scholarly journals Multidisciplinary approach of non-responders after bariatric surgery reduces the indication for revisional surgery: a retrospective cohort study

2020 ◽  
Author(s):  
Marleen Romeijn ◽  
Martine Uittenbogaart ◽  
François M. H. van Dielen ◽  
Arijan A. P. M. Luijten ◽  
Loes Janssen ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Retrospective Cohort ◽  
Weight Regain ◽  
Multidisciplinary Approach ◽  
Physical Therapist ◽  
Revisional Surgery ◽  
Behavioral Changes ◽  
Selection Of Patients ◽  
Selection Of

Abstract Background 20–30% of patients show a lack of response after bariatric surgery (BS). These non-responders may experience insufficient weight loss or significant weight regain. Based on previous research in our center, it has been identified that before the introduction of a multidisciplinary team (MDT), 68% of the non-responders underwent revisional surgery. This study describes the effect of an MDT on treatment strategy in non-responders after BS. Methods this retrospective study included non-responders that were reviewed in an MDT meeting. Patients were categorized as primary non- responders (1NR) or as secondary non-responders (2NR). Outcomes assessed were: I. MDT-based treatment (conservative versus operative), II. Weight loss, III. Complications after revisional surgery. Results a total of 104 patients were included (n = 15 1NR, n = 89 2NR). In 73 patients, lifestyle and/or behavioral changes were indicated. Only eleven patients (13%) were re-operated in which one complication occurred. Twenty patients did not show up at their appointment with the dietician, physical therapist and/or medical psychologist and were excluded from further analysis. Conservatively treated patients lost 2.1 kg < 12 months (SD = 7.29) and 0.8 kg < 24 months (SD = 5.08). Surgically treated patients lost 12.0 kg < 12 months (SD = 4.29) and 26.3 kg < 24 months (SD = 2.75). Conclusions the rate of revisional surgery decreased after the introduction of an MDT. An explanation for this could be that an MDT drives more patients towards a conservative treatment since it identifies modifiable lifestyle and/or behavioral factors contributing to non-response. Incorporation of an MDT may contribute to the selection of patients who might benefit from revisional surgery.

scholarly journals A multidisciplinary approach for non-responders after bariatric surgery: why does it matter?

2020 ◽  
Author(s):  
Marleen Romeijn ◽  
Martine Uittenbogaart ◽  
François M. H. van Dielen ◽  
Arijan A. P. M. Luijten ◽  
Loes Janssen ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Conservative Treatment ◽  
Multidisciplinary Team ◽  
Weight Regain ◽  
Multidisciplinary Approach ◽  
Physical Therapist ◽  
Revisional Surgery ◽  
Multidisciplinary Team Meeting ◽  
Behavioural Factors

Abstract Background: 20-30% of patients show a lack of response after bariatric surgery. These non-responders may experience insufficient weight loss or significant weight regain. While ongoing studies about the beneficial effect of revisional surgery on non-response are being reported, studies about the contributiveness of a multidisciplinary approach fall behind. The aim of this study was to describe the effect of a multidisciplinary approach on treatment strategy in non-responders after gastric bypass and sleeve gastrectomy.Methods: this retrospective study included non-responders that were reviewed in a multidisciplinary team meeting. Outcomes assessed were: given treatment (conservative versus operative), weight loss and complications after operative treatment. Outcomes were described separately for primary non- responders and secondary non-responders.Results: a total of 104 patients were included (n=15 primary, n=89 secondary non-response). Eleven patients underwent revisional surgery (13%), while 73 patients received conservative treatment as they were not eligible for surgery due to lifestyle and/or behavioural factors. Twenty patients did not show up at their appointment with the dietician, physical therapist and/or medical psychologist and were excluded from further analysis. Conservatively treated patients lost 2.1kg <12 months (SD=7.29) and 0.8kg <24 months (SD=5.08). Surgically treated patients lost 12.0kg <12 months (SD=4.29) and 26.3kg <24 months (SD=2.75). One complication occurred in a patient that underwent revisional surgery.Conclusions: a conservative treatment was more frequently proposed by the multidisciplinary team than a surgical treatment. A multidisciplinary approach can be beneficial for the identification of lifestyle and/or behavioural factors contributing to the development of non-response. More studies would help to establish the position of a multidisciplinary approach in the treatment of non-responders in future practices.

scholarly journals Key Time Points After Bariatric Surgery, From Weight Loss To Weight Regain: Long-Term Retrospective Cohort Study

2021 ◽  
Author(s):  
Mahsa Hatami ◽  
Abdolreza Pazouki ◽  
Fatemeh Sadat Hosseini-Baharanchi ◽  
Ali Kabir
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Weight Regain ◽  
Long Term Results ◽  
Time Points

