Post-bariatric Surgery Population Research Articles

Pharmacologic management of weight regain following bariatric surgery.

While bariatric surgery restults in significant long-term weight loss for most patients with obesity, post-surgical weight gain affects a considerable percentage of patients to varying degrees of severity. Furthermore, a small but significant percentage of patients experience inadequate post-surgical weight loss. Although many studies have examined the role of anti-obesity medications to address post-operative weight regain, an evidence-based consensus has not yet been achieved because of the heterogeneity of populations studied and the studies themselves. Observational studies in the post-bariatric surgery population consistently demonstrate the benefit of medical weight management after bariatric surgery, with most evidence highlighting liraglutide, topiramate, and phentermine/topiramate. New anti-obesity medications are anticipated to be helpful for post-surgical weight optimization given their efficacy in the non-surgical population.

Behavioral Interventions After Bariatric Surgery.

Purpose of ReviewBariatric surgery is the most effective and durable treatment for severe obesity. Postoperative behavioral weight management approaches are available for optimizing weight change for both short- and long-term outcomes.Recent FindingsVarying settings such as groups and telemedicine along with techniques such as cognitive behavioral therapy have been assessed in the post-bariatric surgery population. The assessment and application of these programs have been limited due to methodological, financial, and attrition-related constraints.SummaryThis review aims to summarize the current evidence for different postoperative behavioral interventions on postoperative outcomes, specifically highlighting weight loss. Future opportunities for study include mechanisms for overcoming some of the barriers to implementing these programs in clinical, non-research settings.

Complications rate of surgically assisted endoscopic retrograde cholangiopancreatography

• Bariatric surgery is becoming more prevalent throughout the population. • Surgically assisted ERCP is the standard way to access the biliary tree in the majority of post bariatric surgery patients. • Surgical assisted ERCP carries a significant risk of complications. • Further studies are warranted to determine if patients would benefit from alternate methods to access the biliary tree following bariatric surgery. With the rise in obesity and gastric bypass procedures, the normal anatomy and approach for endoscopic retrograde cholangiopancreatography (ERCP) is eliminated. Surgically assisted ERCP is the standard technique to access the biliary system and perform ERCP in these patients. These patients are at increased risk for cholelithiasis. As such, the need for surgically assisted ERCP has increased in patients when transoral access to the biliary tree is not possible. To date, there are little data reporting complications and outcomes of this procedure. We aimed to perform a retrospective cohort study to identify demographic, clinical and outcomes data to ascertain significant complications and complications rates of surgically assisted ERCP. We conducted a retrospective review of electronic health record data of patients who underwent surgically assisted ERCP at three hospitals over a 10-year period, between April 2010 and July 2020, and identified 53 patient encounters for 50 unique patients. Fifty patients who underwent 53 surgically assisted ERCP were identified during the study period. Twenty-two (41.5%) of those patients had a complication. Conversion from laparoscopic to open procedure occurred in 10 cases. The overall complication rate was 44% with most complications (91%) related to surgical access as opposed to ERCP (9%). Surgically assisted ERCP is associated with significant risks for complications primarily due to surgical access. Further studies need to be conducted to compare the risks of surgically assisted ERCP to other approaches for biliary access in the post-bariatric surgery population.

