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Surgical outcome of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass for resolution of type 2 diabetes mellitus:A systematic review and meta-analysis

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World Journal of Gastroenterology 2020年第8期26卷 865-876页

作者： Salman Yousuf Guraya Tim Strate Clinical Sciences Department College of MedicineUniversity of SharjahSharjah 27272United Arab Emirates Department of Surgery Reinbek HospitalAcademic Teaching Hospital of the University of HamburgReinbek D-21465Germany

BACKGROUND Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus(T2DM).laparoscopic Roux-en-Y gastric bypass(LRYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used procedures for weight loss and comorbidity resolution ***,it is not yet known whether the degree of T2DM is influenced by the choice of bariatric *** To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese *** We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM *** manager 5.3 was used for data analysis,and the overall effect summary was represented in a forest *** From 1,650 titles retrieved by an initial search,we selected nine studies for this *** found insignificant differences for T2DM resolution by LRYGB and LSG,with an odds ratio of 0.93(95%CI:0.64-1.35,Z statistics=0.38,P=0.71).Additionally,subset analyses for T2DM resolution showed insignificant differences after 24 mo(χ^2=1.24,df=4,P=0.87,overall Z effect=0.23),36 mo(χ^2=0.41,df=2,P=0.81,overall Z effect=0.51),and 60 mo(χ^2=4.75,df=3,P=0.19,overall Z effect=1.20)by LRYGB and *** study reports a T2DM remission rate of 82.3%by LRYGB and 80.7%by *** This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of ***,long-term follow-up of 10 years is needed to further substantiate these findings.

关键词： Morbid obesity Type 2 diabetes mellitus laparoscopic sleeve gastrectomy laparoscopic Roux-en-Y gastric bypass

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State of art on the mechanisms of laparoscopic sleeve gastrectomy in treating type 2 diabetes mellitus

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World Journal of Diabetes 2023年第6期14卷 632-655页

作者： Fa-Shun Liu Song Wang Xian-Shan Guo Zhen-Xiong Ye Hong-Ya Zhang Zhen Li Department of General Surgery Yangpu HospitalTongji University School of MedicineShanghai 200090China Department of Endocrinology Xinxiang Central HospitalXinxiang 453000Henan ProvinceChina Central Laboratory Yangpu District Control and Prevention CenterShanghai 200090China

Obesity and type-2 diabetes mellitus(T2DM)are metabolic *** increases the risk of T2DM,and as obesity is becoming increasingly common,more individuals suffer from T2DM,which poses a considerable burden on health ***,pharmaceutical therapy together with lifestyle changes is used to treat obesity and T2DM to decrease the incidence of comorbidities and allcause mortality and to increase life *** surgery is increasingly replacing other forms of treatment of morbid obesity,especially in patients with refractory obesity,owing to its many benefits including good long-term outcomes and almost no weight *** bariatric surgery options have markedly changed recently,and laparoscopic sleeve gastrectomy(LSG)is gradually gaining *** has become an effective and safe treatment for type-2 diabetes and morbid obesity,with a high cost-benefit ***,we review the mechanism associated with LSG treatment of T2DM,and we discuss clinical studies and animal experiments with regard to gastrointestinal hormones,gut microbiota,bile acids,and adipokines to clarify current treatment modalities for patients with obesity and T2DM.

关键词： Obesity Type-2 diabetes mellitus laparoscopic sleeve gastrectomy Gastrointestinal hormones Adipokines Gut microbiota Bile acids

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Effect of laparoscopic sleeve gastrectomy on related variables of obesity complicated with polycystic ovary syndrome

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World Journal of Gastrointestinal Surgery 2023年第11期15卷 2423-2429页

作者： Xiao-Tao Wang Yi-Sen Hou Hao-Liang Zhao Jian Wang Chen-Hao Guo Jie Guan Zhi-Gan Lv Peng Ma Jian-Li Han Department of Thyroid&Bariatric Metabolic Surgery Third Hospital of Shanxi Medical UniversityShanxi Bethune HospitalShanxi Academy of Medical SciencesTaiyuan 030032Shanxi ProvinceChina Department of Anesthesia Third Hospital of Shanxi Medical UniversityShanxi Bethune HospitalShanxi Academy of Medical SciencesTaiyuan 030032Shanxi ProvinceChina

