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Ugeskrift For Laeger Dec 2022Patients with excess skin after massive weight loss often experience skin maceration, infection, wounding and reduced quality of life. Abdominoplasty is a surgical... (Review)
Review
Patients with excess skin after massive weight loss often experience skin maceration, infection, wounding and reduced quality of life. Abdominoplasty is a surgical procedure that removes excess skin aiming to relieve physical inconveniences and improve quality of life. The abdominoplasty can be performed with different techniques using a horizontal, vertical and/or a circumferential procedure. The purpose of this review is to describe the indications for the different surgical approaches, the surgical principles and the complications following abdominoplasty in patients after massive weight loss.
Topics: Humans; Quality of Life; Abdominoplasty; Plastic Surgery Procedures; Bariatric Surgery; Skin Diseases; Weight Loss; Retrospective Studies
PubMed: 36621875
DOI: No ID Found -
Clinical Nutrition (Edinburgh, Scotland) Jan 2022While bariatric surgery has demonstrated physical and psychological benefits, a risk of suicide and non-fatal self-harm has also been shown. The aim of this study was to...
BACKGROUND
While bariatric surgery has demonstrated physical and psychological benefits, a risk of suicide and non-fatal self-harm has also been shown. The aim of this study was to compared the rate of hospitalization for self-harm during a three-year observational follow-up period between adolescents/young adults who underwent bariatric surgery in France in 2013-2014 and two control groups.
METHODS
All individuals aged 12-25 years old who underwent bariatric surgery in France between January 1st, 2013, and December 31st, 2014, were identified with a validated algorithm from the French national hospital database, and compared to a healthy sample of the general population matched for age and gender. Information relative to hospitalizations, including for self-harm (ICD-10 codes X60-84), were extracted i) between 2008 and the surgery, and ii) for a three-year follow-up period. A second unmatched control group with obesity but no bariatric surgery was also identified. Survival analyses with adjustments for confounding variables were used.
RESULTS
In 2013-2014, 1984 youths had bariatric surgery in France. During follow-up, 1.5% were hospitalized for self-harm vs. 0.3% for controls (p < 0.0001). After adjustment, subsequent hospitalization for self-harm was associated with bariatric surgery (HR 3.64, 95% CI 1.70-7.81), prior psychiatric disorders (HR 7.76, 95% CI 3.76-16.01), and prior self-harm (HR 4.43, 95% CI 1.75-11.24). When compared to non-operated youths with obesity, bariatric surgery was not associated with self-harm while prior mental disorders and self-harm were. Mortality reached 0.3% after surgery.
CONCLUSIONS
Bariatric surgery is associated with an increased risk of self-harm, mainly in relation to preexisting psychological conditions. Vigilance and appropriate care are thus warranted in vulnerable individuals.
Topics: Adolescent; Adult; Bariatric Surgery; Case-Control Studies; Child; Female; France; Hospitalization; Humans; Male; Mental Disorders; Obesity; Postoperative Complications; Postoperative Period; Risk Factors; Self-Injurious Behavior; Young Adult
PubMed: 34915275
DOI: 10.1016/j.clnu.2021.11.034 -
Obstetrics and Gynecology Nov 2017To examine contraceptive practices and conception rates after bariatric surgery.
OBJECTIVE
To examine contraceptive practices and conception rates after bariatric surgery.
METHODS
The Longitudinal Assessment of Bariatric Surgery-2 is a multicenter, prospective cohort study of adults undergoing first-time bariatric surgery as part of routine clinical care at 10 U.S. hospitals. Recruitment occurred between 2005 and 2009. Participants completed preoperative and annual postsurgical assessments for up to 7 years until January 2015. This report was restricted to women 18-44 years old with no history of menopause, hysterectomy, or estrogen and progesterone therapy. Primary outcomes were self-reported contraceptive practices, overall conception rate, and early (less than 18 months) postsurgical conception. Contraceptive practice (no intercourse, protected intercourse, unprotected intercourse, or tried to conceive) was classified based on the preceding year. Conception rates were determined from self-reported pregnancies.
RESULTS
Of 740 eligible women, 710 (95.9%) completed follow-up assessment(s). Median (interquartile range) preoperative age was 34 (30-39) years. In the first postsurgical year, 12.7% (95% CI 9.4-16.0) of women had no intercourse, 40.5% (95% CI 35.6-45.4) had protected intercourse only, 41.5% (95% CI 36.4-46.6) had unprotected intercourse while not trying to conceive, and 4.3% (95% CI 2.4-6.3) tried to conceive. The prevalence of the first three groups did not significantly differ across the 7 years of follow-up (P for all >.05); however, more women tried to conceive in the second year (13.1%, 95% CI 9.3-17.0; P<.001). The conception rate was 53.8 (95% CI 40.0-71.1) per 1,000 woman-years across follow-up (median [interquartile range] 6.5 [5.9-7.0] years); 42.3 (95% CI 30.2-57.6) per 1,000 woman-years in the 18 months after surgery. Age (adjusted relative risk 0.41 [95% CI 0.19-0.89] per 10 years, P=.03), being married or living as married (adjusted relative risk 4.76 [95% CI 2.02-11.21], P<.001), and rating future pregnancy as important preoperatively (adjusted relative risk 8.50 [95% CI 2.92-24.75], P<.001) were associated with early conception.
