scholarly journals SURGICAL TREATMENT OF SEVERE OBESITY IN TEENS: LATE RESULTS

2015 ◽  
Vol 28 (suppl 1) ◽  
pp. 7-10
Author(s):  
Álvaro Antônio Bandeira FERRAZ ◽  
Luciana Teixeira de SIQUEIRA ◽  
Clarissa Guedes NORONHA ◽  
Danilo Belem Rodrigues de HOLANDA ◽  
José Guido Corrêa de ARAÚJO-JÚNIOR ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Multidisciplinary Team ◽  
Severe Obesity ◽  
Developed Countries ◽  
Late Results ◽  
Overweight And Obesity ◽  
Drug Discontinuation ◽  
Average Weight

Background : In children is estimated that the prevalence of overweight and obesity has increased up to five times in developed countries and up to four in developing countries. In Brazil, the proportion of children and adolescents who are overweight also increased from approximately 4.1% to 13.9%. Aim : To evaluate the surgical results of severe obesity in adolescents. Methods : Retrospective descriptive study of 2737 patients with severe obesity that underwent Roux-en-Y gastric bypass selecting from the total 44 patients with mean age of 18.1 years, 14 males and 30 females, most (37) operated by laparotomy. There was follow-up of 20 patients (45.45%). All were followed preoperatively by a multidisciplinary team and had indication confirmed for surgical unanimous approval of all team members. Results : Among the 20 adolescent, 14 were female. From five teenagers using anti-hypertension or hypoglycemic drugs before surgery, four (80%) had drug discontinuation and one (20%) reduced the dose in 50% postoperatively. The average weight loss was 45.4 kg after a mean follow up of 60 months. There were no deaths or severe postoperative complications. Among those who underwent postoperative follow-up with a multidisciplinary team, 18 were with BMI<30. Conclusions : Adolescents undergoing Roux-en-Y gastric bypass has good response in relation to weight loss and improvement of comorbidities. There was a low rate of complications and no deaths. All patients were satisfied with their personal results.

scholarly journals Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

2021 ◽  
Author(s):  
Arnaud Liagre ◽  
Francesco Martini ◽  
Radwan Kassir ◽  
Gildas Juglard ◽  
Celine Hamid ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Severe Obesity ◽  
Postoperative Mortality ◽  
One Anastomosis Gastric Bypass ◽  
Sustained Weight Loss ◽  
Biliopancreatic Limb ◽  
Percentage Excess Weight Loss

Abstract Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract

Abstract 14888: Lipid Changes 8 Years Post Gastric Bypass in Adolescents With Severe Obesity

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Amy S Shah ◽  
Todd Jenkins ◽  
Elaine M Urbina ◽  
Shelley Kirk ◽  
Robert Siegel ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Severe Obesity ◽  
Weight Loss Surgery ◽  
Ldl Particles ◽  
Signed Rank ◽  
Pre Treatment ◽  
The Impact ◽  
Lipid Parameters

Introduction: Severe obesity in adolescents is increasing and few effective treatments exist. Weight loss surgery is one option, but the extent to which surgery influences cardiovascular risk factors such as lipids in youth is not clear. We studied the impact of weight loss surgery in adolescents with severe obesity on lipid parameters in the Follow-up of Adolescent Bariatric Surgery-5+ (FABS-5+) study >5 years postoperatively. Hypothesis: We predicted weight loss surgery would be associated with a greater improvement in lipids compared to no surgery. Methods: Adolescents and young adults who either underwent laparoscopic Roux-en Y gastric bypass (RYGB; “Surgical”) or who were seeking weight loss treatment (“Non-Surgical”) in 2001-2007 were recruited for the FABS-5+ follow-up study between 2011-2013. Baseline (pre-treatment) BMI and fasting lipids and TG/HDL-C ratio (representing small dense LDL particles) were abstracted from charts. Follow-up data were obtained at a research visit. Changes in BMI and lipids were evaluated using paired t-tests and Wilcoxon signed rank tests. Results: At baseline, surgical participants (n=58; 80% of all RYGB cases performed in 2001-2007) were a mean±SD age of 17±2 years and 25±2 at follow-up. 86% were Caucasian and 64% were female. After RYGB, BMI was 29% lower than baseline (p<0.01). All lipids (except total cholesterol) significantly improved with the largest changes in HDL-C and TG/HDL-C ratio. In the non-surgical comparison group (n=30) from baseline to follow up (ages 15±2 and 22±2 years, respectively), BMI increased by 8% but lipid parameters were similar (Table). Conclusions: This is the longest term and most complete follow-up of youth following RYGB. Weight loss was durably maintained and significant improvements in lipid profile were observed. Whether these lipid improvements translate into reductions in atherosclerosis and cardiovascular events overtime remains to be determined.

