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Bariatric Surgery (bariatric + surgery)
Selected AbstractsMorbid Obesity, Cardiac Disease, and Bariatric SurgeryCLINICAL CARDIOLOGY, Issue 5 2009Nishith K. Singh MD No abstract is available for this article. [source] Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart FailureCLINICAL CARDIOLOGY, Issue 11 2008Gautam V. Ramani MD Abstract Background Morbid obesity (MO) is a risk factor for congestive heart failure (CHF). The presence of MO impairs functional status and disqualifies patients for cardiac transplantation. Bariatric surgery (BAS) is a frontline, durable treatment for MO; however, the safety and efficacy of BAS in advanced CHF is unknown. Hypothesis We hypothesized that by utilizing a coordinated approach between an experienced surgical team and heart failure specialists, BAS is safe in patients with advanced systolic CHF and results in favorable outcomes. Methods We performed a retrospective chart review of 12 patients with MO (body mass index [BMI] 53 ± 7 kg/m2) and systolic CHF (left ventricular ejection fraction [LVEF] 22 ± 7%, New York Heart Association [NYHA] class 2.9 ± 0.7) who underwent BAS, and then compared outcomes with 10 matched controls (BMI 47.2 ± 3.6 kg/m2, LVEF 24 ± 7%, and NYHA class 2.4 ± 0.7) who were given diet and exercise counseling. Results At 1 y, hospital readmission in BAS patients was significantly lower than controls (0.4 ± 0.8 versus 2.5 ± 2.6, p = 0.04); LVEF improved significantly in BAS patients (35 ± 15%, p = 0.005), but not in controls (29 ± 14%, p = not significant [NS]). The NYHA class improved in BAS patients (2.3 ± 0.5, p = 0.02), but deteriorated in controls (3.3 ± 0.9, p = 0.02). One BAS patient was successfully transplanted, and another listed for transplantation. Conclusions Bariatric surgery is safe and effective in patients with MO and severe systolic CHF, and should be considered in patients who have failed conventional therapy to improve clinical status. Copyright © 2008 Wiley Periodicals, Inc. [source] Managing childhood obesity: when lifestyle change is not enoughDIABETES OBESITY & METABOLISM, Issue 11 2010C. Hearnshaw The management of childhood obesity is a clinical dilemma. Paediatricians will see those children whose weight is at the severe end of the spectrum with obesity-related co-morbidities and for whom more intensive weight loss therapies may be appropriate. A literature review was performed (January 1995,January 2010) of the roles of pharmacotherapy or bariatric surgery in the management of childhood obesity. Three hundred and eighty-three abstracts were reviewed and 76 full-text articles were requested. Of these, 34 were excluded and a total of 21 pharmacotherapy papers and 22 papers on surgery were reviewed in detail. All studies involved adolescents. Pharmacotherapy: Most studies were small and of short duration, the notable exceptions being two large RCTs of sibutramine and orlistat. Sibutramine led to a mean estimated change in BMI from baseline of ,3.1 kg/m2 vs. ,0.3 kg/m2 for placebo over 12 months. Orlistat was also beneficial with a mean reduction in BMI of 0.55 vs. an increase of 0.31 kg/m2 in the placebo group at 12 months. Bariatric surgery: Most papers presented clinical observations and there were no randomised controlled trials (RCTs). Robust selection criteria were not used and ideal candidate selection remains unclear. Most papers showed a significant benefit of surgery in severely obese adolescents in the short term but long-term data were sparse. There were a surprisingly large number of papers examining the benefits of intensive weight management in obese adolescents. The study design of many was inadequate and the role of pharmacotherapy or surgery in childhood obesity remains unclear. [source] Perspective on biomaterials used in the surgical treatment of morbid obesityOBESITY REVIEWS, Issue 3 2009J. A. Henry Summary Morbid obesity is defined as having a body mass index greater than or equal to 40.0 kg m,2, or 37.0 kg m,2 with comorbidities. Bariatric surgery remains the most effective treatment for morbid obesity. Bariatric procedures such as sleeve gastrectomy, vertical banded gastroplasty and adjustable gastric banding all generate excess body-weight loss typically over 3,5 years. The biomaterials used during these procedures, namely silicone, polypropylene, expanded polytetrafluoroethylene and titanium, are all non-degradable biomaterials. Hence, their presence in vivo exceeds the functional requirement of an implant to treat morbid obesity. Accordingly, research into non-invasive and reversible surgical procedures has increased, particularly in light of the dramatic increase in paediatric obesity. Tissue engineering is an alternative approach to treat morbid obesity, as it incorporates both engineering and biological principles into the design and development of an implant to surgically treat morbid obesity. It is hypothesized that a biodegradable polymer to treat morbid obesity could be developed to effectively promote excess weight loss. The aim of this review is to discuss