Nachsorge und Supplementation nach Adipositaschirurgie

ZusammenfassungDie Zahl der Patienten mit gewichtsreduzierenden Operationen wegen morbider Adipositas ist in den vergangenen Jahren sprunghaft angestiegen. Für restriktive Verfahren (Magenband, vertikale Gastroplastik, Sleeve-Gastrektomie) wird ein Excess weight loss (EWL) von 40 bis 55 Prozent beschrieben, wobei nachsorgepflichtige chirurgische Komplikationen eher selten sind. Eine Supplementation ist im Regelfall postoperativ nicht notwendig. Operationsverfahren mit malabsorptiver Komponente (Magen-Bypass, biliopankreatische Diversion mit/ohne Duodenalswitch) weisen einen stärkeren EWL von 50 bis 85 Prozent auf, sind jedoch mit einer höheren Komplikationsrate behaftet. Im Follow-up ist eine lebenslange Substitutionstherapie notwendig, da folgende Defizite häufig beobachtet werden: Protein bei 1,4 bis 3 Prozent der Patienten, Eisen bei 45 bis 52 Prozent, Folsäure bei 35 Prozent, Vitamin B12 bei 33 bis 37 Prozent, Kalzium bei zehn bis zwölf Prozent, Vitamin D bei 45 Prozent und andere fettlösliche Vitamine (A, E, K) bei 10 bis 23 Prozent. Obwohl gleichzeitig nach Malabsorptions-Operationen eine verminderte Nahrungsaufnahme wichtiger Nährstoffe und Vitamine beobachtet wird, sind derzeit keine einheitlichen Empfehlungen zur notwendigen Substitution in der Literatur verfügbar. Zukünftige prospektive Studien sind notwendig, um die klinische Beurteilung dieser Mangelzustände besser einschätzen zu können.

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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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Συγκριτική μελέτη της απώλειας βάρους και της εμφάνισης επιπλοκών, ασθενών με νοσογόνο παχυσαρκία (BMI 40-50) που υποβάλλονται σε γαστρική παράκαμψη Roux-en-Y και χολοπαγκρεατική παράκαμψη με Roux-en-Y αποκατάσταση

10.12681/eadd/27968 ◽

2010 ◽

Author(s):

Ευστάθιος Ανεσίδης

Keyword(s):

Weight Loss ◽

Excess Weight Loss ◽

Excess Weight

Ο στόχος της παρούσας μελέτης ήταν η σύγκριση των αποτελεσμάτων και των μεταβολικών επιπλοκών της γαστρικής παράκαμψης Roux-en-Y και μιας εκδοχής της χολοπαγκρεατικής εκτροπής σε έναν αποκλειστικά non-superobese πληθυσμό. Τα κύρια χαρακτηριστικά της χολοπαγκρεατικής εκτροπής ήταν: γαστρικός θύλακος 15±5L, χολοπαγκρεατική έλικα 200, κοινό κανάλι 100 και διατροφική έλικα το λοιπό λεπτό έντερο. Τα κύρια χαρακτηριστικά της RYGBP ήταν: γαστρικός θύλακος 15±5L, χολοπαγκρεατική έλικα 60, Roux έλικα 100 και κοινό κανάλι το υπόλοιπο μήκος του λεπτού εντέρου. Από 130 ασθενείς με BMI 35-50 kg/m², οι 65 υποβλήθηκαν σε RYGBP και οι 65 σε BPD. Όλοι οι ασθενείς ολοκλήρωσαν το δεύτερο μετεγχειρητικό έτος. Η μέση απώλεια υπερβάλλοντος βάρους (excess weight loss, %EWL) ήταν καλύτερη μετά από BPD καθόλη τη διάρκεια του follow-up, ενώ στα 2 χρόνια η EWL ήταν >50% στο 100% των ασθενών της BPD σε σύγκριση με το 88.7% της RYGBP. Η παθολογική ανοχή γλυκόζης, η υπερχοληστερολαιμία, η υπερτριγλυκεριδαιμία και η υπνική άπνοια παρουσίασαν πλήρη ύφεση και στις δύο ομάδες, αλλά τα μέσα επίπεδα ολικής χοληστερόλης ήταν σημαντικά χαμηλότερα μετά από BPD στα 2 χρόνια. Ο διαβήτης υποχώρησε πλήρως σε όλους τους ασθενείς της BPD και σε 7 στους 10 ασθενείς της RYGBP. Δεν παρατηρήθηκαν στατιστικά σημαντικές διαφορές στις πρώιμες και όψιμες μη μεταβολικές επιπλοκές. Υποαλβουμιναιμία παρατηρήθηκε σε 1 ασθενή της RYGBP (1.5%) και σε 6 ασθενείς της BPD (9.2%). Μόνο ένας ασθενής από κάθε ομάδα χρειάστηκε νοσηλεία και ολική παρεντερική διατροφή. Συμπεραίνουμε πως οι μεταβολικές επιπλοκές μετά από BPD δεν ήταν σοβαρές και δεν παρουσίαζαν στατιστικά σημαντική διαφορά ανάμεσα στις δύο ομάδες, οπότε και οι δύο επεμβάσεις είναι ασφαλείς και αποτελεσματικές σε non-superobese πληθυσμούς, αλλά η BPD είναι πιο αποτελεσματική στην απώλεια βάρους και στην επίλυση του διαβήτη και τηςυπερχοληστερολαιμίας.