OP270 Why The Haute Autorité de Santé Rejects the Widespread Use Of “Mini-Bypass”/One Anastomosis Gastric Bypass For Obesity In France

2020 ◽  
Vol 36 (S1) ◽  
pp. 4-4
Author(s):  
Jean-Charles Lafarge ◽  
Denis-Jean David ◽  
Cédric Carbonneil
Keyword(s):  
Esophageal Cancer ◽  
Gastric Bypass ◽  
Adverse Events ◽  
Severe Obesity ◽  
One Anastomosis Gastric Bypass ◽  
Close Monitoring ◽  
Efficacy And Safety ◽  
Multicenter Rct ◽  
Nutritional Complications

IntroductionOne anastomosis gastric bypass (OAGB) has become a widespread technique over the last few years in France, without any prior assessment and despite existing controversies among bariatric surgeons. An older bypass technique for treating obesity, the Roux-en-Y gastric bypass (RYGB), is available and reimbursed, having been assessed and approved for use in 2005. In 2019, the French Haute Autorité de Santé (HAS) assessed OAGB for the treatment of severe and massive obesity. This assessment, the first in the world, was undertaken for OAGBs carried out with a 200- or 150-centimeter biliopancreatic-limb (BP-limb) length.MethodsA systematic review (SR) of the literature and consultation of a working group consisting of both healthcare professionals (clinician and surgeons) and patients were carried out. The primary aim of our assessment was to determine whether the OAGB technique can replace RYGB. The efficacy and safety profile of OAGB was compared with RYGB in adult patients with massive, severe obesity. Complications and postoperative follow up specific to OAGB were identified.ResultsThe three selected randomized controlled trials (RCTs) could not confirm the superiority or the non-inferiority of OAGB, compared with RYGB, on the selected efficacy endpoints of weight loss, resolution of comorbidities, and quality of life. Adverse events reported for OAGB included severe nutritional complications and bile reflux that could potentially lead to lower esophageal cancer. In one RCT, the frequency of serious adverse events in the OAGB group was almost two times higher than in the RYGB group.ConclusionsHAS considered that OAGB carried out with a longer (200 centimeter) BP-limb is not a validated technique for the surgical treatment of massive, severe obesity. Thus, it cannot be considered an alternative to RYGB. There were insufficient data available on OAGB performed with a 150-centimeter BP-limb. Thus, HAS recommended undertaking a multicenter RCT to assess the efficacy and safety of OAGB. Patients who have already undergone OAGB should receive the same follow up as patients who have received RYGB, including close monitoring for nutritional complications and lower esophageal cancer and an endoscopic examination five years after surgery.

scholarly journals Central Noradrenergic Neurotransmission and Weight Loss 6 Months After Gastric Bypass Surgery in Patients with Severe Obesity

2021 ◽  
Author(s):  
J. Marvin Soeder ◽  
Julia Luthardt ◽  
Michael Rullmann ◽  
Georg A. Becker ◽  
Mohammed K. Hankir ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Severe Obesity ◽  
Occipital Cortex ◽  
Brain Regions ◽  
General Tendency ◽  
Strong Positive Correlation ◽  
Reference Tissue ◽  
Efficient Treatment ◽  
Post Surgery