morbid obesity with regards to its aetiology, prevalence and current modalities of treatment. Specifically, the shortcomings of the biomaterials currently used to surgically treat morbid obesity shall be reviewed, and alternative biomaterials shall be proposed. [source] Total knee replacement in the morbidly obese: a literature reviewANZ JOURNAL OF SURGERY, Issue 9 2010Anthony J. Samson Abstract Background:, The ,obesity epidemic' is expected to result in an increased incidence of knee osteoarthritis and hence total knee replacements (TKRs). Reviews have demonstrated the conflicting results of TKR for all obese (body mass index (BMI) >30). The aim of this literature review was to specifically evaluate outcomes of TKR in patients with morbid obesity (MO; BMI >40). Methods:, A systematic review of medical databases (PubMed, Medline, Cochrane Library, ScienceDirect) by use of keywords from January 1990 to September 2009 was undertaken. Results:, Clinical and functional Knee Society Scores (KSS) improve after TKR for patients with MO. The post-operative functional KSS was, in general, less than in controls. Radiographic analysis was inconclusive because of small study populations and short duration of follow-up. All studies reporting complications noted a greater prevalence in MO patients (10,30%). Of concern was the significantly higher prevalence of deep prosthetic infection (3,9-times that of controls). The morbidly obese also had a significantly higher incidence of wound complications. TKR did not result in weight loss for MO patients, and therefore has no benefit on weight-related medical conditions. Bariatric surgery in MO under 65 years of age has been shown to be a cost-effective and clinically effective method of weight reduction. This surgery also results in significant improvement in weight-related medical conditions, the KSS and knee pain. Conclusions:, Given the increase in complications for MO patients after TKR, these patients should be advised to lose weight before surgery and, if suitable, would probably benefit from bariatric surgery. [source] Bariatric surgery for metabolic disordersBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2008J. W. M. Greve Help for diabetics [source] Bariatric surgery , a successful way to battle the weight crisisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2006M. Weber No abstract is available for this article. [source] Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart FailureCLINICAL CARDIOLOGY, Issue 11 2008Gautam V. Ramani MD Abstract Background Morbid obesity (MO) is a risk factor for congestive heart failure (CHF). The presence of MO impairs functional status and disqualifies patients for cardiac transplantation. Bariatric surgery (BAS) is a frontline, durable treatment for MO; however, the safety and efficacy of BAS in advanced CHF is unknown. Hypothesis We hypothesized that by utilizing a coordinated approach between an experienced surgical team and heart failure specialists, BAS is safe in patients with advanced systolic CHF and results in favorable outcomes. Methods We performed a retrospective chart review of 12 patients with MO (body mass index [BMI] 53 ± 7 kg/m2) and systolic CHF (left ventricular ejection fraction [LVEF] 22 ± 7%, New York Heart Association [NYHA] class 2.9 ± 0.7) who underwent BAS, and then compared outcomes with 10 matched controls (BMI 47.2 ± 3.6 kg/m2, LVEF 24 ± 7%, and NYHA class 2.4 ± 0.7) who were given diet and exercise counseling. Results At 1 y, hospital readmission in BAS patients was significantly lower than controls (0.4 ± 0.8 versus 2.5 ± 2.6, p = 0.04); LVEF improved significantly in BAS patients (35 ± 15%, p = 0.005), but not in controls (29 ± 14%, p = not significant [NS]). The NYHA class improved in BAS patients (2.3 ± 0.5, p = 0.02), but deteriorated in controls (3.3 ± 0.9, p = 0.02). One BAS patient was successfully transplanted, and another listed for transplantation. Conclusions Bariatric surgery is safe and effective in patients with MO and severe systolic CHF, and should be considered in patients who have failed conventional therapy to improve clinical status. Copyright © 2008 Wiley Periodicals, Inc. [source] After bariatric surgery, what vitamins should be measured and what supplements should be given?CLINICAL ENDOCRINOLOGY, Issue 3 2009Dimitrios J. Pournaras Summary Bariatric surgery is the most effective treatment for morbid obesity. Although calorie malabsorption does not occur in most bariatric procedures, micronutrient deficiencies are possible. Multivitamin supplementation is essential following bariatric surgery. The recommendation would be to screen for multivitamin deficiencies prior to surgery and to monitor vitamin levels postoperatively at regular intervals. In this paper, we review the data for screening and supplementation after bariatric procedures for different vitamins. [source] Changes in gut hormones after bariatric surgeryCLINICAL ENDOCRINOLOGY, Issue 2 2008R. P. Vincent Summary Bariatric surgery is one of the most effective treatments for achieving long-term weight loss in morbidly obese