Abstract Background and Objective: Bariatric surgery may lead to an unsuccessful weight loss, weight loss plateau, and even weight regain in different time points after various types of surgery. Despite the numerous studies investigated bariatric surgery-induced weight loss, the long-term results of surgery, after repetitive weight fluctuations, is not really clear and remains as one of the most important concerns. The aim of the present study was to determine the key time points of weight changes after three types of bariatric surgery, and the estimation of five-year weight loss after surgery. Setting: This is a retrospective cohort study including patients with morbid obesity conducted in the obesity clinic of Minimally Invasive Surgery Research Center of Iran University of Medical Sciences. Methods The subjects underwent one of the three types of bariatric surgeries including laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) which had been followed up to five years after surgery. The percentage lost to follow-up was 34% until five-year after surgery. Results The mean %EWL a total of 2567 morbid obese participants (mean age=39.03, mean BMI=45.67) in the first six months after surgery was independent of the type of surgery. Ninth and 24th month after surgery were the times that OAGB and then RYGB induced weight loss sped up rather than LSG, respectively. Weight plateau and weight regain were initiated earlier (at 18th month) and more (18.23% of maximum EWL %) in LSG in the period of five years. The %EWL in time intervals of 3-6, 6-9, and 9-12 months after LSG, RYGB, and OAGB, respectively; could estimate the long-term five years %EWL after surgery. Conclusion OAGB provides the fastest and highest %EWL, and LSG induced the earliest and most weight plateau and weight regain during five years interval post-surgery. The pattern of early weight loss could predict the long-term outcome of bariatric surgery. So early identification of suboptimal weight loss could allow consideration of earlier postoperative intervention to enhance long-term weight loss.

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 Dietary and Lifestyle Factors Serve as Predictors of Successful Weight Loss Maintenance Postbariatric Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Afshan Masood ◽  
Lujain Alsheddi ◽  
Loura Alfayadh ◽  
Bushra Bukhari ◽  
Ruba Elawad ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Regain ◽  
Dietary Habits ◽  
Weight Maintenance ◽  
Dietary Counseling ◽  
Beneficial Effects ◽  
Predicting Factors ◽  
Lifestyle Practices ◽  
Fiber Consumption

Bariatric surgery is considered to be an effective treatment for the resolution of severe obesity; however, in more than half of the bariatric surgery patients, weight reacquisition occurs as early as 18 months postsurgery, compromising the surgery’s beneficial effects. Maintaining weight loss after surgery poses a great challenge, necessitating the identification of predicting factors. In the present study, we explored the association between weight regain and dietary habits and behavioral lifestyle practices in patients following bariatric surgery. Fifty patients who underwent bariatric surgery with ≥18-month postoperative period of follow-up were included. They were classified into two groups: weight maintainers (n = 29) were patients who regained <15% of their weight, and weight regainers (n = 21) were patients who regained ≥15% of their weight compared to their lowest postoperative weight. The mean age of the study participants was 41.4 ± 8.9 years, and twenty-eight patients (56%) of the total, were females. A detailed analysis of dietary and lifestyle habits was performed by questionnaire-based interviews. Significant weight regain was noted in the regainers compared to the maintainers (19.6 ± 8.4 kg vs. 4.5 ± 3.5 kg, respectively, P≤0.001), which was attributed to their following of unhealthy dietary habits and behavioral lifestyle practices. The dietary and behavioral lifestyle practices adopted by the maintainers were higher fiber consumption and water intake, monitored pace of eating, evasion of emotional binge, and distracted eating and following of self-assessment behaviors. Additionally, regular nutritional follow-ups and compliance with postoperative dietary counseling significantly helped to improve weight maintenance. In conclusion, the effectiveness of weight loss postbariatric surgery was compromised by weight regain due to unhealthy dietary and behavioral lifestyle practices stemming from a lack of nutritional guidance and knowledge. The implementation of comprehensive nutritional counseling and advice on behavioral changes before and after surgery will help achieve optimal weight results.

scholarly journals MON-LB101 5-Year Data of an Aggressive Pharmacological Approach to Moderate and Morbid Obesity: Is Prevention of Bariatric Surgery Feasible in the Long Run?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Flavio Cadegiani
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Body Weight ◽  
Weight Regain ◽  
Morbidly Obese ◽  
Biochemical Profile ◽  
Initial Weight ◽  
Initial Weight Loss

