Resolution Of Obesity-related Comorbidities Research Articles

Clinical Characteristics and Outcome of Morbidly Obese Bariatric Patients with Concurrent Hepatitis B Viral Infection

Bariatric surgery is the only effective and long-lasting treatment of morbidly obese patients. However, the safety and efficacy of bariatric surgery in patients with hepatitis B viral (HBV) infection is not clear. The aim of the present study is to investigate whether HBV infection influences clinic features and outcomes of bariatric surgery. The preoperative seropositivity of HBV surface antigen (HBsAg) using radioimmunoassay was determined in 592 patients (481 female, 111 male: mean age 30.5 +/- 8.1 years; mean body mass index [BMI] 43.1 +/- 6.0) who had undergone bariatric surgery (209 banding and 383 gastric bypass) for their morbid obesity in the past 5 years. All the clinical data were prospectively collected and stored. The overall seroprevalence of HbsAg was 18.8%. Morbidly obese patients positive for HBV infection were associated with older age and higher diastolic blood pressure, but not with sex, BMI, liver enzyme, blood lipid, and glucose levels. Although minigastric bypass (MGB) had a better weight reduction than gastric banding, there was no difference in weight reduction between patients who were positive and negative for HBV infection. The weight loss curves and resolution of obesity-related comorbidities were similar between the two groups except the postoperative aspartate transaminase (AST) and alanine transaminase (ALT) were significantly higher in patients who were positive for HBV infection. During follow-up, two patients developed fulminating hepatitis after MGB with one mortality. Morbidly obese patients with the existence of HBV infection do not influence the outcome of bariatric surgery, but continuing monitor of the liver function is indicated.

Laparoscopic Mini-gastric Bypass: Experience with Tailored Bypass Limb According to Body Weight

Gastric bypass surgery is an effective and long-lasting treatment of morbidly obese patients. However, the bypass limb may need to be tailored in morbidly obese patients with a wide range of obesity. The aim of the present study was to report clinical result of tailored bypass limb in a group of patients receiving laparoscopic mini-gastric bypass surgery. From Jan 2002 to Dec 2006, laparoscopic mini-gastric bypass was performed in 644 patients [469 women, 175 men: mean age 30.5 +/- 8.1 years; mean body mass index (BMI) 43.1 +/- 6.0] in our department. The gastric bypass limb was tailored according to the preoperative BMI. The clinical data and outcomes were analyzed. All the clinical data were prospectively collected and stored. Two hundred eighty-six patients belonged to lower BMI (BMI < 40; mean 36.0), 286 patients moderate BMI (BMI 40-50; mean 43.2), and 72 patients higher BMI (BMI > 50; mean 55.4). All procedures were completed laparoscopically. Mean operative time was 130 min, and mean hospital stay was 5.0 days. Twenty-three minor early complications (4.3%) and 13 major complications (2.0%) were encountered, with one death occurred (0.016%). There was no significant difference in operation time and complication rate between the groups. The mean bypass limb was 150 cm for the lower BMI group, 250 cm for moderate BMI group, and 350 cm for the higher BMI group. The mean BMI reduction 2 years after surgery was 10.7, 15.5, and 23.3 for the lower, moderate, and higher BMI group. The weight loss curves and resolution of obesity related comorbidities were compatible with the tailored bypass limbs between the groups. However, the lower BMI patients had more severe anemia than the other two groups. Morbidly obese patients receiving gastric bypass surgery may need to tailor the bypass limb according to BMI. The application of gastric bypass in lower BMI patients should be more carefully.

Outcomes of bariatric surgery in patients ≥65 years

Background Although the Medicare Coverage Advisory Committee found that significant evidence supports the safety and effectiveness of bariatric surgery, few data are available on the outcomes of bariatric procedures in patients ≥65 years. The aim of this study was to report on contemporary outcomes of Roux-en- Y gastric bypass (RYGB) in patients ≥65 years. Methods We reviewed prospectively collected data from all patients ≥65 years who underwent RYGB at two Florida university-based programs from 1999 to 2005. Similarly, the Florida Discharge Database was queried for patients ≥65 years who had undergone RYGB from 1999 to 2005. The data are presented as the mean ± SEM. Results A total of 25 patients ≥65 years had undergone RYGB at our institutions (age 68 ± 1 years, body mass index 50 ± 3 kg/m 2). The overall complication rate was 20%, and the length of stay was 7 ± 3 days. One patient (4%) died 5 weeks postoperatively of septic complications. For the 13 patients with a median follow-up of 21 months (range 9–61), the percentage of excess body weight loss was 51% ± 7%; medication use for co-morbidities decreased from 9 ± 1 to 4 ± 1 medications/day ( P <.01). The Florida Discharge Database reported 231 patients ≥65 years who had undergone RYGB. In that group of patients, the mean age was 67 ± 0.2 years, the length of stay was 6 ± 1 days, in-hospital mortality rate was 1.3%, and the overall complication rate was 15%. Conclusion In a small cohort of patients ≥65 years, RYGB resulted in significant weight loss and resolution of obesity-related co-morbidities. The findings from the mandatory reported Florida Discharge Database strongly confirmed the safety of RYGB in patients ≥65 years.

Perioperative management of the bariatric surgery patient: focus on cardiac and anesthesia considerations.

Obesity is a major public health problem in developed nations worldwide. Currently, the only treatment for severe obesity (BMI > or = 35 kg/m2 with comorbidity) that provides long-term weight loss is bariatric surgery. Restrictive, malabsorptive, and combination procedures have been developed. Each type of procedure has its merits and unique set of risks and complications. Weight loss after bariatric surgery is accompanied by predictable improvement or resolution of obesity-related comorbidities and improved quality of life and life expectancy. Candidates for bariatric surgery are often at high risk for complications because of obesity-related comorbidities. Therefore, careful patient selection for bariatric surgery, together with well-designed strategies for preventing and managing complications, are keys to success. Close monitoring for nutritional deficiencies and short- and long-term complications is required to completely assess outcomes of these procedures.

GASTRIC BYPASS

Nearly all morbidly obese patients with satisfactory postoperative weight loss experience substantial improvement in the quality of their lives. Improved health status is characterized by increased exercise tolerance and improvement or resolution of obesity-related comorbidities. Improvement of obesity-related medical problems (discussed in the article by Klein elsewhere in this issue) is a primary goal of gastric bypass. The patient's ability to interact with others in social situations is also enhanced. At present, RYGB may be the only bariatric operation that has produced durable long-term weight loss at an acceptable level of risk.