patients. Bariatric surgery causes weight loss through substantial decline of hunger and increased satiety. Recently our understanding of neuroendocrine regulation of food intake and weight gain, especially regarding the role of gut hormones, has significantly increased. The changes in these hormones following bariatric surgery can partly explain the mechanism behind weight loss achieved through these procedures. In this paper, we review the effect bariatric procedures have on different gut hormone levels and how they in turn can alter the complex neuroendocrine regulation of energy homeostasis. [source] Managing childhood obesity: when lifestyle change is not enoughDIABETES OBESITY & METABOLISM, Issue 11 2010C. Hearnshaw The management of childhood obesity is a clinical dilemma. Paediatricians will see those children whose weight is at the severe end of the spectrum with obesity-related co-morbidities and for whom more intensive weight loss therapies may be appropriate. A literature review was performed (January 1995,January 2010) of the roles of pharmacotherapy or bariatric surgery in the management of childhood obesity. Three hundred and eighty-three abstracts were reviewed and 76 full-text articles were requested. Of these, 34 were excluded and a total of 21 pharmacotherapy papers and 22 papers on surgery were reviewed in detail. All studies involved adolescents. Pharmacotherapy: Most studies were small and of short duration, the notable exceptions being two large RCTs of sibutramine and orlistat. Sibutramine led to a mean estimated change in BMI from baseline of ,3.1 kg/m2 vs. ,0.3 kg/m2 for placebo over 12 months. Orlistat was also beneficial with a mean reduction in BMI of 0.55 vs. an increase of 0.31 kg/m2 in the placebo group at 12 months. Bariatric surgery: Most papers presented clinical observations and there were no randomised controlled trials (RCTs). Robust selection criteria were not used and ideal candidate selection remains unclear. Most papers showed a significant benefit of surgery in severely obese adolescents in the short term but long-term data were sparse. There were a surprisingly large number of papers examining the benefits of intensive weight management in obese adolescents. The study design of many was inadequate and the role of pharmacotherapy or surgery in childhood obesity remains unclear. [source] Bariatric surgery vs. advanced practice medical management in the treatment of type 2 diabetes mellitus: rationale and design of the Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently trial (STAMPEDE)DIABETES OBESITY & METABOLISM, Issue 5 2010Sangeeta R. Kashyap Obesity and Type 2 diabetes mellitus (T2DM) are closely interrelated, and are two of the most common chronic, debilitating diseases worldwide. Surgical approaches to weight loss (bariatric surgery) result in marked improvement of T2DM, however randomized trials directly comparing the efficacy of surgical and medical approaches are lacking. The Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial was designed to evaluate the efficacy of two bariatric surgery procedures involving gastric restriction only (laparascopic sleeve gastrectomy) and gastric bypass (Roux-en-Y) to advanced medical therapy in patients with T2DM with modest obesity with BMI of 27,42 kg/m2. This single site, prospective, randomized controlled trial will enroll 150 subjects who will be followed. The primary end point will be the rate of biochemical resolution of T2DM at 1 year as measured by HbA1c < 6%. The safety and adverse event rates will also be compared between the three arms of the study. [source] Current treatment of non-alcoholic fatty liver diseaseDIABETES OBESITY & METABOLISM, Issue 3 2009Mohamed H. Ahmed Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in Western World and frequently associated with insulin resistance and overweight and occurs often with type 2 diabetes. Interestingly, NAFLD is not only regarded as a hepatic component of the metabolic syndrome but also as an independent risk factor and a marker for increase in cardiovascular disease (CVD). Significantly, NAFLD is associated with an increased risk of all-cause mortality and predicts future CVD events independent of age, sex, LDL-cholesterol and features of metabolic syndrome. Although there was initial concern about drug toxicity with NAFLD, increasing evidence suggests that commonly used drugs such as metformin and statins do not cause harm and the thiazolidinediones (TZDs) may even confer a therapeutic benefit in NAFLD. Interestingly, medical and surgical treatments of obesity show potential benefit in treating NAFLD. In this review, we have focused on the safety and therapeutic impact of TZDs, statins, metformins and obesity medications in NAFLD. The potential benefit of bariatric surgery and the role of weight loss per se in treating NAFLD are also discussed. [source] Obesity, bariatric surgery and type 2 diabetes,a systematic reviewDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 6 2004Cynthia V. Ferchak Abstract Obesity is endemic in the United States and is closely linked