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International Journal of Surgery... Apr 2023Enhanced recovery after surgery (ERAS), a multidisciplinary and multimodal perioperative care protocol, has been widely used in several surgical fields. However, the...
BACKGROUND
Enhanced recovery after surgery (ERAS), a multidisciplinary and multimodal perioperative care protocol, has been widely used in several surgical fields. However, the effect of this care protocol on patients receiving minimally invasive bariatric surgery remains unclear. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent minimally invasive bariatric surgery.
MATERIAL AND METHODS
PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify literature reporting the effects of the ERAS protocol on clinical outcomes in patients undergoing minimally invasive bariatric surgery. All the articles published until 01 October 2022, were searched, followed by data extraction of the included literature and independent quality assessment. Then, pooled mean difference (MD) and odds ratio with a 95% CI were calculated by either a random-effects or fixed-effects model.
RESULTS
Overall, 21 studies involving 10 764 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (MD: -1.02, 95% CI: -1.41 to -0.64, P <0.00001), hospitalization costs (MD: -678.50, 95% CI: -1196.39 to -160.60, P =0.01), and the incidence of 30-day readmission (odds ratio =0.78, 95% CI: 0.63-0.97, P =0.02) were significantly reduced. The incidences of overall complications, major complications (Clavien-Dindo grade ≥3), postoperative nausea and vomiting, intra-abdominal bleeding, anastomotic leak, incisional infection, reoperation, and mortality did not differ significantly between the ERAS and SC groups.
CONCLUSIONS
The current meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving minimally invasive bariatric surgery. Compared with SC, this protocol leads to significantly shorter hospitalization lengths, lower 30-day readmission rate, and hospitalization costs. However, no differences were observed in postoperative complications and mortality.
Topics: Humans; Enhanced Recovery After Surgery; Bariatric Surgery; Bariatrics; Postoperative Nausea and Vomiting; Perioperative Care; Length of Stay; Postoperative Complications; Systematic Reviews as Topic; Meta-Analysis as Topic
PubMed: 36999781
DOI: 10.1097/JS9.0000000000000372 -
Obesity Surgery May 2021The 2018 IFSO Survey focused on similarities and disparities in the number and types of surgical and endoluminal interventions among the IFSO chapters occurred in the...
BACKGROUND
The 2018 IFSO Survey focused on similarities and disparities in the number and types of surgical and endoluminal interventions among the IFSO chapters occurred in the last decade.
METHODS
All IFSO Societies were asked to fill in the IFSO survey form on how many and which surgical and endoluminal interventions have been performed in the 2018. A special section was added, asking about the existence of national guidelines for bariatric and metabolic surgery, national recommendations for preoperative gastroscopy, type of reimbursement for bariatric/metabolic surgery, including for patients with BMI < 35 kg/m. The trend analyses from 2008 to 2018 were also performed.
RESULTS
Fifty-seven/65 (87.7%) IFSO Societies submitted completed forms. The American Society for Metabolic and Bariatric Surgery did not fill the IFSO survey form but provided an official report on the performed interventions. The total number of surgical and endoluminal procedures performed in 2018 in the world was 696,191. Sleeve gastrectomy (SG) remained the most commonly performed bariatric procedure (N = 386,096; 55.4%). Among the total reported bariatric/metabolic interventions, 604,223 (86.8%) were primary surgical and 29,167 (4.2%) primary endoluminal operations; 62,801 (9%) were revisional procedures.
CONCLUSIONS
There was only a slight increase (10.317 procedures) in the total number of the reported bariatric interventions compared to the last IFSO survey. SG continues to be the most commonly performed operation since 2014. The one anastomosis gastric bypass (OAGB), currently the third most performed procedure after SG and Roux-en-Y gastric bypass (RYGB), continues to rise in popularity worldwide.