Abstract Background: Maintenance of weight loss in patients that undergo weight loss interventions is highly challenging, irrespective of the type of approach to obesity (whether surgical, pharmacological, or non-pharmacological). We proposed a protocol of an aggressive clinical treatment for obesity aiming to prevent the need of bariatric surgery, in patients unwilling to undergo this procedure, by proposing a protocol that included the combination of different anti-obesity medications and non-pharmacological modalities, for longer duration, and with an active approach to prevent weight regain. Our initial 2-year data showed that 93% (40 of 43 patients) with moderate and morbid obesity were able to avoid the need of bariatric surgery, with concomitant improvements of the biochemical profile. However, whether these patients would maintain their successful rates after five years was uncertain. Our objective is to describe the efficacy and safety of a long term (5-year data) pharmacological and multi-modal treatment for moderate and severe obesity. Methods: The 40 patients that were successful in the two-year approach in our obesity center (Corpometria Institute, Brasilia, DF, Brazil) were enrolled. A long-term anti-obesity protocol was employed, with continuous or intermittent use of anti-obesity drugs, trimestral body composition analysis, psychotherapy, visit to a nutritionist every four months, and both resistance and endurance exercises at least four times a week. Body weight (BW), total weight excess (TWE), body fat, markers of lipid and glucose metabolism, liver function, and inflammation were analyzed. Subjects that dropped out were considered as weight regain. Therapeutic success for the 5-year follow-up included as the maintenance of &gt;20% loss of the initial BW loss, and no weight regain (or &lt; 20% of the initial weight loss). Results: A total of 27 patients (67.5%) were able to maintain the body weight, seven dropped out, and six regained more than 20% of the initial weight loss. Of these, 21 (77.8%) had significant further increase of muscle mass and decrease of fat loss, while 17 (63.0%) had further weight loss (p &lt; 0.05), compared to the 2-year data. Improvements on the biochemical profile persisted in all 27 patients, and had significant further improvements in 24 (88.9%) of these patients. Conclusion: The risk of weight regain five years after a weight loss treatment for obesity was significantly lower compared to previous literature, and comparable to the long-term outcomes of bariatric procedures. An aggressive, structured, and long-term clinical weight loss approach has been shown to be feasible, even for morbidly obese patients.

scholarly journals The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study

2017 ◽  
Vol 13 (3) ◽  
pp. 491-500 ◽  
Author(s):  
Fatima Cody Stanford ◽  
Nasreen Alfaris ◽  
Gricelda Gomez ◽  
Elizabeth T. Ricks ◽  
Alpana P. Shukla ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Regain ◽  
Weight Loss Medications ◽  
Multi Center Study ◽  
Inadequate Weight Loss ◽  
Center Study

Revisional Bariatric Surgery

2018 ◽  
Author(s):  
Catherine Frenkel ◽  
Aurora Pryor
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Weight Regain ◽  
Gastric Band ◽  
Surgical Techniques ◽  
Jejunoileal Bypass ◽  
Revisional Bariatric Surgery ◽  
Laparoscopic Gastric Band ◽  
Ensure Patient Safety ◽  
Failed Weight Loss

The annual volume of bariatric surgery is growing, giving rise to an increase in complications requiring complex management, including revision. Bariatric revision procedures are also becoming increasingly necessary for weight-loss recidivism and patients at the extreme of obesity. This chapter outlines clinical management pathways used to address secondary bariatric surgery. It summarizes reasons for, and outcomes with, revision of a laparoscopic gastric band, vertical banded gastroplasty, sleeve gastrectomy, or Roux-en-Y gastric bypass. Surgical techniques used to manage weight regain or failed weight loss after bariatric surgery are also discussed. Finally, surgical solutions for bariatric surgery-induced malnutrition are described, particularly in the setting of biliopancreatic diversion, duodenal switch, or jejunoileal bypass. Overall, the chapter concludes that standardization of revisional procedures can have a significant patient impact, and guidelines must be evidence-based in order to ensure patient safety and success.

scholarly journals Endoscopic plasma argon coagulation in treatment of weight regain after bariatric surgery: what does the patient think about this?

2014 ◽  
Vol 27 (suppl 1) ◽  
pp. 47-50 ◽  
Author(s):  
Simone Dallegrave MARCHESINI ◽  
Giorgio Alfredo Pedroso BARETTA ◽  
Maria Paula Carlini CAMBI ◽  
João Batista MARCHESINI
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Multidisciplinary Team ◽  
Weight Regain ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
The Internet ◽  
Bariatric Patients ◽  
Second Chance

BACKGROUND: Bariatric surgery, especially Roux-en-Y gastric bypass is an effective treatment for refractory morbid obesity, causing the loss of 75% of initial excess weight. After the surgery, however, weight regain can occur in 10-20% of cases. To help, endoscopic argon plasma coagulation (APC) is used to reduce the anastomotic diameter. Many patients who undergo this treatment, are not always familiar with this procedure and its respective precautions. AIM: The aim of this study was to determine how well the candidate for APC understands the procedure and absorbs the information provided by the multidisciplinary team. METHOD: We prepared a questionnaire with 12 true/false questions to evaluate the knowledge of the patients about the procedure they were to undergo. The questionnaire was administered by the surgeon during consultation in the preoperative period. The patients were invited to fill out the questionnaire. RESULTS: We found out that the majority learned about the procedure through the internet. They knew it was an outpatient treatment, where the anesthesia was similar to that for endoscopy, and that they would have to follow a liquid diet. But none of them knew that the purpose of this diet was to improve local wound healing. CONCLUSION: Bariatric patients who have a second chance to resume weight loss, need continuous guidance. The internet should be used by the multidisciplinary team to promote awareness that APC will not be sufficient for weight loss and weight-loss maintenance in the long term. Furthermore, there is a need to clarify again the harm of drinking alcohol in the process of weight loss, making its curse widely known.

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