One-Stage vs Two-Stage Laparoscopic Roux-en-Y Gastric Bypass in Obese Patients with Body Mass Index >55 Kg/m2; 5-YEAR FOLLOW UP

Abstract Background and Aims Overweight or obese patients with autosomal dominant polycystic kidney disease (ADPKD) are associated with the decline of glomerular filtration rate. However, little is known about the annual rate of change in total kidney volume (TKV) in patients with ADPKD according to the body mass index (BMI) corrected by TKV and total liver volume (TLV). Method We analyzed 364 patients with ADPKD from the KoreaN Cohort Study for Outcomes in Patients with Chronic Kidney Disease. We compared the changes in TKV in less than 1-year, 2-years and 4-year follow-up from patients by dividing baseline body mass index (BMI) by 18.5 to 22.9 (normal), 23 to 24.9 (overweight), and > 25 kg/m2 (obesity). Results During the 4-year follow-up period, TKV tended to increase statistically with increasing BMI (P = 0.032). Similarly, higher BMI group showed higher TKV than lower BMI group (P = 0.016). Conventional BMI is affected by TKV and TLV in advanced ADPKD patients. Therefore, we reclassified patients by corrected BMI using the adjusted body weight (body weight – TKV – TLV). Although the statistical significances between absolute value of TKV and corrected BMI groups were disappeared during the follow-up, TKV% change/year showed significantly higher in ADPKD patients with obesity among corrected BMI groups (normal; 20.2%, overweight; 17.6% and obesity; 30.6%, P for trend = 0.022) Conclusion Even after correcting the TKV and TVL, obese patients showed a high of TKV% change/year compared to non-obese patients with ADPKD.

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The Early Results of the Laparoscopic Mini-Gastric Bypass/One Anastomosis Gastric Bypass on Patients with Different Body Mass Index

Journal of Obesity ◽

10.1155/2020/7572153 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Mohsen Mahmoudieh ◽

Behrouz Keleidari ◽

Naser Afshin ◽

Masoud Sayadi Shahraki ◽

Shahab Shahabi Shahmiri ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Gastric Bypass ◽

Vitamin B12 ◽

Body Mass ◽

Excess Weight Loss ◽

Excess Weight ◽

One Anastomosis Gastric Bypass ◽

Mini Gastric Bypass

Introduction. Obesity is among the newest health matters that human beings are struggling with. Length of bypassed intestine is important in achievement of most weight loss and least nutritional and absorptive disorders. This study has aimed to assess short-term metabolic and nutritional effects of laparoscopic mini-gastric bypass/one anastomosis gastric bypass (MGB/OAGB) with a loop bypass length of 180 centimeters (cm) and compare these factors among patients with a body mass index (BMI) of 40–45 and 45–50 kilograms per square meter (kg/m2). Methods. 25 patients were put in group 1 (BMI = 40–45 kg/m2) and 25 patients in group 2 (BMI = 45–50 kg/m2). Patients’ BMI, postoperative weight, excess weight loss, and laboratory tests including fasting blood sugar (FBS), lipid profile, serum iron (Fe), ferritin, total iron-binding capacity (TIBC), 25-OH vitamin D, vitamin B12, liver function tests, and albumin were recorded preoperatively and within 3- and 6-month follow-up. Results. Weight loss and BMI reduction was significantly more in patients with higher BMI level (P=0.007), and excess weight loss was higher in patients with lower preoperative BMI level (P=0.007). Six-month follow-up showed statistically significant reduction in total cholesterol, total triglyceride, Fe, and vitamin B12 among patients with higher BMI level (P value <0.05). Conclusion. Based on this study, 180-cm intestinal bypassed length works for patients with a BMI level of 40–45 and 45–50 kg/m2, according to their significant decrease in weight, BMI, and improving glycolipid profile.

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The impact of obesity on perioperative and postoperative outcomes after elective endovascular abdominal aortic aneurysm repair

Vascular ◽

10.1177/17085381211063316 ◽

2021 ◽

pp. 170853812110633

Author(s):

Selami Gurkan ◽

Ozcan Gur ◽

Ayhan Sahin ◽

Mehmet Donbaloglu

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Endovascular Aneurysm Repair ◽