Abstract Purpose Roux-en-Y gastric bypass (RYGB) surgery is currently the most efficient treatment to achieve long-term weight loss in individuals with severe obesity. This is largely attributed to marked reductions in food intake mediated in part by changes in gut-brain communication. Here, we investigated for the first time whether weight loss after RYGB is associated with alterations in central noradrenaline (NA) neurotransmission. Materials and Methods We longitudinally studied 10 individuals with severe obesity (8 females; age 43.9 ± 13.1 years; body mass index (BMI) 46.5 ± 4.8 kg/m2) using (S,S)-[11C]O-methylreboxetine and positron emission tomography to estimate NA transporter (NAT) availability before and 6 months after surgery. NAT distribution volume ratios (DVR) were calculated by volume-of-interest analysis and the two-parameter multilinear reference tissue model (reference region: occipital cortex). Results The participants responded to RYGB surgery with a reduction in BMI of 12.0 ± 3.5 kg/m2 (p < 0.001) from baseline. This was paralleled by a significant reduction in DVR in the dorsolateral prefrontal cortex (pre-surgery 1.12 ± 0.04 vs. post-surgery 1.07 ± 0.04; p = 0.019) and a general tendency towards reduced DVR throughout the brain. Furthermore, we found a strong positive correlation between pre-surgery DVR in hypothalamus and the change in BMI (r = 0.78; p = 0.01). Conclusion Reductions in BMI after RYGB surgery are associated with NAT availability in brain regions responsible for decision-making and homeostasis. However, these results need further validation in larger cohorts, to assess whether brain NAT availability could prognosticate the outcome of RYGB on BMI. Graphical abstract

Short-Term Results of Single-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Alaa Abbas Sabry ◽  
Karim Sabry Abd-Elsamee ◽  
Mohamed Ibrahim Mohamed ◽  
Mohammed Mohamed Ahmed Abd-Elsalam
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Weight Regain ◽  
Revisional Surgery ◽  
One Anastomosis Gastric Bypass ◽  
Short Term ◽  
Multicenter Studies ◽  
Metabolic Outcomes

Abstract Background It is already known that Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain is considered as a complication. Demand for secondary surgery is rising, partly for this reason, but through that study we try to discover the efficacy of conversion of failed sleeve gastrectomy to one anastomosis gastric bypass (OAGB) regarding weight loss and metabolic outcomes. Objective To asses the efficacy and safety of one anastomosis gastric bypass (OAGB) as a conversion surgery post Sleeve Gastrectomy failure as regard weight loss and metabolic outcomes. Patients and Methods This study is a retrospective cohort study which included 20 patients underwent one anastomosis gastric bypass at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric center, Cairo, Egypt From February 2019 to July 2019 with 6 months of postoperative follow up till January 2019. Results In this study, we reviewed and analyzed the outcomes from the revision of the SG due to either inadequate weight loss or weight regain to one anastomosis gastric bypass (OAGB) with %EBWL of 6.65% at 1 month, 13.61 % at 3 months and 20.86% at 6 months. Conclusion OAGB appears to be an effective and safe therapeutic technique as a revisional surgery for failed primary SG with good short-term results for treating morbid obesity and its associated comorbidities with a significantly low rate of complications. However the EBWL was less than what is reported after primary OAGB weight. Multicenter studies with larger series of patients and longer term follow up after SG revisions to OAGB are warranted.

scholarly journals Improved heart rate recovery after marked weight loss induced by gastric bypass surgery: Two-year follow up in the Utah Obesity Study

Heart Rhythm ◽  
2011 ◽  
Vol 8 (1) ◽  
pp. 84-90 ◽  
Author(s):  
Stephen L. Wasmund ◽  
Theophilus Owan ◽  
Frank G. Yanowitz ◽  
Ted D. Adams ◽  
Steven C. Hunt ◽  
...  
Keyword(s):  
Heart Rate ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Bypass Surgery ◽  
Heart Rate Recovery ◽  
Gastric Bypass Surgery ◽  
Marked Weight

scholarly journals Determinants of Adequate Response of Patient Undergoing Roux-en-y Gastric Bypass Surgery

