patients may suffer from iron deficiency without anaemia before surgery. The management of peri-operative iron deficiency improves patient outcome and quality of life. Under certain circumstances intravenous (IV) iron must be considered. IV iron (which may avoid iron blockage in enterocytes and macrophages) has turned out to be a safe and efficient alternative. Objetives: 1) To assess the prevalence of iron deficiency in morbidly obese patients candidates for bariatric surgery. 2) Assess whether supplementation of parenteral iron in iron-deficient patients is effective in preventing the decrease in hematocrit after surgery. prospective, observational study which included 89 morbidly obese patients who underwent bariatric surgery. The population was divided according to whether or not patients had pre-op iron deficiency, and post-op evolution was analyzed. Iron-deficient patients were supplemented with 500 mg of intravenous (IV) carboximaltose and were evaluated post-op. twenty-three patients (25.8%) presented preop iron deficiency pre-operatively while six (6.74%) had anemia. 74.2% (66 patients) had no iron deficiency. The group without iron deficiency at one month of surgery had the following laboratory values: Hematocrit: 41.30% ± 3.77; hemoglobin: 13.64 g/l ± 1.25 and transferrin saturation: 30.55 %. The patients with pre-op iron deficiency had the following values: Hematocrit: 40.40% ± 3.03; hemoglobin: 13.40 g/l ± 1.07; transferrin saturation: 15.50% ± 4.18, and ferritin: 87.10 ng/ml ± 81.23. Post-op hematocrit reduction was 38.40% ± 3.17 (p: 0.034). In iron-deficient patients without IV iron supplementation (n=15), hematocrit and hemoglobin were 41.2% ± 2.5 and 13.7 g/l ± 0.9 respectively with post-op reduction (37.5% ± 3.4 and 12.3 g/l p < 0.05). IV iron supplementation in iron-deficient patients (n = 9) increased hemoglobin (13.5 g/l ± 0.7), compared with the pre-op (12.8 g/l ± 1.2; p: 0.05), as well as transferrin saturation and ferritin. One month after surgery there were no significant changes in hematocrit (pre-op: 39%, post-op: 40% p: > 0.05). 1) Almost 26% of patients present pre-op iron deficiency. 2) Treatment with IV iron seems to be efficient to prevent hematocrit reduction and to improve iron metabolism in pre-op iron-deficient patients. In patients without iron deficiency, hematocrit and iron metabolism remain normal one month after surgery without the need for iron supplementation.

Effectiveness of Intragastric Balloon Treatment for Obese Patients: Retrospective Clinical Trial

Objective: Obesity is a serious and chronic disease with genetic and environmental interference. Several treatment modalities exist such as medical treatment, surgical treatment, endoscopic interventions. Methods: Thirteen patients’ data were evaluated retrospectively at the Erzincan University Medical Faculty Hospital Endoscopy Unit. Intragastric balloons were performed between 2012 January-2013 December. When patients gain the desired weight, approximately 8 to 12 months later; the balloons were removed. Results: The mean duration of gastric balloons in patients was 10.0±1.22 months. It was determined that the mean weight loss within the prescribed time was 25.1±5.5 kg. There is a statistically significant difference among the values when comparing the values before and after gastric balloon (p=0.001) Conclusion: Intragastric balloon replacement is a safe and effective procedure for weight reduction. The intragastric balloon can play a role for the temporary weight reduction of morbidly obese patients in diet supporting, as well as in the preoperative treatment of patient candidates for bariatric surgery or other surgical procedures in order to decrease morbidity and mortality. (JAREM 2013; 3: 97-9)

VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI) and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrasonographic findings), type of surgery (open or laparoscopic), abdominal circumference, body mass index (BMI) and post-operative ultrasonography search for venous insufficiency and deep venous thrombosis. Between March 2007 and December 2009, 95 patient candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%), the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%), but no one had clinically manifested pulmonary embolism. No relation between BMI, CEAP classification and venous ultrasonographic findings were found. Although prophylaxis was used in all patients, the incidence of post-operative distal venous thrombosis was considerably high.