S20 Common Bile Duct Dilation After Roux-en-Y Gastric Bypass Surgery

Introduction: As the obesity epidemic continues, surgical interventions to address this issue have become more prevalent. One of the most widely used methods for bariatric surgery is Roux-en-Y gastric bypass (RYGB). A unique problem that has been identified in the post-bariatric surgery population is biliary duct dilation without specific pancreatobiliary pathology. This study aims to evaluate the change in common bile duct (CBD) diameter following RGYB. Methods: This was a single center retrospective study that evaluated patients who had undergone RYGB between 1/1/2010 and 12/31/2020. Adults (>18 years of age) who had CT imaging for non-pancreatobiliary reasons before and after their RYGB were included. Patients with known pancreatobiliary pathology were excluded from analysis. An abdominal radiologist measured the diameters of the CBD in all images at the porta hepatis. Linear regression modeling and t-tests in SPSS were used to analyze data. Results: 46 patients met the inclusion criteria. The average age and BMI at time of RYGB was 48.4 years and 46.4. The average age and BMI at time of post-operative CBD measurement was 49 years and 38.1. The mean CBD diameter of all included patients pre-RYGB was 5.93 mm (SD 1.5) and the mean diameter post-RYGB was 7.0 mm (SD 3.3). Mean diameter change between pre and post RYGB was 1.31 mm (SD 2.8, P < 0.05). Controlling for prior cholecystectomy as well as narcotic use at the time of post-operative imaging, the change in CBD diameter was 1.15 mm (SD 0.6, P value 0.06). Prior cholecystectomy and narcotic usage did not affect in person change of CBD diameter (P 0.9, P 0.6). Conclusion: There are many known causes of non-pathological biliary duct dilation, including age, history of cholecystectomy and narcotic use. Our data shows that biliary dilation can occur after bariatric surgery. This finding is important because endoscopic biliary evaluation with EUS and ERCP in RYGB anatomy is challenging and associated with high failure rates. Other biliary interventions like laparoscopic assisted, percutaneous and trans-gastric procedures are associated with higher risk of complications. Given these issues, it is crucial for patients to have a strong indication for biliary intervention. As physicians treat an increasing number of patients with RYGB anatomy, they must consider that incidentally found biliary dilation might not necessarily indicate the presence of biliary pathology in order to prevent avoidable imaging and interventions.

Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery

ObjectiveThis study aimed to explore the experiences of women who had developed excessively restrictive eating behaviours following bariatric surgery.MethodFive female participants, who were at least nine months post-bariatric surgery and exhibiting restrictive eating behaviours, were recruited from Bariatric Surgery Psychology Services and asked to complete qualitative face-to-face semi-structured interviews. The data was analysed using interpretative phenomenological analysis (IPA).ResultsThree super-ordinate themes emerged: (1) experiences of weight stigma and weight history on self, (2) the impact of loose skin, (3) thoughts about food and disordered eating patterns. These captured the impact of past weight-related experiences—including weight stigma, intense fears of weight gain, negative cognitions about the self, the impact of excess skin, changes in the way the women thought about food and restrictive eating behaviours.DiscussionThis study is one of the first to specifically explore restrictive eating disorders after bariatric surgery using a qualitative approach. The findings of this study may offer helpful aspects for professionals to hold in mind when identifying individuals with problematic restrictive eating behaviours following bariatric surgery. Body contouring surgery, internalised weight bias and weight stigma are explored in relation to the post-bariatric surgery treatment pathway. The current diagnostic criterion for anorexia nervosa are discussed to highlight difficulties in diagnosing this presentation in the post-bariatric surgery population, where people can have BMIs over 25 kg/m2 but are severely restricting energy intake.

Body Contouring Surgery after Massive Weight Loss: Excess Skin, Body Satisfaction, and Qualification for Reimbursement in a Dutch Post-Bariatric Surgery Population.

Body contouring surgery improves quality of life, weight loss, and body image after bariatric surgery. It is unclear why only a minority of the post-bariatric surgery population undergoes body contouring surgery. This study assesses overhanging skin, body satisfaction, and qualification for reimbursement of body contouring surgery in a Dutch post-bariatric surgery population. Post-bariatric patients were selected from a prospective database. Electronic questionnaires evaluated demographics, desire for body contouring surgery, excess skin, and satisfaction with their body. A total of 590 patients were included: 368 patients (62.4 percent) desired body contouring surgery, 157 (26.6 percent) did not and 65 (11.0 percent) had undergone body contouring surgery. There were no significant differences between the groups regarding the percentage of patients who met the qualifications for reimbursement. Patients who desired body contouring surgery had more body parts affected by overhanging skin and more often rated the overhanging skin with a Pittsburgh Rating Scale grade 3 compared with patients without a desire to undergo body contouring surgery. The plastic surgeon was never consulted by 39.1 percent of the "desire" population; 44.1 percent of these patients met the weight criteria. Post-bariatric patients who desired body contouring surgery had more excess skin than patients without a desire and were less satisfied with their body. Almost half of these patients never consulted a plastic surgeon, partly because of incorrect assumptions regarding reimbursement. Plastic surgeons (together with bariatric teams) should better inform these patients about body contouring surgery possibilities.

Mo1351 - Ampullary Stenosis after Roux-En-Y Gastric Bypass Surgery: A New Phenomenon in the Post-Bariatric Surgery Population

Mo1351 - Ampullary Stenosis after Roux-En-Y Gastric Bypass Surgery: A New Phenomenon in the Post-Bariatric Surgery Population

A182 - Use of Audience Response System (Ars) Technology in a Post-Bariatric Surgery Population

A182 - Use of Audience Response System (Ars) Technology in a Post-Bariatric Surgery Population

Risk factors for pannus formation in the post-bariatric surgery population.