CONCLUSIONS
Postsurgical contraceptive use and conception rates do not reflect recommendations for an 18-month delay in conception after bariatric surgery.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT00465829.
Topics: Adolescent; Adult; Bariatric Surgery; Contraception; Contraception Behavior; Female; Fertilization; Follow-Up Studies; Humans; Longitudinal Studies; Obesity; Postoperative Period; Pregnancy; Pregnancy Rate; Prospective Studies; Young Adult
PubMed: 29016506
DOI: 10.1097/AOG.0000000000002323 -
JSLS : Journal of the Society of... 2022Obesity is a chronic, multifactorial disease associated with multiple cardiometabolic conditions. The successful management of this condition includes a... (Review)
Review
BACKGROUND
Obesity is a chronic, multifactorial disease associated with multiple cardiometabolic conditions. The successful management of this condition includes a multidisciplinary approach with interventions focused on lifestyle modification, pharmaceutical therapies, and bariatric surgery. Endoscopic bariatric therapies (EBT) have been proposed as a way to bridge the gap between medical management and bariatric surgery. The Association for Bariatric Endoscopy in conjunction with the American Society for Gastrointestinal Endoscopy published the position statement approving and integrating EBT into practice. The aim of this article is to review the most common primary EBT's, their indications, outcomes, and complications.
DATABASE
A medical literature review was conducted using the defined keywords. Databases included PubMed, Google Scholar, Embase, and EBSCO. Articles in English were considered for review from June 1, 2000 to June 30, 2021.
CONCLUSION
Endoscopic bariatric therapies should be offered in conjunction with lifestyle modification and with nutritional guidance, as part of a multidisciplinary approach in obesity management. They require a formal training process for endoscopists and bariatric surgeons to obtain the endoscopic skills needed before performing these procedures. Longer follow-up and larger trials are needed to validate current evidence, in order to enhance the process of standardization of these techniques.
Topics: Bariatric Surgery; Endoscopy, Gastrointestinal; Humans; Obesity
PubMed: 35444403
DOI: 10.4293/JSLS.2021.00066 -
Revista Chilena de Pediatria 2019The obesity epidemic affects transversally the entire life cycle. Particularly in recent decades, an in crease in severe obesity has been observed in adolescents. At... (Review)
Review
The obesity epidemic affects transversally the entire life cycle. Particularly in recent decades, an in crease in severe obesity has been observed in adolescents. At this stage of life, characterized by deep physical and emotional changes, and great vulnerability, severe obesity has few effective treatment options. In adolescents, the treatment results focused on lifestyle modifications are poor and the pharmacological options are very limited and ineffective. Bariatric Surgery (BS) has emerged as a via ble therapeutic option for a selected group of adolescents. The objective of this review is to update the current view regarding indications, contraindications, complications, and results of these procedures in the adolescent population.
Topics: Adolescent; Bariatric Surgery; Contraindications, Procedure; Humans; Obesity, Morbid; Pediatric Obesity; Postoperative Complications; Quality of Life; Treatment Outcome; Weight Loss
PubMed: 31095215
DOI: 10.32641/rchped.v90i1.875 -
The Journal of Clinical Endocrinology... Aug 2023Severe obesity in adolescence negatively impacts upon health and wellbeing. Lifestyle modifications do not usually achieve a sufficient degree or durability of weight... (Review)
Review
Severe obesity in adolescence negatively impacts upon health and wellbeing. Lifestyle modifications do not usually achieve a sufficient degree or durability of weight loss to mitigate the risk of medical complications. In recent years, metabolic and bariatric surgery (MBS), already a well-established treatment for adults with severe obesity, has emerged as an option in adolescents. Controlled studies in this age group have demonstrated substantial and sustained weight loss, improvements in associated health parameters, and a safety profile surpassing that observed in adult patients. This review aims to present published data on the results of MBS in adolescents with a focus on long-term outcomes. Indications for bariatric surgery and aspects of timing in the young person's life are also presented, along with safety considerations and factors influencing patient selection for surgery. We conclude, predominantly from short- to medium-term outcomes data, that MBS is a safe and valuable therapeutic option for adolescents with severe obesity. Considering the poor health and social wellbeing prognosis in this group, MBS appears to be underutilized. The need for continued research, multiprofessional specialist provision, coherent contemporary clinical guidelines, and routine long-term follow-up in adolescents undergoing MBS is highlighted.
