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Defining the role of bariatric surgery in polycystic ovarian syndrome patients

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World Journal of Diabetes 2012年第4期3卷 71-79页

作者： Shaveta M Malik Michael L Traub Michael L Traub Department of Obstetrics and GynecologyStaten Island University Hospital Island Reproductive Services Staten IslandNY 10314United States

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in *** meet PCOS criteria,women must have a combination of hyperandrogenism,anovulation and ultrasound *** 10% of all reproductive age women worldwide show signs of *** women often seek care for gynecological or body image concerns,many PCOS women are at risk for metabolic syndrome (MS).Many of the metabolic consequences are overlooked and un-dertreated by physicians because these patients tend to be young,reproductive age *** and obesity coexist commonly with *** young women are predisposed to glucose abnormalities and ulti-mately diabetes mellitus,dyslipidemia and eventually cardiovascular *** surgery can be an ef-fective means of weight loss in PCOS *** techniques have become safer and less invasive over time and have been found to be effective in achieving significant weight *** options have also in-creased,giving patients more *** surgery may prevent or reverse metabolic *** surgery may also have reproductive benefits in PCOS *** bariatric surgery has historically been performed in older,reproductive aged women,it has recently gained favor in adolescents as *** is of particular importance due to the prevalence of both PCOS and MS in *** of PCOS and MS certainly requires a combination of medical therapy,psychological support and lifestyle *** treatments are difficult and often frustrating for pa-tients and *** surgery can be effective in achieving significant weight loss,restoration of the hypothalamic pituitary axis,reduction of cardiovascular risk and even in improving pregnancy ***-mately,bariatric surgery should be considered part of the treatment in PCOS women,especially in those with MS.

关键词： Polycystic ovarian syndrome Metabolic syn-drome bariatric surgery Obesity Pregnancy Infertility

Predictors of Gallstone Formation in Morbidly Obese Patients after bariatric Surgery: A Retrospective Observational Study

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Surgical Science 2014年第1期5卷 1-5页

作者： Mohammad H. Abo-Ryia Hamdy S. Abd-Allah Osama H. El-Khadrawy Gamal I. Moussa Department of Surgery Gastrointestinal Surgery Unit Tanta University Hospital Tanta Egypt

Background: Obesity alone and rapid weight loss induced by bariatric surgery are recognized risk factors for the development of cholelithiasis. This study aimed to identify the predictive factors for gallstone formation after bariatric surgery. Patient and methods: The files of all morbidly obese patients underwent bariatric surgery in our unit during the period from March 2003 till October 2010 were reviewed and analyzed. All patients underwent routine preoperative ultrasonography and selective concomitant cholecystectomy was done in all patients with ultrasonographic-confirmed cholelithiasis. After excluding cases with prior and concomitant cholecystectomies, patients were divided into two groups;those who developed gallstones and those who did not and the two groups were compared. Results: Of the 143 reviewed files 135 were eligible to be included in the study. The incidence of cholelithiasis before surgery was 25.9% (35 cases). 19 cases (19%) of the 100 cases free at surgery developed gallstone at a mean of 13.2 months. Comparing the two groups, no significant difference was revealed regarding gender, age, preoperative BMI or type of the operation. But the percent of excess weight loss was significantly higher in the group that formed gallstones. Conclusion: Gender, age, preoperative BMI and type of the operation were not predictive of gallstones formation after bariatric surgery. The percent of excess weight loss was the only predictive postoperative factor.

关键词： Obesity Gallstone bariatric Surgery

bariatric endoscopy: treatment of obesity and bariatric surgery complications

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中华肥胖与代谢病电子杂志 2016年第4期2卷 185-190页

作者： Natan Zundel Josemberg Marins Campos Lyz Bezerra Silva Maíra Gomes Manoel Galvao Neto Department of Surgery Florida International University USA Department of Surgery Federal University of Pernambuco Brazil

The fast increase in the number of patients undergoing bariatric surgery has led to the emergence of bariatric endoscopy as a therapeutic interface for minimally invasive treatment of complications. These techniques have the potential to be safer, reversible and cost-effective, with decreased morbidity, because of their less invasive nature.