Group Versus ◽

Obese Group ◽

Obese Patients ◽

Dose Area Product ◽

Aneurysm Repair ◽

The Impact

Background Obesity is a common and growing health problem in vascular surgery patients, as it is in all patient groups. Evidence regarding body mass index (BMI) on endovascular aneurysm repair (EVAR) outcomes is not clear in the literature. We aimed to determine the impact of obesity on perioperative and midterm outcomes of elective EVAR between obese and non-obese patients. Methods Under a retrospective study design, a total of 120 patients (109 males, 11 females, mean age: 74.45 ± 8.59 (53–92 years)) undergoing elective EVAR between June 2012 and May 2020 were reviewed. Patients were stratified into two groups: obese (defined as a body mass index (BMI) ≥ 30 kg/m2) and non-obese (mean BMI < 30 kg/m2 (32.25 ± 1.07 kg/m2 vs 25.85 ± 2.69 kg/m2)). Results Of the 120 patients included in the study, 81 (67.5%) were defined as “nonobese,” while 39 (32.5%) were obese. The mean BMI of the study group was 27.93 ± 3.78 kg/m2. In obese patients, the procedure time, fluoroscopy time, and dose area product (DAP) values were longer than those of non-obese patients: 89.74 ± 20.54 vs 79.69 ± 28.77 min ( p = 0.035), 33.23 ± 10.14 vs 38.17 ± 8.61 min ( p = 0.01) and 133.69 ± 58.17 vs 232.56 ± 51.87 Gy.cm2 ( p < 0.001). Although there was no difference in sac shrinkage at 12-month follow-up, there was a significant decrease at 6-month follow-up in both groups ( p = 0.017). Endoleak occurred in 17.9% ( n = 7) of the obese group versus 11.1% ( n = 9) of the non-obese group ( p = 0.302). Iliac branch occlusion developed in four patients, 3 (3.7%) in the non-obese group and 1 (2.6%) in the obese group ( p = 0.608). The all-cause mortality rate was slightly higher in the obese group; however, it did not differ between the groups ( p = 0.463). Conclusion In addition to the longer procedure times, fluoroscopy times, and DAP values in obese patients, regardless of obesity, significant sac shrinkage in the first 6 months of follow-up was observed in both groups. No difference was documented with regards to mortality or morbidity following EVAR.

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Acute Bowel Obturation: Treatment Outcomes

Creative Surgery and Oncology ◽

10.24060/2076-3093-2021-11-1-15-19 ◽

2021 ◽

Vol 11 (1) ◽

pp. 15-19

Author(s):

A. L. Charyshkin ◽

E. A. Keshyan

Keyword(s):

Colorectal Cancer ◽

Body Mass Index ◽

Treatment Outcomes ◽

Body Mass ◽

Skin Irritation ◽

Skin Lesions ◽

The Body ◽

Obese Patients ◽

Two Stage ◽

Faecal Leakage

Background. Two-stage colostomy is a common choice in treatment for obstruction-complicated colorectal cancer.Aim. Research into paracolostomy complications in obese and non-obese patients.Materials and methods. Material on obstruction-complicated colorectal cancer was collected from 50 patients divided into two cohorts by the body mass index (BMI). Cohort 1 contained 25 patients with BMI <24, and cohort 2 — patients with BMI >30.Results. Compared to cohort 1 with BMI <24, obese cohort 2 revealed more paracolostomy complications, the increase in parastomal skin lesions by 32% (p < 0.05), pyoinflammatory complications by 36% (p < 0.05) and abscesses by 24% (p < 0.05).Discussion. Paracolostomy complications in patients with BMI >30 are due to obesity, a poorly fitting colostomy bag, faecal leakage, skin irritation, infection and crude coagulation in haemostasis. Stoma gradually becomes difficult to visualise, faecal leakage continues and the paracolostomy space is poorly drained in obese patients, contributing to pyoinflammatory parastomal complications.Conclusion. The main causes of pyoinflammatory parastomal complications in obese patients are a low stoma positioning and poor paracolostomy drainage. The circumstances described warrant improvement of colostomy techniques in obese patients.

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Evaluation of risk factors in superobese patients submitted to conventional Fobi-Capella surgery

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032008000100002 ◽

2008 ◽

Vol 45 (1) ◽

pp. 3-10 ◽

Cited By ~ 11

Author(s):