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Laparoscopic gastric bypass achieves greater excess weight loss, remission of diabetes, and improvement in quality of life than gastric banding at 2 years' follow-up

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2010.02.004 ◽

2010 ◽

Vol 6 (2) ◽

pp. 224-225

Author(s):

N. Hamza ◽

M.H. Abbas ◽

A. Darwish ◽

Z. Shafeek ◽

B.J. Ammori

Keyword(s):

Quality Of Life ◽

Weight Loss ◽

Gastric Bypass ◽

Gastric Banding ◽

Laparoscopic Gastric Bypass ◽

Excess Weight Loss ◽

Excess Weight ◽

Remission Of Diabetes

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Influence of Excess Weight Loss and Weight Regain on Biochemical Indicators During a 4-Year Follow-up After Roux-en-Y Gastric Bypass

Obesity Surgery ◽

10.1007/s11695-014-1349-0 ◽

2014 ◽

Vol 25 (2) ◽

pp. 279-284 ◽

Cited By ~ 24

Author(s):

Carolina Ferreira Nicoletti ◽

Bruno Affonso Parenti de Oliveira ◽

Marcela Augusta Souza de Pinhel ◽

Bruna Donati ◽

Julio Sergio Marchini ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Weight Regain ◽

Excess Weight Loss ◽

Excess Weight ◽

Biochemical Indicators

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Long-Term Complications of Open Mason's Vertical Banded Gastroplasty at a Single Tertiary Center and Literature Review

The American Surgeon ◽

10.1177/000313481908501234 ◽

2019 ◽

Vol 85 (12) ◽

pp. 1386-1390

Author(s):

Tristan Greilsamer ◽

David Jacobi ◽

Michel Krempf ◽

Guillaume Boulanger ◽

Marie Guillouche ◽

...

Keyword(s):