Topics: Bariatric Surgery; Gastrectomy; Gastric Bypass; Humans; Obesity, Morbid; Surveys and Questionnaires
PubMed: 33432483
DOI: 10.1007/s11695-020-05207-7 -
Revista Da Associacao Medica Brasileira... Sep 2020Obesity is a chronic disease characterized by excess fat in the body and a real public health problem. Bariatric surgery, in recent decades, has gained space in its... (Review)
Review
Obesity is a chronic disease characterized by excess fat in the body and a real public health problem. Bariatric surgery, in recent decades, has gained space in its treatment due to the efficiency obtained in weight loss and significant reduction of the related comorbidities. The most commonly performed bariatric procedures include Roux-en-Y gastric bypass, adjustable gastric band, and laparoscopic sleeve gastrectomy. Possible complications described include fistulas, dehiscence, marginal ulcers, intestinal obstruction, internal hernias, and anastomotic stenosis. These complications may have unfavorable clinical outcomes since symptoms are often nonspecific. Abdominal computed tomography (CT) is an important tool in the evaluation of postoperative complications, both in the immediate and late postoperative status of patients undergoing such a procedure. We analyzed the most illustrative tomographic findings of the different complications after reducing gastroplasty in 203 patients without distinction of age or gender. Correct interpretation requires radiologists to understand the surgical technique since postoperative anatomy and surgery-specific complications may be obstacles to proper interpretation.
Topics: Bariatric Surgery; Gastric Bypass; Humans; Laparoscopy; Obesity, Morbid
PubMed: 33027460
DOI: 10.1590/1806-9282.66.9.1289 -
Ugeskrift For Laeger Dec 2017This is a review of the recommendations regarding pregnancy after bariatric surgery from the Danish Society of Obstetrics and Gynaecology. The risk of vitamin/mineral... (Review)
Review
This is a review of the recommendations regarding pregnancy after bariatric surgery from the Danish Society of Obstetrics and Gynaecology. The risk of vitamin/mineral deficiencies should be emphasized and checked with blood samples. Measurements of fetal growth should be offered at gestational age 28 and 34 as a supplement to the standard prenatal procedures because of the increased risk of intrauterine growth retardation. Because of persistent obesity there is still an increased risk of hypertension and diabetes mellitus. In case of abdominal pain internal herniation should be suspected.
Topics: Bariatric Surgery; Denmark; Dietary Supplements; Female; Humans; Obesity, Morbid; Practice Guidelines as Topic; Preconception Care; Pregnancy; Pregnancy Complications; Recommended Dietary Allowances; Risk Factors
PubMed: 29212591
DOI: No ID Found -
World Journal of Gastroenterology Oct 2023Obesity rates have increased, and so has the need for more specific treatments. This trend has raised interest in non-surgical weight loss techniques that are novel,... (Review)
Review
Obesity rates have increased, and so has the need for more specific treatments. This trend has raised interest in non-surgical weight loss techniques that are novel, safe, and straightforward. Thus, the present review describes the endoscopic bariatric treatment for obesity, its most recent supporting data, the questions it raises, and its future directions. Various endoscopic bariatric therapies for weight reduction, such as intragastric balloons (IGBs), aspiration therapy (AT), small bowel endoscopy, endoscopic sleeve gastroplasty, endoluminal procedures, malabsorption endoscopic procedures, and methods of regulating gastric emptying, were explored through literature sourced from different databases. IGBs, AT, and small bowel endoscopy have short-term effects with a possibility of weight regain. Minor adverse events have occurred; however, all procedures reduce weight. Vomiting and nausea are common side effects, although serious complications have also been observed.
Topics: Humans; Obesity; Gastroplasty; Endoscopy, Gastrointestinal; Weight Loss; Gastric Emptying; Bariatric Surgery; Treatment Outcome; Obesity, Morbid
PubMed: 37970474
DOI: 10.3748/wjg.v29.i40.5526 -
The Journal of Clinical Endocrinology... Nov 2008Over 23 million Americans are afflicted with severe obesity, i.e. their body mass index (in kilograms per square meter) values exceed 35. Of even greater concern is the... (Review)
Review
CONTEXT
Over 23 million Americans are afflicted with severe obesity, i.e. their body mass index (in kilograms per square meter) values exceed 35. Of even greater concern is the association of the adiposity with comorbidities such as diabetes, hypertension, cardiopulmonary failure, asthma, pseudotumor cerebri, infertility, and crippling arthritis.
OBJECTIVE
Diets, exercise, behavioral modification, and drugs are not effective in these individuals. This article examines the effect of surgery on the control of the weight and the comorbidities, as well as the safety of these operations.