Euclides Dias Martins-Filho ◽

José Bezerra Câmara-Neto ◽

Álvaro Antônio Bandeira Ferraz ◽

Melânia Amorim ◽

Edmundo Machado Ferraz

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Gastric Bypass ◽

Risk Factor ◽

Sleep Apnea ◽

Body Mass ◽

Severe Obesity ◽

The Body ◽

Obese Patients ◽

Major Complications

BACKGROUND: Obesity is one of the world’s greatest health problems. The Roux-en-Y gastric bypass is the gold standard treatment for severe obesity. Surgery in obese patients has an acceptable level of morbidity and mortality. The superobese patient, a subcategory of severe obese patients with a high surgical risk has not yet been analyzed as a group. METHODS: A retrospective and prospective cohort study was conducted enrolling 135 patients submitted to Roux-en-Y gastric bypass for treatment of severe obesity at the " Hospital das Clínicas" , Federal University of Pernambuco, Recife, PE, Brazil, between November 1997 and September 2003. The independent variables were possible risk factors of adverse outcomes: age, gender, weight, body mass index, diabetes, hypertension, hypercholesterolemia, sleep apnea, cardiopathy/coronariopathy, pneumopathy or any other co-morbidity. The dependent variables were major complications, minor complications and death. RESULTS: Diabetes (RR = 1.6 and CI = 1.02-2.40) and sleep apnea (RR = 1.8 and CI = 1.18-2.64) were associated to minor complications. Cardiopathy/coronariopathy were associated with major complications (RR = 5.42 and CI = 1.22-2.40) and death (RR = 16.25 and CI = 3.00-87.95). BMI >55 kg/m² was associated with minor complications (RR = 1.58 and CI = 1.04-2.40), major complications (RR = 3.17 and CI = 1.03-9.80) and death (P = 0.007). After logistic regression, the body mass index >55 kg/m² remained as a strong risk factor of death (OR = 3.6 and CI = 1.05-12.32). CONCLUSIONS: The body mass index >55 kg/m² was the main risk factor for severe complications and death. Other risk factors affecting the outcome were diabetes, obstructive sleep apnea and cardiopathy/coronariopathy.

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One-stage operation for superficialization of native radio-cephalic fistula in obese patients

The Journal of Vascular Access ◽

10.1177/1129729818762994 ◽

2018 ◽

Vol 20 (1_suppl) ◽

pp. 45-49 ◽

Cited By ~ 1

Author(s):

Takao Okawa ◽

Masaaki Murakami ◽

Ryo Yamada ◽

Satoshi Tanaka ◽

Kiyoshi Mori ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Patency Rate ◽

Cephalic Vein ◽

Secondary Patency ◽

Obese Patients ◽

One Stage ◽

Small Series ◽

Secondary Patency Rate ◽

The Mean

Purpose: The population of obese patients is increasing in general and also at hemodialysis initiation. For successful cannulation of arteriovenous fistula, the National Kidney Foundation-Dialysis Outcome Quality Initiative guidelines suggest that the required maturation parameters are at a depth of <6 mm. There are several reports describing two-stage superficialization of arteriovenous fistulas in obese cases. Therefore, we investigated the utility and complications of one-stage superficialization of radio-cephalic fistula. Methods: From January 2011 to March 2017, we simultaneously performed forearm radio-cephalic fistula creation and superficialization of the cephalic vein for 10 patients having obesity (body mass index > 30 kg/m2) and deep cephalic vein (>6 mm). Initially, an arteriovenous anastomosis was created at an appropriate site. Subsequently, an 8–10 cm longitudinal skin incision was made along the lateral aspect of the forearm cephalic vein. The cephalic vein was identified and exposed. The cephalic vein was repositioned superficially. Results: The mean age of the patients was 53 years (range: 40–72 years) and the mean body mass index was 40.2 kg/m2 (33.1–59.7 kg/m2). The cause of renal failure in eight patients was diabetic nephropathy, and in two patients, it was unknown. After the procedure, vein depth became 3.4 mm (1.9–4.6 mm) from 8.2 mm (6.0–13.4 mm). All patients who initiated dialysis underwent successful two-needle cannulation. Primary patency rate was 71.4% at 12 months (two patients underwent percutaneous transluminal angioplasty) and secondary patency rate was 100%. There was one procedure-related complication and delayed wound healing, which was improved by observation without antibiotics. Conclusion: This small series of patients indicates that one-stage superficialization of radio-cephalic fistula is a safe and effective option to start hemodialysis in obese subjects.