Weight Loss ◽

Vertical Banded Gastroplasty ◽

Excess Weight Loss ◽

Excess Weight ◽

Long Term Outcome ◽

Banded Gastroplasty ◽

Tertiary Center ◽

The Mean

Vertical banded gastroplasty (VBG), introduced by Mason in 1982, is now discarded because of important long-term complications and technical difficulties to do revisional surgery. We investigated the long-term complications of VBG in our center and compared it with the literature data. Patients who underwent an open VBG at the University Hospital of Nantes between October 1991 and May 2006 were included. We reviewed preoperative clinical data, long-term outcome in weight loss, complications, and revisional surgeries with a long follow-up. Sixty-three patients (52 women and 11 men) were included, with a mean age of 43 ± 10 years and a body mass index of 46.7 ± 8.3 kg/m. The mean follow-up was 8.2 ± 4.2 years. At the end of follow-up, the mean excess weight loss (EWL) was 29.8%. Long-term success (excess weight loss > 50%) of the procedure was observed in 25 patients (39.7%). A second intervention was performed in 15 patients (23.8%), and three needed a third redo procedure. Six patients (40%) had this new intervention for late complications, and nine (60%) for weight regain. Weight loss is satisfying in the long term although the rate of reintervention is high. Long-term complication can be severe, especially with gastric stenosis that could lead to esophageal cancer. A second reintervention could be technically demanding, especially by laparoscopy, and the patients should be referred to a specialized center.

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Predictors of Excess Weight Loss in Obese Patients After Gastric Bypass: a 60-Month Follow-up

Obesity Surgery ◽

10.1007/s11695-015-1911-4 ◽

2015 ◽

Vol 26 (6) ◽

pp. 1178-1185 ◽

Cited By ~ 17

Author(s):

Anália S. Barhouch ◽

Alexandre V. Padoin ◽

Daniela S. Casagrande ◽

Raquel Chatkin ◽

Samanta P. Süssenbach ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Excess Weight Loss ◽

Excess Weight ◽

Obese Patients

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Impact of Preoperative Serum Vitamin D Level on Postoperative Complications and Excess Weight Loss After Gastric Bypass

Obesity Surgery ◽

10.1007/s11695-017-2600-2 ◽

2017 ◽

Vol 27 (8) ◽

pp. 1982-1985 ◽

Cited By ~ 3

Author(s):

Caroline Schaaf ◽

Jean Gugenheim

Keyword(s):

Vitamin D ◽

Weight Loss ◽

Gastric Bypass ◽

Postoperative Complications ◽

Excess Weight Loss ◽

Serum Vitamin ◽

Excess Weight ◽

Serum Vitamin D ◽

Preoperative Serum

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Evaluation of Weight Loss Failure, Medical Outcomes, and Personal Experiences after Roux-en-Y Gastric Bypass: A Critical Analysis

ISRN Obesity ◽

10.1155/2013/943423 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Rogier Hörchner ◽

Dave Schweitzer

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Excess Weight Loss ◽

Excess Weight ◽

Medical Outcomes ◽

Personal Experiences ◽

Degree Of Satisfaction ◽

Using Data

Background. Roux-en-Y gastric bypass (RYGB) is considered an effective and well-tolerated surgical procedure. In this retrospective study, we critically assessed efficacy and negative personal experiences (NPEs) after RYGB with a self-administered questionnaire (SAQ). Methods. This questionnaire study included 404 patients who had undergone RYGB. Analysis was performed using data from medical records, referral letters, and SAQs at an average of 33 months after procedure. We evaluated the occurrence of hypertension, CPEP use and type 2 diabetes mellitus (T2DM), the amount of excess weight loss, degree of satisfaction and negative personal experiences (NPEs) related to the procedure, and adherence to a dedicated life style program and (non)attendance to followup. consults after surgery. Results. 42.3% of all SAQs were evaluable for analysis. T2DM remained similar, while hypertension and continuous positive airway pressure (CPAP) use decreased significantly; excess weight loss of ≥40% was reported in 69% and of <40% in 19%, a significant improvement. Absolute weight gain was reported in 10.5%, fatigue in 44.4%, dysphagia in 11.6%, and other NPEs in 7.6%. Dissatisfaction over weight loss was reported in 9.4%. Mean number of follow-up visits was 9.6 per respondent, while nonattendance of any follow-up visit consults occurred in 1.8%. Conclusions. The use of post-RYGB SAQs provided evaluable data in 42.3%. Treatment failure after RYGB appears to be relevant, encouraging the use of SAQ studies in large cohorts.

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