to the development of type 2 diabetes. Both obesity and diabetes are responsible for significant morbidity and mortality. Likewise, both conditions are resistant to treatment. Recent studies have evaluated prevention of type 2 diabetes through intensive lifestyle intervention, while others are examining the impact of bariatric surgery on type 2 diabetes. This article presents an overview of the impact of bariatric surgical and lifestyle interventions on the prevention and treatment of type 2 diabetes. Although studies using a variety of bariatric surgical techniques are included, the focus is on two interventions in particular: the Roux-en-Y gastric bypass and the laparoscopic silicone gastric banding procedure. Outcomes of these procedures are further contrasted with recent lifestyle intervention studies, in particular, the Diabetes Prevention Program study. Gastric bypass studies have been associated with a 99 to 100% prevention of diabetes in patients with IGT and an 80 to 90% clinical resolution of diagnosed early type 2 diabetes. Gastric banding procedures are associated with a lower median (50,60%) clinical remission of type 2 diabetes. Lifestyle intervention studies of obese and glucose-intolerant patients have achieved a 50% reduction in the progression of IGT to diabetes over the short term, with no reported resolution of the disease. Weight loss by any means in the obese patient appears to prevent progression to type 2 diabetes, at least in the short term. Furthermore, sustained weight loss through bariatric surgical intervention is associated both with prevention of progression of IGT and with clinical remission of early type 2 diabetes. Copyright © 2004 John Wiley & Sons, Ltd. [source] Effect of bariatric surgery on circulating chemerin levelsEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 3 2010C. Ress Eur J Clin Invest 2010; 40 (3): 277,280 Abstract Background, Subclinical inflammation in obesity is critical for development of several obesity-associated disorders. We set out to investigate the effect of pronounced weight loss on circulating chemerin levels, a chemoattractant protein that also influences adipose cell function by paracrine and autocrine mechanisms. Material and methods, Thirty-two obese patients undergoing bariatric surgery were tested before and on an average of 18 months after gastric banding or gastric bypass surgery. Results, Pronounced weight loss after bariatric surgery was accompanied by improvements in parameters of lipid and glucose metabolism and increased adiponectin levels. Chemoattractant chemerin significantly decreased from 175·91 ± 24·50 to 145·53 ± 26·44 ng mL,1 after bariatric surgery (P , 0·01). Concomitantly, hs-CRP as a marker of subclinical inflammation was significantly reduced after weight reduction (P , 0·01). Conclusions, We hypothesize that weight-loss induced reduction in circulating chemerin might in conjunction with other factors be associated with diminished recruitment of macrophages in adipose tissue and reduction of subclinical inflammation, which again could partly explain beneficial long-term effects of weight reduction in obese subjects. [source] Cerebellar Tonsillar Herniation After Weight Loss in a Patient With Idiopathic Intracranial HypertensionHEADACHE, Issue 1 2010Jerome J. Graber MD (Headache 2010;50:146-148) Acquired cerebellar tonsillar herniation is a known complication of lumboperitoneal shunt (LPS) for any indication, including idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri.1 While the underlying pathophysiology of IIH remains unknown, increasing body mass index is a clear risk factor for the development of IIH. We describe an obese patient with IIH unresponsive to LPS who developed symptoms of intracranial hypotension and cerebellar tonsillar herniation after bariatric surgery and a 50-kg weight loss. [source] Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management,HEPATOLOGY, Issue 1 2009Raj Vuppalanchi Nonalcoholic fatty liver disease (NAFLD) is among the most common causes of chronic liver disease in the western world. It is now recognized that these patients have myriad of important co-morbidities (e.g., diabetes, hypothyroidism and metabolic syndrome). The workup of patients with suspected NAFLD should consist of excluding competing etiologies and systemic evaluation of metabolic comorbidities. NAFLD is histologically categorized into steatosis and steatohepatitis, two states with fairly dichotomous natural history. While significant progress has been made in terms of noninvasively predicting advanced fibrosis, insufficient progress has been made in predicting steatohepatitis. Currently, liver biopsy remains the gold standard for the histological stratification of NAFLD. While sustained weight loss can be effective to treat NASH, it is often difficult to achieve. Foregut bariatric surgery can be quite effective in improving hepatic histology in selected patients without liver failure or significant portal hypertension. Thiazolidinediones have shown promise and the results from the ongoing, large multicenter study