关键词： bariatric endoscopy Treatment of obesity Complication

Nutritional risks and defi ciencies pre and post bariatric surgery:Recommendations for optimal dietary management

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中华肥胖与代谢病电子杂志 2018年第4期4卷 183-195页

作者： Amanda Wray Rachel Davis Nicholas Wray Flinders University South Australia PO Box 2100 Adelaide SAAustralia

Objective This paper aims to summarise the key recommendations from the most recent literature,to support Chinese bariatric surgeons and their multidisciplinary teams in the optimal nutritional management of their *** is a growing body of evidence that recognises the risk of untreated nutritional deficiencies pre and post bariatric *** paper will focus on the most prevalent and catastrophic of nutritional *** workup prior to surgery,in addition to postoperative nutrition follow up is highly desirable to avoid complications associated with restrictive diets and large variations in body mass[1].Dietetic counselling to address presurgical nutritional defi ciencies,appropriate use of presurgical Very Low-Calorie Diets(VLCD),postsurgical dietary protocol and adequate supplementation is *** that patients are informed and prepared for the postsurgical restrictive dietary changes and lifestyle modifi cations is critical for long term ***,longer term dietetic follow up can also monitor patient dietary compliance to avoid the extremes of nutritional defi *** Pre and post bariatric nutritional screening and long term nutritional follow up in addition to adherence to a life-long nutritional supplementation regimen,is critical for successful postoperative outcomes.

关键词： Dietetics Caloric restriction bariatric surgery Diet Nutritional status Dietary supplements Malnutrition Counselling

Outcome after gastrectomy in gastric cancer patients with type 2 diabetes

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World Journal of Gastroenterology 2012年第1期18卷 49-54页

作者： Jong Won Kim Jae-Ho Cheong Woo Jin Hyung Seung-Ho Choi Sung Hoon Noh Department of Surgery Gangnam Severance Hospital Yonsei University College of Medicine Department of Surgery Severance Hospital Yonsei University College of Medicine

AIM: To evaluate the prognosis of type Ⅱ diabetes mellitus (T2DM) after gastrectomy and related factors in gastric cancer patients. METHODS: 403 gastric cancer patients with T2DM were studied, who underwent gastrectomy between May 2003 and September 2009. A review of medica records and telephone interviews was performed in this cross-sectional study. The factors included in the statistical analysis were as follows: gender, age, type of surgery, preoperative body mass index (BMI), current BMI, BMI reduction ratio, preoperative insulin or oral diabetic medicine requirement, follow-up duration, and current state of diabetes. Assessment of diabetes status after surgery was classified into four categories according to the change in hypoglycemic agents after surgery and present status of T2DM: resolution, improvement, same, and worse.(± 20.6 mo), preoperative BMI was 24.7 kg/m2 (± 3.0 kg/m2), and BMI reduction ratio was 9.8% (± 8.6%). After surgery, T2DM was cured in 58 patients (15.1%) and was improved in 117 patients (30.4%). According to the type of surgery, the BMI reduction ratio was signif icantly higher in the total gastrectomy and Roux-en-Y reconstruction group [14.2% ± 9.2% vs 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001] and signif icantly lower in the subtotal gastrectomy and Billroth Ⅰ reconstruction group [7.6% ± 8.0%, 9.2% ± 7.7% (Billroth Ⅱ group), P < 0.001]. The BMI reduction ratio, follow-up duration after surgery, type of surgery, extent of gastrectomy, and performance of duodenal bypass were signif icantly correlated to the course of T2DM (P < 0.05). The BMI reduction ratio was the most influential factor on T2DM status. In a subgroup analysis of patients with a BMI reduction ratio of 10% or less (n = 206), T2DM was cured in 15 (7.6%) patients and was improved in 57 (28.8%) patients after surgery, and only the duration of surgery was signif icantly correlated to T2DM status (P = 0.022).

关键词： Gastric cancer Diabetes mellitus Metabolic surgery bariatric surgery

Portomesenteric venous thrombosis:An early postoperative complication after laparoscopic biliopancreatic diversion

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World Journal of Gastroenterology 2015年第8期21卷 2546-2549页

作者： Manuela Cesaretti Hosam Elghadban Nicola Scopinaro Francesco Saverio Papadia Department of Surgery San Martino Hospital University of Genoa

The number of bariatric operations,as well as the incidence of perioperative complications,has risen sharply in the past ten *** acute portal vein thrombosis is an infrequent and potentially severe postoperative complication that has not yet been reported after biliopancreatic diversion(BPD).Three cases are presented of portal vein thrombosis that occurred following BPD treatment for morbid obesity and type 2 *** thromboses were detectedby abdominal ultrasound and computed tomography with intravenous *** portomesenteric venous thromboses in all three cases presented as unexpected abdominal pain several days after discharge from the *** complications occurred despite adequate perioperative prophylaxis and progressed to bowel gangrene in the diabetic patients *** cases demonstrate the occurrence of this rare type of complication,which may be observed by physicians that do not routinely treat bariatric *** of this surgical complication will allow for early diagnosis and prompt initiation of adequate therapy.