INTERVENTIONS
Although the article focuses on the outcomes of the three most commonly performed operations, i.e. adjustable gastric banding, the gastric bypass, and the biliopancreatic bypass with duodenal switch, it aims for perspective with the inclusion of abandoned and current investigational procedures, a review of the complications, and an emphasis on the appropriate selection of patients. POSITIONS: Ample evidence, including controlled randomized studies, now document that bariatric surgery produces durable weight loss exceeding 100 lb (46 kg), full and long-term remission of type 2 diabetes in over 80% with salutary effects on the other comorbidities as well with significant reductions in all-cause mortality. Although the severely obese present with serious surgical risks, bariatric surgery is performed safely with a 0.35% 90-d mortality in Centers of Excellence throughout the United States-similar to the complication rates after cholecystectomy.
CONCLUSIONS
Until better approaches become available, bariatric surgery is the therapy of choice for patients with severe obesity.
Topics: Bariatric Surgery; Body Weight; Contraindications; Diabetes Mellitus, Type 2; Humans; Models, Biological; Obesity, Morbid; Risk; Therapies, Investigational; Treatment Outcome
PubMed: 18987275
DOI: 10.1210/jc.2008-1641 -
BMC Surgery Sep 2022Bariatric surgery procedures are the most successful and durable treatment for morbid obesity. Hemorrhage represents a life-threatening complication, occurring in...
BACKGROUND
Bariatric surgery procedures are the most successful and durable treatment for morbid obesity. Hemorrhage represents a life-threatening complication, occurring in 1.3-1.7% of bariatric surgeries.
MATERIALS AND METHODS
We examined patients undergoing Bariatric Surgery from July 2017 to June 2020 (Group A) and those operated from July 2020 to June 2022 (Group B) in our Department. Starting from July 2020 we have implemented intraoperative measures to prevent postoperative bleeding, increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneal pressure of CO to 8 mmHg in the last 15 min of the operation.
RESULTS
The study gathered 200 patients divided into the two described groups. The mean age of Group A is 44 ± 8.49 and 43.73 ± 9.28. The mean preoperative BMI is 45.6 kg/m ± 6.71 for Group A and 48.9 ± 7.15 kg/m for Group B. Group A recorded a mean MAP of 83.06 ± 18.58 mmHg and group B a value of 111.88 ± 12.46 mmHg (p value < 0.05 and z-score is 4.15226 and the value of U is 13,900). We observed 9 cases of bleeding in group A, most of them being treated with medical therapy and transfusions; only 1 hemodynamically unstable patient underwent re-laparoscopy. We reported only 2 cases of bleeding in group B, one of which required blood transfusions.
CONCLUSION
From our study we can conclude that increasing mean arterial pressure (MAP) by 30% compared to preoperative and reducing the pneumoperitoneum pressure of CO to 8 mmHg in the last 15 min of the operation led to a decrease in bleeding cases in group B and, most importantly, all the bleedings were easily controllable with medical therapy and/or transfusions. These measures allowed us to reduce postoperative bleeding.
Topics: Bariatric Surgery; Carbon Dioxide; Humans; Laparoscopy; Obesity, Morbid; Pneumoperitoneum; Postoperative Hemorrhage
PubMed: 36058915
DOI: 10.1186/s12893-022-01783-w -
BMJ Clinical Evidence Oct 2015The prevalence of childhood obesity in the UK and in many countries worldwide remains high. Behavioural interventions to modify lifestyle, such as diet and physical... (Review)
Review
INTRODUCTION
The prevalence of childhood obesity in the UK and in many countries worldwide remains high. Behavioural interventions to modify lifestyle, such as diet and physical activity, usually form part of weight management strategies for obese children. Whether or not surgical interventions are effective and safe in treating childhood obesity is unclear.
METHODS AND OUTCOMES
We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of surgical interventions for the treatment of childhood obesity? We searched Medline, Embase, The Cochrane Library, and other important databases up to August 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS
At this update, after deduplication and removal of conference abstracts, 67 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 19 studies and the further review of 48 full publications. Of the 48 full articles evaluated, two systematic reviews were included at this update.
CONCLUSIONS
In this systematic overview, we categorised the efficacy for two comparisons based on information about the effectiveness and safety of bariatric surgery versus no intervention and different types of bariatric surgery versus each other.