should become available soon. Large multicenter studies of CB, receptor anatagonists are also underway but their results will not be available for several years. Several recent studies have highlighted that cardiovascular disease is the single most important cause of morbidity and mortality in this patient population. Conclusion: Health care providers should not only focus on liver disease but also concentrate on aggressively modifying and treating their cardiovascular risk factors. (HEPATOLOGY 2009;49:306-317.) [source] Body positions and esophageal sphincter pressures in obese patients during anesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010A. DE LEON Background: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions. Methods: Using high-resolution solid-state manometry, we studied 17 patients (27,63 years) with a BMI,35 kg/m2 who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20°) and in the Trendelenburg position (,20°). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordings in the different positions were repeated. Results: Before anesthesia, there were no differences in UES pressure in the different positions but compared with the other positions, it increased during the reverse Trendelenburg during anesthesia. LES pressure decreased in all body positions during anesthesia. The LES pressure increased during the Trendelenburg position before but not during anesthesia. The BP remained positive in all body positions both before and during anesthesia. Conclusion: LES pressure increased during the Trendelenburg position before anesthesia. This effect was abolished during anesthesia. LES and BPs decreased during anesthesia but remained positive in all patients regardless of the body position. [source] Evaluation of the Video Intubation Unit in morbid obese patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010I. BATHORY Background: Tracheal intubation may be more difficult in morbidly obese (MO) patients than in the non-obese. The aim of this study was to evaluate clinically if the use of the Video Intubation Unit (VIU), a video-optical intubation stylet, could improve the laryngoscopic view compared with the standard Macintosh laryngoscope in this specific population. Methods: We studied 40 MO patients (body mass index >35 kg/m2) scheduled for bariatric surgery. Each patient had a conventional laryngoscopy and a VIU inspection. The laryngoscopic grades (LG) using the Cormack and Lehane scoring system were noted and compared. Thereafter, the patients were randomised to be intubated with one of the two techniques. In one group, the patients were intubated with the help of the VIU and in the control group, tracheal intubation was performed conventionally. The duration of intubation, as well as the minimal SpO2 achieved during the procedure, were measured. Results: Patient characteristics were similar in both groups. Seventeen patients had a direct LG of 2 or 3 (no patient had a grade of 4). Out of these 17 patients, the LG systematically improved with the VIU and always attained grade 1 (P<0.0001). The intubation time was shorter within the VIU group, but did not attain significance. There was no difference in the SpO2 post-intubation. Conclusion: In MO patients, the use of the VIU significantly improves the visualisation of the larynx, thereby improving the intubation conditions. [source] Secondary Hypertension: Obesity and the Metabolic SyndromeJOURNAL OF CLINICAL HYPERTENSION, Issue 7 2008Gregory M. Singer MD The epidemic of obesity in the United States and around the world is intensifying in severity and scope and has been implicated as an underlying mechanism in systemic hypertension. Obese hypertensive individuals characteristically exhibit volume congestion, relative elevation in heart rate, and high cardiac output with concomitant activation of the renin-angiotensin-aldosterone system. When the metabolic syndrome is present, insulin resistance and hyperinsulinemia may contribute to hypertension through diverse mechanisms. Blood pressure can be lowered when weight control measures are successful, using, for example, caloric restriction, aerobic exercise, weight loss drugs, or bariatric surgery. A major clinical challenge resides in converting short-term weight reduction into a sustained benefit. Pharmacotherapy for the obese hypertensive patient may require multiple agents, with an optimal regimen consisting of inhibitors of the renin-angiotensin-aldosterone system, thiazide diuretics, ,-blockers, and calcium channel blockers if needed to attain contemporary blood pressure treatment goals. [source] Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switchJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2008Theodossis S Papavramidis Abstract Background and Aim:, Gastrocutaneous fistulas (GCF) are uncommon complications accounting for 0.5,3.9% of gastric operations. When their management is not effective, the mortality rate is high. This study reports the conservative treatment of GCF in morbidly obese patients who underwent biliopancreatic diversion with duodenal switch. Methods:, Ninety-six