Topics: Adult; Humans; Adolescent; Obesity, Morbid; Bariatric Surgery; Obesity; Prognosis; Weight Loss
PubMed: 36947630
DOI: 10.1210/clinem/dgad155 -
Frontiers in Endocrinology 2022Metabolic and bariatric surgery is the most effective therapy for weight loss and improving obesity-related comorbidities, comprising the Roux-en-Y gastric bypass... (Review)
Review
Metabolic and bariatric surgery is the most effective therapy for weight loss and improving obesity-related comorbidities, comprising the Roux-en-Y gastric bypass (RYGB), gastric banding, sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch. While the effectiveness of weight loss surgery is well-rooted in existing literature, weight recurrence (WR) following bariatric surgery is a concern. Endoscopic bariatric therapy presents an anatomy-preserving and minimally invasive option for managing WR in select cases. In this review article, we will highlight the endoscopic management techniques for WR for the most commonly performed bariatric surgeries in the United States -RYGB and SG. For each endoscopic technique, we will review weight loss outcomes in the short and mid-terms and discuss safety and known adverse events. While there are multiple endoscopic options to help address anatomical issues, patients should be managed in a multidisciplinary approach to address anatomical, nutritional, psychological, and social factors contributing to WR.
Topics: Bariatric Surgery; Gastrectomy; Gastric Bypass; Humans; Retrospective Studies; United States; Weight Loss
PubMed: 35909531
DOI: 10.3389/fendo.2022.946870 -
Journal of Visceral Surgery Feb 2018Complications in bariatric surgery are varied; they are severe at times but infrequent. They may be surgical or non-surgical, and may occur early or late. The goal of... (Review)
Review
Complications in bariatric surgery are varied; they are severe at times but infrequent. They may be surgical or non-surgical, and may occur early or late. The goal of this systematic review is to inform and help the attending physician, the emergency physician and the non-bariatric surgeon who may be called upon to manage surgical complications that arise after adjustable gastric band (AGB), sleeve gastrectomy (SG), or gastric bypass (GBP). Data from evidence-based medicine were extracted from the literature by a review of the Medline database and also of the most recent recommendations of the learned societies implicated. The main complications were classified for each intervention, and a distinction was made between early and late complications. Early complications after AGB include prosthetic slippage or perforation; SG can be complicated early by staple line leak or fistula, and BPG by fistula, stenosis and postoperative hemorrhage. Delayed complications of AGB include intragastric migration of the prosthesis, late prosthetic slippage and infection, while SG can be complicated by gastro-esophageal reflux, and BPG by anastomotic ulcer and internal hernia. The analysis of available data allowed us to develop decisional algorithms for the management of each of these complications.
Topics: Bariatric Surgery; Body Mass Index; Evidence-Based Medicine; Female; Gastric Balloon; General Surgery; Humans; Male; Obesity, Morbid; Postoperative Complications; Practice Guidelines as Topic; Prognosis; Risk Assessment; Surgeons; Treatment Outcome
PubMed: 29277390
DOI: 10.1016/j.jviscsurg.2017.10.012 -
World Journal of Gastroenterology Nov 2014The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their... (Review)
Review
The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21(st) century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.
Topics: Bariatric Surgery; Diffusion of Innovation; Humans; Laparoscopy; Obesity, Morbid; Patient Selection; Postoperative Complications; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 25386062
DOI: 10.3748/wjg.v20.i41.15135 -
Surgery For Obesity and Related... Feb 2022Obesity is considered a risk factor for cataracts. The association between weight loss and a cataract among patients with obesity has not been assessed to date.
BACKGROUND
Obesity is considered a risk factor for cataracts. The association between weight loss and a cataract among patients with obesity has not been assessed to date.
OBJECTIVES
To assess the association between weight loss following bariatric surgery and cataracts.
SETTING
Nationwide Swedish healthcare registries between 2006 and 2019.
METHODS
We performed a population-based cohort study. Patients aged 40-79 years who underwent bariatric surgery were matched on their propensity score (PS) to up to 2 patients with obesity ("unexposed patients"). Cox proportional hazard regression analyses calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of developing cataracts following bariatric surgery, compared with unexposed patients. Subgroup analyses by age, sex, bariatric surgery type, and duration of follow-up were conducted.
RESULTS
In total, 22,560 bariatric surgery patients were PS-matched to 35,523 unexposed patients. The risk of cataracts was decreased in bariatric surgery patients compared with unexposed patients (HR .71, 95% CI .66-.76). We observed the lowest risk of cataracts among bariatric surgery patients aged 40-49 years (HR .52, 95% CI .44-.75) but a null result for patients aged ≥60 years. Gastric bypass or duodenal switch were associated with decreased risks of cataracts, whereas sleeve gastrectomy yielded a null result. Subgroups of sex and duration of follow-up showed no evidence of effect modification (hazards were proportional throughout follow-up).
CONCLUSION
Our results suggest that substantial weight loss following bariatric surgery is associated with a decreased risk of cataracts, especially if bariatric surgery was performed before age 60.
Topics: Adult; Aged; Bariatric Surgery; Cataract; Cohort Studies; Gastric Bypass; Humans; Middle Aged; Obesity, Morbid; Propensity Score; Retrospective Studies
PubMed: 34863672
DOI: 10.1016/j.soard.2021.10.021