ANTI-REFLUX PROCEDURES AFTER ROUX-EN-Y GASTRIC BYPASS

ABSTRACT Background: Roux-en-Y gastric bypass (RYGB) has been the choice of bariatric procedure for patients with symptomatic reflux - and is known to be effective in reducing the need for anti-reflux medication postoperatively. However, a small number of RYGB patients can still develop severe reflux symptoms that require a surgical intervention. Aim: To examine and describe the patient population that requires an anti-reflux procedure after RYGB evaluating demographics, characteristics, symptoms and diagnosis Methods: A retrospective chart review was performed on 32 patients who underwent a hiatal hernia repair and/or Nissen fundoplication after RYGB Jul 1st, 2014 and Dec 31st, 2019. Patients were identified using the MBSAQIP database and their electronic medical records were reviewed. Results: Most patients were female (n=29, 90.6%). The mean age was 52.8 years and the mean body mass index (BMI) was 34.1 kg/m2 at the time of anti-reflux procedure. Patients underwent the anti-reflux procedure at a mean of 7.9 years after the RYGB procedure. The mean percentage of excess BMI loss during the time between RYGB and anti-reflux procedure was 63.4%. Conclusions: Female patients with a significant weight loss may develop a severe reflux symptoms years after RYGB. Complaints of reflux after RYGB should not be overlooked. Careful follow-up and appropriate treatment (including surgical intervention) is needed for this population.

The influence of patient’s age on metabolic and bariatric results of laparoscopic sleeve gastrectomy in 2-year observation

Background The incidence of obesity has been constantly growing and bariatric procedures are considered to be the most effective treatment solution for morbidly obese patients. The results of laparoscopic sleeve gastrectomy (LSG) may differ depending on patient’s age, gender, preoperative body mass index (BMI) and physical activity. Methods The aim of this study was to evaluate age-related differences in the outcome of LSG in terms of weight loss parameters, lipid and carbohydrate profile. The retrospective analysis of 555 patients who had undergone LSG was performed to compare the metabolic outcomes of surgery in individuals < 45 and ≥ 45 years old. Evaluation of weight loss parameters along with selected laboratory data was performed to demonstrate the results of LSG in 2 years follow-up. Results Overall, 238 males and 317 females (43%/57%) with median age of 43 years and median preoperative BMI of 46.41 (42.06–51.02) kg/m2 were analyzed. Patients in both groups presented significant weight loss at 24 months after the surgery with comparable percentage of total weight loss (40.95% in < 45 years old group and 40.44% in ≥ 45 years old group). The percentage of excess weight loss (78.52% vs. 74.53%) and percentage of excess BMI loss (91.95% vs. 88.01%) were higher in patients < 45 years old. However, the differences were not statistically significant (p = 0.662, p = 0.788 respectively). Patients under 45 years old experienced faster decrease in fasting glucose level that was observed after only 3 months (109 mg/dl to 95 mg/dl in < 45 years old group vs. 103.5 mg/dl to 99.5 mg/dl in ≥ 45 years old group, p < 0.001). Both groups presented improvement of lipid parameters during the observation. However, patients < 45 years old achieved lower values of LDL at 3 and 12 months follow-up (115 mg/dl vs. 126 mg/dl, p = 0.010; 114.8 mg/dl vs. 122 mg/dl, p = 0.002). Younger group of patients also showed superior improvement of triglycerides level. Conclusions LSG results in significant weight loss in all patients regardless age. In turn, superior and faster improvement in lipid and carbohydrate profile is achieved in patients under 45 years old.

Efficacy of bariatric surgery in a Colombian population

Background Obesity (OB) is defined as having a body mass index (BMI) of ≥ 30 kg/m2. It has a high risk of mortality due to its association with comorbidities. Bariatric surgery (BS) is indicated for a BMI of 40 kg/m2 or of 35 kg/m2 if concurrent with a metabolic disorder. Methods A retrospective observational study of patients subjected to BS, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric band (AGB). A survey was applied to determine the BMI and patterns of comorbidities before and after BS. Results The study included 30 patients who underwent 25 RYGB, 4 SG and 1 AGB procedures. A total of 17 patients were evaluated at the one-year follow-up and all showed improvement in comorbidities and weight loss, with a mean excess BMI loss (%EBMIL) of 89.5% At the two-year follow-up, 3 patients reported a %EBMIL of 75%. At the three-year follow-up, 10 patients had a %EBMIL of 70.8%%, but 70% (7/10) still had a BMI > 30 kg/m2. Type 2 diabetes mellitus resolved in all (12/12) and the doses of antihypertensive drugs were reduced in 86.4% of hypertensive patients (11/13). Half of the patients followed a diet. Conclusion In our service, BS was effective one year after the procedure. After three years, BMI > 30 kg/m2 persisted in 70% of patients All diabetics were cured. The doses of antihypertensives were lowered in 86.4% of hypertensive patients. Ultrasound scan detected no fatty liver diseases at the one-year follow-up of 85.7% of patients.

Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices: a data note

Objectives Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight after implantation, which is associated with higher complication rates and is a contraindication for heart transplantation (HT). The objective was to analyze the outcomes of obese patients with ESHF and VADs who underwent laparoscopic sleeve gastrectomy (LSG) at Ochsner Medical Center in New Orleans, which is the only program performing VADs and HT in the State of Louisiana, and also one of the largest VAD centers in the USA. Data description This dataset contains detailed baseline, perioperative, and long-term data of patients with VADs undergoing LSG. These variables were collected retrospectively from electronic medical records. Patients who achieved ≥ 50% excess BMI loss, BMI ≤ 35 kg/m2, listing for HT, HT, or myocardial recovery were identified and the timing to each of these milestones was documented. These data can be used alone or in combination with other datasets to achieve a larger sample size with more power for further analysis of these variables, which include the most important, standard, and objective bariatric and ESHF outcomes of patients with VADs undergoing LSG. Elaboration of composite outcomes is feasible.

Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Euthyroid Patients with Morbid Obesity

Obesity is associated with several endocrine abnormalities, including thyroid dysfunction. The objective of this study was to investigate the effect of weight loss after bariatric surgery on thyroid-stimulating hormone (TSH) levels in euthyroid patients with morbid obesity. We performed an observational study, evaluating patients with morbid obesity submitted to bariatric surgery. We included 129 patients (92 women) and 31 controls (21 women). Clinical, anthropometric, biochemical, and hormonal parameters were evaluated. The primary endpoint was circulating TSH (µU/mL). Fasting TSH levels were higher in the obese group (3.3 ± 0.2) than in the control group (2.1 ± 0.2). The mean excessive body mass index (BMI) loss (EBMIL) 12 months after bariatric surgery was 72.7 ± 2.1%. TSH levels significantly decreased in the obese patients after surgery; 3.3 ± 0.2 vs. 2.1 ± 0.2 before and 12 months after surgery, respectively. Free thyroxine (T4) (ng/dL) levels significantly decreased in the obese patients after surgery; 1.47 ± 0.02 vs. 1.12 ± 0.02 before and 12 months after surgery, respectively. TSH decreased significantly over time, and the decrement was associated with the EBMIL. In euthyroid patients with morbid obesity, weight loss induced by bariatric surgery promotes a significant decline of the increased TSH levels. This decrement of TSH is progressive over time after surgery and significantly associated with excess BMI loss.

Long-term results of laparoscopic gastric sleeve resection due to morbid obesity and metabolic syndrome

Introduction. The aim of this paper was to presents long-term results of a laparoscopic gastric sleeve resection in a ?super super? obese patient and a follow-up period of eight years. Case Outline. A patient with Body Mass Index (BMI) of 70 kg/m2 and Stage 3 obesity according to ?King?s Obesity Staging Criteria? (KOSC), with metabolic syndrome and cardiovascular risk of over 20%, and a pronounced severe obstructive sleep apnea, underwent a laparoscopic gastric sleeve resection (LGS). After two years, the patient reached BMI of 28.4 kg/m2 and eight years after the surgery has BMI of 34.3 kg/m2, and %EBMIL (% Excess BMI Loss) of 79.3%. According to the KOCS, he falls under Stage 0. Conclusion. LGS resection may be performed as a stand-alone procedure in ?super super? obese patients, with excellent long-term results.

Laparoscopic Sleeve Gastrectomy with Comparable Weight Loss in All Obese Groups: A VA Hospital Experience

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a standalone procedure for the surgical treatment of obesity in the superobese because of higher failure with Roux-en-Y gastric bypass. We report a single-institution experience with LSG as the procedure of choice in all obese groups and comparing weight loss in the nonsuperobese and superobese patients. LSGs performed between February 2009 and June 2011 were reviewed. Body mass index (BMI), percentage excess weight loss (%EWL), and percentage excess BMI loss were analyzed for two groups of nonsuperobese (Group I) and superobese (Group II) at 3, 6, and 12 months postoperative visits. Two-sample t tests were used to compare groups. At each postoperative visit, reductions in BMI and amount of weight loss were higher in Group II but %EWL was statistically similar in both groups. The %EWL was 29.5 versus 29.9 per cent at 3 months ( P = 0.9246), 51.7 versus 47.5 per cent at 6 months ( P = 0.9800), and 52.8 versus 52.6 per cent at 12 months ( P = 0.9755). Both groups demonstrated satisfactory resolution of most preoperative comorbidities. Success rate of weight loss after LSG as a standalone procedure is comparable in the superobese and nonsuperobese patients.

Emotional Eating: A Virtually Untreated Risk Factor for Outcome Following Bariatric Surgery

Empirical investigations implicate emotional eating (EE) in dysfunctional eating behavior such as uncontrolled overeating and insufficient weight loss following bariatric surgery. They demonstrate that EE may be a conscious or reflexive behavior motivated by multiple negative emotions and/or feelings of distress about loss-of-control eating. EE, however, has not been targeted in pre- or postoperative interventions or examined as an explanatory construct for failed treatment of dysfunctional eating. Three cases suggest that cognitive behavioral treatment (CBT) might alleviate EE. One describes treatment for distress provoked by loss-of-control eating. The first of two others, associated with negative emotions/life situations, link treatment of a super-super-preoperative obese individual’s reflexive EE with 52% excess BMI (body mass index) loss maintained for the past year, 64 months after surgery. The second relates treatment of conscious/reflexive EE with 84.52% excess BMI loss 53 months after surgery. Implications for research and treatment are discussed.