morbidly obese patients were treated in our department with biliopancreatic diversion with duodenal switch (Marceau technique) and, in six of them, a high-output GCF developed. A general protocol was applied to all patients presenting a GCF. Everyone was treated by total parenteral nutrition (TPN) and somatostatin for at least 7 days after the appearance of the leak. If the leak continued, then fibrin glue was used as a tissue adhesive. Endoscopic application of the sealant was accomplished under direct vision via a double-lumen catheter passed through a forward-viewing gastroscope. Results:, All patients were treated successfully with conservative treatment (either solely with TPN and somatostatin, or with endoscopic fibrin sealing sessions). No evidence of fistula was observed at gastroscopy 3 and 24 months after therapy. Conclusion:, The conservative treatment of GCF following biliopancreatic diversion with duodenal switch is highly effective. All patients should enter a protocol that includes TPN and somatostatin. When the GCF persist, endoscopic sealing glue should be considered before operation because it is simple, safe, effective and, in some cases, life-saving. Therefore, conservative treatment should be employed as a therapeutic option in GCF developing after bariatric surgery. [source] Systematic review: the effects of conservative and surgical treatment for obesity on gastro-oesophageal reflux diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11-12 2009N. L. DE GROOT Summary Background, Incidence rates of both obesity and gastro-oesophageal reflux disease (GERD) are increasing, particularly in the Western world. It has been suggested that GERD symptoms may be improved by weight reduction. Aim, To review the literature on the effect of various weight reducing modalities on manifestations of GERD in obese patients. Methods, A literature search was performed using PubMed, EMBASE and the Cochrane Library, combining the words obesity and gastro-oesophageal reflux with bariatric surgery, diet, lifestyle intervention and weight loss. Results, With regard to diet/lifestyle intervention (conservative), four of seven studies reported an improvement of GERD. For Roux-en-Y gastric bypass, a positive effect on GERD was found in all studies, although this was mainly evaluated by questionnaires. In contrast, for vertical banded gastroplasty, no change or even an increase of GERD was noted, whereas the results for laparoscopic adjustable gastric banding were conflicting. Conclusions, Dietary and lifestyle intervention may improve GERD in obese patients; however, the most favourable effect is likely to be found after bariatric surgery, especially after Roux-en-Y gastric bypass. Future studies need to elucidate for which GERD patients laparoscopic adjustable gastric banding might have a beneficial effect and how they can be identified preoperatively. [source] Apoptosis is associated with CD36/fatty acid translocase upregulation in non-alcoholic steatohepatitisLIVER INTERNATIONAL, Issue 6 2010Lars P. Bechmann Abstract Background & aims: Hepatocyte apoptosis is a key event in non-alcoholic steatohepatitis (NASH). We studied the effect of obesity on free fatty acid (FFA) levels, fatty acid transport proteins (FATPs) and on extrinsic and intrinsic activation of apoptosis in the liver. Methods: Liver biopsies were harvested from 52 morbidly obese patients [body mass index (BMI): 53.82±1.41; age: 45±10.50; 15 males/37 females] undergoing bariatric surgery, and were scored for NASH, evaluated for fibrosis, and investigated for intrahepatic expression of FATPs, death receptors and cytosolic apoptosis-related molecules. Findings were correlated with serum FFA levels and the degrees of intrahepatic (terminal dUTP nick end labelling) and systemic (M30) apoptosis. Results: In patients' liver sections, FATPs as well as select parameters of extrinsic and intrinsic apoptosis were found to be upregulated (CD36/FAT: × 11.56; FATP-5: × 1.33; CD95/Fas: × 3.18; NOXA: × 2.79). These findings correlated with significantly elevated serum FFAs (control: 14.72±2.32 mg/dl vs. patients: 23.03±1.24 mg/dl) and M30 levels (control: 83.12±7.46 U/L vs. patients: 212.61±22.16 U/L). We found correlations between FATPs and apoptosis mediators as well as with histological criteria of NASH and fibrosis. Conclusions: Increased FFA and FATPs are associated with extrinsically and intrinsically induced apoptosis, liver damage and fibrosis in obese patients. Thus, FATPs may offer an interesting new approach to understand and potentially intervene NASH pathogenesis. [source] Liver transplantation for subacute hepatocellular failure due to massive steatohepatitis after bariatric surgeryLIVER TRANSPLANTATION, Issue 6 2008Luiz Augusto Carneiro D'Albuquerque New therapeutic options for obesity include restrictive bowel surgery and surgery that promotes malabsorption, such as the Fobi-Capella (gastric bypass) and Scopinaro (biliopancreatic diversion) techniques. Complications associated with these procedures, such as hepatocellular failure, have been observed with