Six Months Results of the Duodenal-Jejunal Bypass Liner for the Treatment of Obesity and Type 2 Diabetes

Background: The duodenal-jejunal bypass liner (DJBL) is an endoscopic device that excludes the duodenum and initial portion of the jejunum from the contact with the chyme. It has been shown to be effective for weight loss and may improve the control of type 2 diabetes mellitus (T2DM). The objective of this study is to evaluate the efficacy of the DJBL in weight loss and in T2DM control over a 24-week period. Patients and Methods: Obese (BMI ≥ 35 kg/m²) and T2DM patient candidates for bariatric surgery were prospectively assigned to the implant of the DJBL at an academic endoscopy referral center (São Paulo - Brazil) Results: Twenty-two patients were submitted to the implant procedure, with technical success of 100%. At week 24, mean weight loss was 14 kg (p<0.001). BMI dropped on average 5.4 points and excess weight loss was 22.2%. Fasting glucose (baseline = 171.8 mg/dl; W24 = 141.5 mg/dl) and glycosylated hemoglobin levels (8.8% to 7.3%) were significantly reduced. There was also a reduction in the usage of anti-diabetic medications (except metformin). Conclusions: The DJBL is an effective weight loss method and also promotes glucose control over a 24-week period. Long-term studies with post-removal follow-up are required to determine its role in the management of type 2 diabetes.

Fast track anaesthesia in patients candidates for bariatric surgery: Xenon vs desfluorane

Fast track anaesthesia in patients candidates for bariatric surgery: Xenon vs desfluorane

Medida de la satisfacción del paciente e identificación de oportunidades de mejora en la preparación de pacientes de cirugía bariátrica

ObjectiveTo evaluate the satisfaction of patients candidates for bariatric surgery with the performance of a group training program prior to surgery, identifying opportunities for improvement in the program and evaluating participants satisfaction following their implementation. MethodAn “ad hoc” designed survey was used, addressed to assess opinions on different aspects of the program, overall satisfaction and identification of areas for improvement. The survey was administered to two groups of patients: the first after one year of implementation of the program to identify suggestions for improvement, and the second after one year of the implementation of the improvement. A total of 112 patients were assessed, 66 in the first pass of the questionnaire and 46 in the second. Both groups were homogeneous in demographic variables ResultsThe main improvement detected was expert patients in the preparation of the program. After implantation, slight changes in the ratings of the questions were produced, that were not significant. Overall satisfaction rose from 9.5 to 9.74 out of 10. The other proposals for improvement were to improve audiovisuals and to fit the room furniture to the characteristics of the patients. ConclusionsThe very high satisfaction levels obtained are usual in studies on hospital satisfaction, our results still being above the studies consulted, as well as in levels of excellence. This prevents statistically significant differences being found. There were no significant differences in the results before and after implementation of improvement. Continuous assessment allows new possibilities for improvement.

New look at nutritional care for obese patient candidates for bariatric surgery

BackgroundThe combination of preoperative deficiencies and the restrictions and malabsorption possibly induced by bariatric surgery could lead patients to experience important nutritional deficits during the late postoperative period. Our objective was to characterize the eating, anthropometric, and biochemical profiles of obese candidates for bariatric surgery at a bariatric surgery center of a university hospital. MethodsA retrospective study with the analysis of medical records of candidates for bariatric surgery from 2007 to 2008 was performed. A total of 80 adult patients, aged 45 ± 11 years, were included in the present study. ResultsThe mean patient weight was 145 ± 24 kg, and the mean body mass index was 54 ± 8 kg/m2. Of the 80 patients, 78% had ≥1 co-morbidities related to obesity. The reported daily energy intake before surgery was 1981 ± 882 kcal, with 48% ± 11% consisting of carbohydrate, 29% ± 8% of lipids, and 23% ± 8% of protein. The mean number of daily meals was 4 ± 1. Patients with a greater body mass index ingested a smaller amount of calories per kilogram of current weight. The occurrence of hyperglycemia, hyperuricemia, and dyslipidemia and of nutritional deficiencies, among them magnesium (19%), vitamin A (15%), vitamin C (16%), iron (9%), β-carotene (3%), and vitamin B12 (3%), was high. ConclusionThe high occurrence of micronutrient deficiency detected by biochemical analysis in morbidly obese candidates for bariatric surgery, representing a disabsorptive process, might involve a poorer prognosis during the late postoperative period. A preoperative evaluation of the nutritional parameters and the food intake pattern is recommended for these patients, together with the necessary interventions.