2020 ◽  
Author(s):  
Thales Philipe Rodrigues Silva ◽  
Flávia Moraes Silva ◽  
Larissa Loures Mendes ◽  
Alexandra Dias Moreira D'assunção ◽  
Lauro Pinheiro Ferreira de Araujo ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Logistic Regression ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Inadequate Response ◽  
Post Surgery ◽  
Adequate Response ◽  
Follow Up Care

Abstract INTRODUCTION: Roux-en-Y gastric bypass surgery (RYGB) is known to induce, on average,60 to 75% excess body weight loss between 18 and 24 months post-surgery. However, several studies have shown weight regain after two years post-surgery, thus patients must have adequate follow-up in order to guarantee and/or maintain response to RYGB. AIM: To evaluate the determinants of adequate response in patients who underwent RYGB. METHODS: A longitudinal study with 193 adults who underwent RYGB between 2012 and 2014. Adequate response to RYGB was determined by Excess Weight Loss (%EWL). Logistic regression models were constructed to verify the degree of association between adequate response of patient after RYGB and determinants of variable risk based on estimate Odds Ratios (OR). RESULTS: RYGB improves Systemic arterial hypertension (SAH), Diabetes Mellitus (DM) and body mass index (BMI). From the multivariate logistic regression model, being female and not having SAH and DM reduce the chance of inadequate RYGB response. Regarding preoperative BMI, an increase in one unit of kg/m2 was associated with increased odds of inadequate response after RYGB. And patients who did not receive follow-up care with a psychologist or psychiatrist in the postoperative period presented higher odds of inadequate response to RYGB. CONCLUSION: The findings of this study contribute to the effective planning of interventions by multi-professional teams involved in RYGB, aimed at offering a better follow-up care focused mainly on post-surgery changes and adequate RYGB response.

Abstract 16013: Evidence for Improvement in NYHA Class and Freedom From Hospitalization in Bariatric Surgery Patients With an Established Diagnosis of Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael W Foster ◽  
Sara E Badenhausen ◽  
Colleen Tewksbury ◽  
Noel N Williams ◽  
J Eduardo Rame ◽  
...  
Keyword(s):  
Heart Failure ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Medical Record ◽  
Median Time ◽  
Severe Obesity ◽  
Nyha Class ◽  
High Volume ◽  
Metabolic And Bariatric Surgery

Introduction: Heart failure patients with severe obesity endure significant morbidity and frequent hospitalizations. Bariatric surgery is proven to provide durable weight loss for those with severe obesity, but the clinical impact and safety of these procedures among patients with heart failure has not been well-demonstrated. Methods: We conducted a medical record query of patients who have a previous diagnosis of heart failure (HFpEF and HFrEF) and underwent subsequent Roux-En-Y gastric bypass or laparoscopic sleeve gastrectomy at a high-volume metabolic and bariatric surgery center. We compared clinical, demographic, and echocardiographic data captured just prior to the bariatric procedure to the most recent data available in the medical record for each patient. Results: There were 50 patients (88% had HFpEF) included in this study. Time from HF diagnosis to most recent follow-up ranged from 0.2 to 20.3 years (median 6.7 years) and there was no recorded mortality. The median time from HF diagnosis to surgery was 2.3 years and median time from surgery to recent follow-up was 2.9 years. Post-operative median decrease in BMI was 8.8 kg/m 2 , HF hospitalizations were 0.4 per patient year (PPY) to 0.15 PPY, p=0.008, and median NYHA Class was II pre-op and I post-op, p=0.048). LVEF, LVESD, and LVEDD were not significantly changed post-operatively (Table 1). Conclusion: Weight loss following bariatric surgery for patients with HF led to improvements in NYHA Class, fewer hospitalizations for HF, and was not associated with perioperative mortality. It is reasonable to consider bariatric surgery for this patient population, but further prospective investigation is warranted.

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