Previous studies describe a relationship between pannus mass and panniculectomy-related complication rates. Patient management may be improved by elucidating the key factors influencing pannus formation. A retrospective review was conducted of 135 patients who had undergone laparoscopic Roux-en-Y gastric bypass from 1996 to 2010 and subsequent panniculectomy. Outcome measures included age, sex, body mass index, time of surgery, resected pannus mass, comorbidities, and panniculectomy-related complications. Nonparametric continuous and nominal variables were assessed using Spearman rank-correlation and Mann-Whitney U tests, respectively. One hundred thirty-five patients (123 women and 12 men; mean age, 44.7 years) were included in analysis. All patients had body contouring surgery more than 1 year after bariatric surgery (median time interval, 2.1 years). Median body mass index at the time of bypass, 1 year after bypass, and at the time of body contouring surgery was 48.7, 30.0, and 29.4 kg/m, respectively. Median pannus mass was 2.2 kg. Larger pannus mass was associated with greater age at gastric bypass surgery (p = 0.034), higher pre-gastric bypass body mass index (p = 0.031), higher prepanniculectomy body mass index (p < 0.001), and longer time interval between gastric bypass and panniculectomy (p = 0.046). Female patients requiring blood transfusions had a significantly larger pannus mass than those who did not (p = 0.048). Performing bariatric surgery on patients at a younger age or having patients reduce body mass index as much as possible before bariatric surgery may be useful for minimizing symptomatic pannus formation and in turn may decrease rates of panniculectomy-related complications. Risk, III.

Mrs. Gutierrez: Twelve Years After Bariatric Surgery

OPEN ACCESSJanuary 19, 2014Mrs. Gutierrez: Twelve Years After Bariatric Surgery Carla Lupi, MD, Anthony Oliva, Ansley Splinter Carla Lupi, MD Florida International University Herbert Wertheim College of Medicine Google Scholar More articles by this author , Anthony Oliva Florida International University Herbert Wertheim College of Medicine Google Scholar More articles by this author , Ansley Splinter Florida International University Herbert Wertheim College of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9666 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: This interdisciplinary problem-based learning case for third-year and advanced second-year students describes a woman urgently referred from her primary care provider to a neurologist several years after bariatric surgery. Learners will move through the unfolding diagnostic reasoning of a rare condition that presents identically to a common one, considering the importance of monitoring response to therapy as a means of confirming the original diagnosis, and the use of non-response to therapy as a trigger for reevaluation of that diagnosis. Methods: This case provides the opportunity for students to “take the history” from the facilitator rather than simply receive predetermined information. It also invites students to review emerging guidelines on the long-term care of this growing population of patients, consider occupational exposures, and the use of the history to determine the likelihood of heavy menses as the cause of anemia in a woman. Advanced learners may also consider issues of cost-effectiveness of the diagnostic work-up, the communication challenge of explaining highly uncertain prognosis, ethical issues in the ongoing care of patients who lose insurance coverage, and best practices for the education and follow-up of these patients. Results: We have formally surveyed 39 third-year students immediately after the session. All 39 students agreed or strongly agreed that this case improved their understanding of basic science concepts related to nutrition. Thirty-seven students agreed or strongly agreed that this case improved their understanding of the effects of different types of bariatric surgery on nutritional needs. All 39 students agreed or strongly agreed that the case was believable. Discussion: We have used this case with students on the neurology clerkship at our institution for a cross-clerkship curriculum designed to help students integrate basic science into their rapidly-expanding clinical learning. Other curricular needs prompting us to write this case were in the areas of nutrition, reflection on diagnostic reasoning, and the care of the rapidly growing postbariatric surgery population. Educational Objectives By the end of this resource, learners will be able to: Develop a differential diagnosis for anemia in a woman using the kinetic approach (production, hemolysis, and blood loss) and/or the morphologic approach (microcytic, normocytic, and macrocytic).Interpret the laboratory tests used in the work-up of anemia, including the variations in correlation of B12 and folate levels with clinical symptoms.Develop and reason a differential diagnosis for combined vestibular and sensory abnormalities.Describe the types of bariatric surgery and their risks for nutritional deficiencies.Review the current recommendations for management of nutrition and supplementation in the postbariatric patient.Describe the central and peripheral demyelinating disorders as well as clinical manifestations for the disruption of sensory and motor pathways.Explain the specific biochemical roles of vitamins and minerals in hematopoiesis.Describe the absorption of vitamins and minerals important in hematopoiesis and nerve function as well as the mechanisms of their deficiencies in the postbariatric patient.Explain the mechanism of nephrolithiasis in the postbariatric surgery patient. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.pdf Facilitator Version.pdf Student Version.pdf Student Learning Survey.pdf PBL Rubric.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2014 Lupi et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsMyelopathySpinal Cord DiseasesCopperMultiple SclerosisDiagnostic ReasoningVitamin B 12NutritionFolateBariatric SurgeryWomen's Health CareGuidelinesAnemiaFolic AcidOccupational Diseases Disclosures None to report. Funding/Support None to report. Loading ...