Topics: Bariatric Surgery; Child; Humans; Life Style; Pediatric Obesity; Treatment Outcome
PubMed: 26469547
DOI: No ID Found -
Eating and Weight Disorders : EWD Mar 2022Bariatric surgery determines a rearrangement of the gastrointestinal tract that influences nutrient handling and plays a role in the metabolic changes observed after... (Review)
Review
Bariatric surgery determines a rearrangement of the gastrointestinal tract that influences nutrient handling and plays a role in the metabolic changes observed after surgery. Most of the changes depend on the accelerated gastric emptying observed in Roux-en-Y gastric bypass (RYGB) and, to a lesser extent, in sleeve gastrectomy (SG). The rapid delivery of meal into the jejunum, particularly after RYGB, contributes to the prompt appearance of glucose in peripheral circulation. Glucose increase is the principal determinant of GLP-1 increase with the consequent stimulation of insulin secretion, the latter balanced by a paradoxical glucagon increase that stimulates EGP to prevent hypoglycaemia. Protein digestion and amino acid absorption appear accelerated after RYGB but not after SG. After RYGB, the adaptation of the gut to the new condition participates to the metabolic change. The intestinal transit is delayed, the gut microbioma is changed, the epithelium becomes hypertrophic and increases the expression of glucose transporter and of the number of cell secreting hormones. These changes are not observed after SG. After RYGB-less after SG-bile acids (BA) increase, influencing glucose metabolism probably modulating FXR and TGR5 with an effect on insulin sensitivity. Muscle, hepatic and adipose tissue insulin sensitivity improve, and the gut reinforces the recovery of IS by enhancing glucose uptake and through the effect of the BA. The intestinal changes observed after RYGB result in a light malabsorption of lipid but not of carbohydrate and protein. In conclusion, functional and morphological adaptations of the gut after RYGB and SG activate inter-organs cross-talk that modulates the metabolic changes observed after surgery.Level of evidence Level V, narrative literature review.
Topics: Bariatric Surgery; Blood Glucose; Gastrectomy; Gastric Bypass; Gastrointestinal Tract; Humans; Nutrients
PubMed: 33895917
DOI: 10.1007/s40519-021-01194-5 -
Surgical Endoscopy Oct 2020Following bariatric surgery, ongoing postoperative testing is required to measure nutritional deficiencies; the purpose of this study was to quantify the prevalence of...
INTRODUCTION
Following bariatric surgery, ongoing postoperative testing is required to measure nutritional deficiencies; the purpose of this study was to quantify the prevalence of these nutritional deficiencies based on two-year follow-up tests at recommended time points.
METHODS AND PROCEDURES
A retrospective data analysis was conducted of all laboratory tests for bariatric patients who underwent surgery between May 2016 and January 2018 with available lab data (n = 397). Results for nine different nutritional labs were categorized into six recommended postoperative time periods based on time elapsed since the procedure date. Binary variables were created for each laboratory result to calculate descriptive statistics of abnormalities for each lab test over time and used in the individual GEE logistic regression models. Grouped logistic regression examined the total nutritional deficiencies of the nine combined nutrients considering total available labs.
RESULTS
Multiple lab tests indicated a very low frequency of abnormalities (e.g., Vitamin A, Vitamin B12, Copper, and Folate). Many of the nine included nutritional labs had an average deficiency of less than 10% across all time points. The grouped logistic model found preoperative nutritional deficiency to be predictive of postoperative nutritional deficiency (OR 3.70, p < 0.001).
CONCLUSIONS
We found the vast majority of routine lab test results to be normal at multiple time points. Current practice can add up to significant lab expenses over time. The frequency of postoperative testing in this population may be redundant and of very little value. Unnecessary follow-up laboratory testing costs the patients and the health care system in both time and resources. Patients with preoperative deficiencies appear to be at higher risk for nutritional deficiencies when compared to bariatric surgery patients that did not have preoperative nutritional deficiencies. Future research should focus on defining cost effective postoperative lab testing guidelines for at risk bariatric patients.
Topics: Bariatric Surgery; Clinical Laboratory Techniques; Female; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 31676922
DOI: 10.1007/s00464-019-07216-9