increasing frequency. Reported here are 3 patients who, 7 to 24 months after bariatric surgery, developed hepatocellular failure, for which liver transplantation was considered to be indicated. Liver transplantation was undertaken in 2 of the patients; the third patient died while waiting for this procedure. We discuss the possible causes of this uncommon and poorly understood complication of surgery for obesity. One possibility is that it might arise as a result of progression of steatohepatitis. An alternative concept is that this complication may be secondary to rapid, massive loss of body weight. Liver Transpl 14:881,885, 2008. © 2008. [source] Gastric tone, volume and emptying after implantation of an intragastric balloon for weight controlNEUROGASTROENTEROLOGY & MOTILITY, Issue 9 2010S. Layec Abstract Background, The intragastric balloon, filled with air or liquid is used before elective bariatric surgery because its efficacy is limited. This might be the consequence of altered gastric functions. Therefore, we aimed to investigate, in an animal model, the changes in gastric motility and emptying induced by long-term insertion of a balloon used for weight reduction. Methods, Ten Göttingen mini-pigs were allocated into two groups with and without an intragastric balloon for 5 months. Balloons were inserted under endoscopy during general anesthesia and were filled with 350 mL of air. Gastric emptying was evaluated by scintigraphy. Gastric volume was measured by single photon emission computed tomography and proximal gastric compliance obtained using an electronic barostat. Changes in vagal tone were assessed by heart rate variability (HRV). Key Results, After balloon insertion, gastric volume was significantly increased (2047 ± 114.8 cm3 after vs 1674 ± 142.5 cm3 before insertion, P < 0.05). Gastric compliance was also larger in balloon group (219 ± 23.4 mL mmHg,1 in balloon vs 168 ± 7.7 mL mmHg,1 in control group). Gastric emptying was reduced after insertion of the balloon (T1/2 = 204 ± 28.8 min vs 159 ± 25.4 before vs after insertion). High frequency components of the spectral analysis of HRV, representing vagal tone, were increased in balloon group. Conclusions & Inferences, The proximal stomach was enlarged after the insertion of a balloon in the stomach as a consequence of an increased gastric compliance. This change in compliance was probably causative for a reduction in gastric emptying rate of solids. These alterations were associated with increased vagal tone. [source] The use of propofol and remifentanil for the anaesthetic management of a super-obese patientANAESTHESIA, Issue 8 2007L. La Colla Summary Morbid obesity is defined as body mass index (BMI) >,35 kg.m,2, and super-obesity as BMI >,55 kg.m,2. We report the case of a 290-kg super-obese patient scheduled for open bariatric surgery. A propofol-remifentanil TCI (target controlled infusion) was chosen as the anaesthetic technique both for sedation during awake fibreoptic nasotracheal intubation and for maintenance of anaesthesia during surgery. Servin's weight correction formula was used for propofol. Arterial blood samples were taken at fixed time points to assess the predictive performance of the TCI system. A significant difference between measured and predicted plasma propofol concentrations was found. After performing a computer simulation, we found that predictive performance would have improved significantly if we had used an unadjusted pharmacokinetic set. However, in conclusion (despite the differences between measured and predicted plasma propofol concentrations), the use of a propofol-remifentanil TCI technique both for sedation during awake fibreoptic intubation and for Bispectral Index-guided propofol-remifentanil anaesthesia resulted in a rapid and effective induction, and operative stability and a rapid emergence, allowing rapid extubation in the operating room and an uneventful recovery. [source] Total knee replacement in the morbidly obese: a literature reviewANZ JOURNAL OF SURGERY, Issue 9 2010Anthony J. Samson Abstract Background:, The ,obesity epidemic' is expected to result in an increased incidence of knee osteoarthritis and hence total knee replacements (TKRs). Reviews have demonstrated the conflicting results of TKR for all obese (body mass index (BMI) >30). The aim of this literature review was to specifically evaluate outcomes of TKR in patients with morbid obesity (MO; BMI >40). Methods:, A systematic review of medical databases (PubMed, Medline, Cochrane Library, ScienceDirect) by use of keywords from January 1990 to September 2009 was undertaken. Results:, Clinical and functional Knee Society Scores (KSS) improve after TKR for patients with MO. The post-operative functional KSS was, in general, less than in controls. Radiographic analysis was inconclusive because of small study populations and short duration of follow-up. All studies reporting complications noted a greater prevalence in MO patients (10,30%). Of concern was the significantly higher prevalence of deep prosthetic infection (3,9-times that of controls). The morbidly