What every hospitalist should know about the post‐bariatric surgery patient

Obesity is a growing worldwide epidemic, increasingly addressed through surgical options for weight loss. Benefits of these operations, such as weight loss and improvement or reversal of obesity-related comorbidities, are well established; however, postoperative complications do occur. This article will evaluate common causes for hospital admissions in the post-bariatric surgery population as they relate to the hospitalist who is often responsible for their care. Here we provide an overview of the most common bariatric procedures currently performed, early postoperative complications, late medical complications (ie, abdominal complaints, weight fluctuations, nutritional deficiencies, and metabolic bone disease), and late surgical complications that often affect these patients and result in hospital admissions. Special attention will be paid to radiologic pearls that can assist in the initial evaluation and diagnosis of these patients.

Combined group and individual model for postbariatric surgery follow-up care

BackgroundThe prevalence of bariatric surgery in the United States has increased significantly during the past decade, increasing the number of patients requiring postbariatric surgery follow-up care. Our objective was to develop and implement an efficient, financially viable, postbariatric surgery practice model that would be acceptable to patients. The setting was the Mayo Clinic (Rochester, MN). MethodsBy monitoring the attendance rates and using patient surveys, we tested patient acceptance of a new, shared medical appointment practice model in the care of postbariatric surgery patients. Efficiency was assessed by comparing differences in time per patient and total provider time required between the former and new care models. Individual-only patient/provider visits were replaced by combined group and individual visits (CGV). ResultsOur CGV model was well-attended and accepted. The patient attendance rate was >90% at all postoperative follow-up points. Furthermore, 83%, 85.2%, and 75.7% of the 3-, 6-, and 12-month postbariatric surgery patients, respectively, responded that they would not prefer to have only individual visits with their healthcare providers. The CGV model also resulted in greater time efficiency and cost reduction. On average, 5 patients were seen within 4.9 provider hours compared with 10.4 provider hours with the individual-only patient/provider visit model. Furthermore, the average billable charge for the CGV model's group medical nutrition therapy was 50–64% less than the equivalent individual medical nutrition therapy used in the individual-only patient/provider visit model. ConclusionShared medical appointments have a valuable role in the care of the postbariatric surgery population, offering a time- and cost-effective model for healthcare provision that is well-accepted by patients.

Obesity, bariatric surgery, and bone

A greater number of morbidly obese individuals are undergoing bariatric surgery, expanding the postbariatric surgery population. Both obesity and bariatric surgery are accompanied by a variety of vitamin and mineral deficiencies, with some affecting bone health. Currently, there is no consensus regarding bone health evaluation and its management in obese and postbariatric population. This review will focus on nutritional deficiencies in obese and postbariatric surgical patients, with a special focus on bone health. The latest findings on the complicated relationship between adipose tissue and bone will be discussed. And the presumed protective effect of obesity on osteoporosis will be evaluated. Nutritional deficiencies in postbariatric patients already exist prior to the surgery. Therefore, a comprehensive nutritional evaluation prior to bariatric surgery is imperative, to prevent further decline of the already deficient nutrients. Nutrients such as calcium and vitamin D have an effect on bone health. Therefore, monitoring their level is important in preventing bone loss. Taking a multivitamin with minerals postbariatric surgery is a standard of practice.

Problems after bariatric surgery

We are pleased that patients and health care providers are devoting attention to the postbariatric surgery population. There are indeed variations in individual practice in approaching these patients. With respect to vitamin B12 supplementation, there does not appear to be primary literature