关键词： Portal thrombosis Laproscopy bariatric surgery Bil

Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding

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World Journal of Gastroenterology 2013年第36期19卷 6035-6043页

作者： Nam Q Nguyen Philip Game Justin Bessell Tamara L Debreceni Melissa Neo Carly M Burgstad Pennie Taylor Gary A Wittert Department of Gastroenterology and Hepatology Royal Adelaide Hospital Discipline of Medicine University of Adelaide Department of Surgery Royal Adelaide Hospital Adelaide Obesity Surgery Calvary Wakefield Hospital Department of Surgery Flinders University

AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications after RYGB(1995-2009;n=609;116M:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131M:555F;37.2±0.4years)were extracted from prospective ***:Pre-operative BMI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,P<001);more patients with BMI<35 kg/m2underwent LAGB than RYGB(17.1%vs 4.1%,P<0.0001).BMI decrease was greater after *** were direct relationships between weight loss and pre-operative BMI(P<0.001).Although there was no difference in weight loss between genders during the first 3-year post-surgery,male LAGB patients had greater BMI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,P<0.001);majority related to wound *** had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,P<0.001).Conversion to RYGB resulted in greater BMI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB ***:RYGB produces substantially greater weight loss than *** peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB.

关键词： bariatric surgery Gastric bypass Gastric banding Weight loss Complications Co-morbidity Outcomes

Current status of intragastric balloon for obesity treatment

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World Journal of Gastroenterology 2016年第24期22卷 5495-5504页

作者： Seung Han Kim Hoon Jai Chun Hyuk Soon Choi Eun Sun Kim Bora Keum Yoon Tae Jeen Division of Gastroenterology and Hepatology Department of Internal Medicine Institute of Gastrointestinal Medical Instrument Research Korea University College of Medicine

Endoscopic bariatric therapy may be a useful alternative to pharmacological treatment for obesity, and it provides greater efficacy with lower risks than do conventional surgical procedures. Among the various endoscopic treatments for obesity, the intragastric balloon is associated with significant efficacy in body weight reduction and relief of comorbid disease symptoms. Anatomically, this treatment is based on gastric space-occupying effects that increase the feeling of satiety and may also affect gut neuroendocrine signaling. The simplicity of the intragastric balloon procedure may account for its widespread role in obesity treatment and its applicability to various degrees of obesity. However, advances in device properties and procedural techniques are still needed in order to improve its safety and cost-effectiveness. Furthermore, verification of the physiological outcomes of intragastric balloon treatment and the clinical predictive factors for treatment responses should be considered. In this article, we discuss the types, efficacy, safety, and future directions of intragastric balloon treatment.

关键词： Intragastric balloon Obesity bariatric Metabolic Endoscopy

Nutritional issues in patients with obesity and cirrhosis

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World Journal of Gastroenterology 2018年第30期24卷 3330-3346页

作者： Luigi Schiavo Luca Busetto Manuela Cesaretti Shira Zelber-Sagi Liat Deutsch Antonio Iannelli Department of Translational Medical Science University of Campania“Luigi Vanvitelli”Naples 80131Italy Ⅸ Division of General Surgery Vascular Surgery and Applied BiotechnologyNaples University PoliclinicNaples 80131Italy Department of Medicine University of PaduaPadua 35128Italy Center for the Study and the Integrated Management of Obesity University Hospital of PaduaPadua 35128Italy Department of HPB Surgery and Liver Transplantation Hopital BeaujonAP-HPClichy 92110France Department of Nanophysics Italian Institute of TechnologyGenova 16163Italy School of Public Health University of HaifaHaifa 3498838Israel Department of Gastroenterology and Liver disease Tel Aviv Medical Center62431Tel-Aviv 62431Israel The Sackler Faculty of Medicine Tel-Aviv UniversityTel-Aviv 62431Israel Digestive Unit Archet 2 HospitalUniversity Hospital of NiceF-06202NiceFrance Inserm U1065Team 8“Hepatic complications of obesity”Nice F-06204France University of Nice Sophia-Antipolis Nice F-06107France

Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to *** with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver *** obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronicliver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver *** patients with obesity are at high risk for depletion of various fat-soluble,water-soluble vitamins and trace elements and should be supplemented ***,physical activity and protein intake should be carefully monitored in these fragile patients according to recent *** surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver *** risk of sarcopenia,micronutrient status,and the recommended supplementation in patients with obesity and cirrhosis are discussed in this ***,the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.

关键词： obesity cirrhosis sarcopenia malnutrition bariatric surgery