obese also had a significantly higher incidence of wound complications. TKR did not result in weight loss for MO patients, and therefore has no benefit on weight-related medical conditions. Bariatric surgery in MO under 65 years of age has been shown to be a cost-effective and clinically effective method of weight reduction. This surgery also results in significant improvement in weight-related medical conditions, the KSS and knee pain. Conclusions:, Given the increase in complications for MO patients after TKR, these patients should be advised to lose weight before surgery and, if suitable, would probably benefit from bariatric surgery. [source] Changing work patterns for benign upper gastrointestinal and biliary disease: 1994,2007ANZ JOURNAL OF SURGERY, Issue 7-8 2010Alexander P. M. Jay Abstract Background:, The evolution of surgical technology has impacted on surgical practice. We determined trends in surgical caseload for common benign biliary and uppergastrointestinal conditions in Australia over the last 15 years. Methods:, Using the Medicare Australia web site, the use of Medicare item numbers specific to gall stone, bariatric and anti-reflux procedures were determined nationally and for each Australian state for each year from 1994 to 2007. Rates of operative cholangiography, laparoscopic to open cholecystectomy conversion and bile duct exploration were calculated. Per capita use of bariatric procedures was also determined. Anti-reflux surgery was analysed as total and specific subgroups of anti-reflux procedures. Results:, The use of intra-operative cholangiography has increased over time, and the conversion to open cholecystectomy and application of common bile duct exploration both decreased. A rapid increase in restrictive bariatric procedures has occurred, and this has been followed by a similar increase in revision bariatric surgery and lap band adjustments. The application of anti-reflux surgery has also increased significantly with the repair of large hiatus hernia accounting for most of the increase over the last five years, whereas revision anti-reflux surgery remains uncommon. Conclusions:, These data demonstrate significant increases in the application of some laparoscopic surgical techniques, particularly for morbid obesity. Future health-care planning will need to consider the impact of these changes. [source] BT01 LAP BAND ,"IS IT A DURABLE BARIATRIC PROCEDURE?"ANZ JOURNAL OF SURGERY, Issue 2009THE WESLEY BRISBANE EXPERIENCE Introduction: , The Wesley Private Hospital has been a world leading centre for bariatric surgery in Brisbane, Australia. We have been involved with laparoscopic adjustable gastric band surgery since 1996. Since that time we have performed over 3000 primary lap band procedures. In this study we hoped to ascertain the long term durability of the procedure over an eight year follow up period. Methods and Materials: , We have conducted a retrospective analysis of all patients who underwent LAGB surgery at our institute from 1st January 2000 to 31st December 2000. The end points were related to the outcomes in terms of weight loss and complications. Results: , 158 patients underwent LAGB surgery during the above period. There were 135 females and 23 males in this study. The age ranged from 13,69 years. Mean age of 41 years. The mean weight on presentation was 127 kg. The current mean weight is 104 kg. 80% follow-up rate over eight years. There was no mortality in our series. Conclusion: , LAGB surgery has proven durability over an eight year period in our series with a minimum of morbidity and no mortality. [source] BT02 LAPAROSCOPIC SLEEVE GASTRECTOMY AS A SINGLE-STAGE BARIATRIC PROCEDUREANZ JOURNAL OF SURGERY, Issue 2009T. Sammour Purpose: , Laparoscopic sleeve gastrectomy is increasingly being recognised as a stand-alone procedure in bariatric surgery, with long term follow-up data now emerging. We present our early experience patients with a mean BMI in the super-obese range. Methodology: , Retrospective review of laparoscopic sleeve gastrectomies performed by two surgeons at Middlemore Hospital, between March 2007 and July 2008. Results: , One hundred and one patients were identified, with a mean age of 42.7 years (95% CI 40.9,44.5). Maori and Pacific Islanders made up 31% of the patient subset. Patients had a mean BMI of 50.2 kg/m2 (95% CI 48.8,51.7), and 45 patients were super-obese. They had a median hospital stay of 2 days (1,7 days), and a mean follow-up of 6.0 months. Mean excess BMI loss (excluding patients with a major complication) was 46% (95% CI 43.3,48.7). 64% of diabetics and 37% of hypertensives showed in an improvement in medication requirement. There was a major complication rate of 8%, including 3 staple line leaks (one of which required laparotomy), 2 staple line bleeds (one requiring laparotomy), 1 infected haematoma, and 1 critical stricture. There were no deaths. Conclusion: , Laparoscopic sleeve gastrectomy has achieved satisfactory weight-loss results with an acceptable complication rate in the short to medium term. [source] | ||||||||||||||||||||||||||||||||||