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An Individual Patient Data Meta-Analysis with Colombian Studies on the Effect of Dark Chocolate Consumption on Cardiovascular Risk Parameters

Journal of Nutrition and Metabolism ◽

10.1155/2020/3419598 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Leidy Alvarez ◽

Javier Contreras ◽

Mónica Giraldo

Keyword(s):

Body Mass Index ◽

Clinical Trials ◽

Lipid Profile ◽

Body Mass ◽

Meta Analysis ◽

Abdominal Circumference ◽

Two Stage ◽

One Stage ◽

Study Results ◽

The One

Background. It is postulated that cocoa solids possess cardioprotective capacity by various mechanisms. In the different cocoa studies evaluating cardiovascular disease, there are no conclusive data on the role it plays in controlling the lipid profile and anthropometric variables, perhaps because the concentration of cocoa, the geographical origin of the population, and the different concentrations supplied lead to a high heterogeneity of results. This study aims to estimate the effect of consuming cocoa-rich chocolate compared to placebo on the lipid profile and anthropometric variables based on data from three clinical trials conducted in Colombia. Methods. Meta-analysis of individual data from three randomized clinical trials conducted in Colombia. The entire population of the primary studies was included, which was reassigned into intervention groups if they consumed 50 grams of 70% concentrated cocoa or placebo, which was considered to be cocoa-free or with a concentration less than 50 grams. The variables at the beginning of the study were analyzed with medians, interquartile ranges, means, and deviations according to whether they met the normality assumption. Multiple imputations were used to manage missing data and were analyzed using the two approaches proposed for this type of study, that of one and two stages. In the two-stage approach, the data were weighted on a conventional Forrest plot, while in the one-stage approach, linear regressions with mixed models were applied. This study is governed by the regulations described in the 2013 Declaration of Helsinki and by article 11 of Resolution 8430 of 1993, which classifies it as a risk-free study. Results. A total of 275 participants were included, who consumed cocoa or placebo for 81 days on average; 52.7% were female and few smoked at the time of the intervention (31/275). Physical activity performed in number of hours per week was comparable between the intervention groups. When evaluating total cholesterol, low-density cholesterol (LDL), high-density cholesterol (HDL), triglycerides, abdominal circumference, and final body mass index with both the one-stage and two-stage approaches, there were no significant differences between the two groups. Conclusions. According to the results obtained in the meta-analysis, the consumption of cocoa in the Colombian population does not seem to significantly modify variables such as lipid profile, abdominal circumference, and body mass index. This conclusion according to the quality of the evidence has a weak recommendation and a low-to-moderate certainty. However, the analysis through the two proposed approaches yielded similar results.

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Impact of Increased Body Mass Index on Accuracy of B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP for Diagnosis of Decompensated Heart Failure and Prediction of All-Cause Mortality

Clinical Chemistry ◽

10.1373/clinchem.2009.129742 ◽

2010 ◽

Vol 56 (4) ◽

pp. 633-641 ◽

Cited By ~ 23

Author(s):

Robert H Christenson ◽

Hassan ME Azzazy ◽

Show-Hong Duh ◽

Susan Maynard ◽

Stephen L Seliger ◽

...

Keyword(s):

Heart Failure ◽

Body Mass Index ◽

Body Mass ◽

Decompensated Heart Failure ◽

Normal Weight ◽

Multivariate Logistic Regression Model ◽

Obese Patients ◽

All Cause Mortality ◽

Study Population

Abstract Background: BNP and N-terminal proBNP (NT-proBNP) concentrations may be depressed in patients with increased body mass index (BMI). Whether increased BMI affects accuracy of these biomarkers for diagnosing decompensated heart failure (HF) and predicting outcomes is unknown. Methods: We measured BNP and NT-proBNP in 685 patients with possible decompensated HF in a free-living community population subdivided by BMI as obese, overweight, and normal weight. HF diagnosis was adjudicated by a cardiologist blinded to BNP and NT-proBNP results. We tabulated all-cause mortality over a median follow-up of 401 days and assessed marker accuracy for HF diagnosis and mortality by ROC analysis. Results: Of the 685 patients, 40.9% were obese (n = 280), 28.2% were overweight (n = 193), and 30.9% had normal BMI (n = 212). Obese patients had lower BNP and NT-proBNP compared with overweight or normal-weight individuals (P < 0.001) and decreased mortality compared with normal-weight individuals (P < 0.001). Both biomarkers added significantly to a multivariate logistic regression model for diagnosis of decompensated HF across BMI categories. NT-proBNP outperformed BNP for predicting all-cause mortality in normal-weight individuals (χ2 for BNP = 6.4, P = 0.09; χ2 for NT-proBNP = 16.5, P < 0.001). Multivariate regression showed that both biomarkers remained significant predictors of decompensated HF diagnosis in each BMI subgroup. Conclusions: In this study population, obese patients had significantly lower BNP and NT-proBNP that reflected lower mortality. BNP and NT-proBNP can be used in all BMI groups for decompensated HF diagnosis, although BMI-specific cutpoints may be necessary to optimize sensitivity.

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