BACKGROUND Polycystic ovary syndrome(PCOS)is closely related to obesity,and weight loss can significantly improve the metabolic,endocrine and reproductive functions of obese individuals with ***,the efficacy of laparoscopic sleeve gastrectomy(LSG)for obesity with PCOS are *** The purpose of the study was to investigate the effect of LSG on related variables in obese patients with *** A retrospective analysis was performed on 32 obese patients with PCOS who received LSG treatment at the Third Hospital of Shanxi Medical University from 2013 to *** changes in anthropometric indices,insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH),menstrual cycle and LH/FSH ratio before and 1 mo,3 mo,6 mo and 12 mo after the operation were statistically *** At 1 mo,3 mo,6 mo and 12 mo after surgery,the anthropometric indices,such as body weight and body mass index,of all patients were lower than those before the *** percentage excess weight loss(EWL%)at 1 mo,3 mo,6 mo and 1 year of follow-up were 25,40,46 and 65,*** PCOS-related indices,such as insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH)and menstrual cycle,were improved to varying *** the 1-year follow-up,the average serum testosterone decreased from preoperative 0.72 ng/mL to 0.43 ng/mL(P<0.05),average fasting insulin level(9.0 mIU/mL,preoperative 34.2 mil,LH level,4.4 mIU/mL,preoperative 6.1 mIU/mL).The level of FSH(3.8 U/L,4.8 U/p0.05)and the ratio of LH/FSH(0.7,1.3/p0.05)were more relieved than those before *** the postoperative follow-up,it was found that the menstrual cycle of 27 patients(nasty 27)returned to normal,and 6 patients(18%)who intended to become pregnant became pregnant within 1 year after *** The weight loss effect of LSG is obvious and affirmative,and the endocrine index of obese patients with PCOS is also improved to some extent,a

关键词： laparoscopic sleeve gastrectomy Polycystic ovary syndrome Hyperandrogenism Insulin resistance

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Association between operative position and postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 2088-2095页

作者： Zhao-Peng Li Yan-Cheng Song Ya-Li Li Dong Guo Dong Chen Yu Li Department of Gastrointestinal Surgery The Affiliated Hospital of Qingdao UniversityQingdao 266033Shandong ProvinceChina Department of Operation Room The Affiliated Hospital of Qingdao UniversityQingdao 266033Shandong ProvinceChina

BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric *** present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric *** To explore the effect of the operative position during bariatric surgery on *** Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively *** logistic regression analysis and the t-test were used to study the influence of operative position on *** There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically *** position should be carefully considered for obese patients before surgery.

关键词： Postoperative nausea and vomiting Bariatric surgery laparoscopic sleeve gastrectomy Operative positions Obesity

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Can Left Pleural Effusion Be an Indicator of Gastric Leaks after laparoscopic sleeve gastrectomy?

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Open Journal of Radiology 2021年第1期11卷 11-18页

作者： Sultan R. Alharbi Department of Radiology and Medical Imaging College of Medicine King Saud University Riyadh Saudi Arabia

Background: Coincidental pleural effusion has been observed by computed tomography (CT) scans in individual patients with gastric leaks after laparoscopic sleeve gastrectomy;however, the frequency of this phenomenon has not been investigated in cohort studies. Objectives: This study aimed to assess the diagnostic accuracy of left pleural effusion as an indicator of gastric leaks after laparoscopic sleeve gastrectomy. Setting: University hospital and bariatric surgery center of excellence. Methods: This single-center retrospective analysis included consecutive patients who had undergone laparoscopic sleeve gastrectomy followed by CT scans to investigate suspected gastric leaks from September 2011 to September 2018. The sensitivity, specificity, Youden’s index, and predictive values were estimated using a 2 × 2 cross-tabulation. Results: The study involved assessing the CT scans of 148 patients;80 patients (44 men and 36 women, mean age: 34 years, mean body mass index {BMI}: 46 kg/m2) had positive findings of gastric leaks after laparoscopic sleeve gastrectomy, such as contrast leak, gas leak, and peri-gastric collection (either singly or in combination). The CT findings were negative for gastric leaks in 68 patients (38 men and 30 women, mean age: 33 years, mean BMI: 45 kg/m2). Pleural effusion manifested as a fluid density in the dependent portion of pleural cavity on CT. The sensitivity of left pleural effusion to predict gastric leaks after laparoscopic sleeve gastrectomy was 73.8%, and the specificity was 91.2%. The positive and negative predictive values were 90.8% and 74.7%, respectively, and the Youden’s index was 64.9%. Conclusion: Left pleural effusion exhibits good diagnostic accuracy for gastric leaks after laparoscopic sleeve gastrectomy. Notably, the specificity (91.2%) was very high.

关键词： Computed Tomography Gastric Leak laparoscopic sleeve gastrectomy Pleural Effusion

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Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study

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World Journal of Gastrointestinal Endoscopy 2017年第4期9卷 162-170页

作者： Harshit Garg Pratyusha Priyadarshini Sandeep Aggarwal Samagra Agarwal Rachna Chaudhary Department of Surgical Disciplines All India Institute of Medical Sciences Department of Medicine All India Institute of Medical Sciences

To compare the impact of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design. METHODSForty patients undergoing LRYGB, who completed their two year follow-up were matched with 40 patients undergoing LSG for age, gender, body mass index and presence of type 2 diabetes mellitus (T2DM). Data of these patients was retrospectively reviewed to compare the outcome in terms of weight loss and improvement in comorbidities, i.e., T2DM, hypertension (HTN), obstructive sleep apnea syndrome (OSAS), hypothyroidism and gastroesophageal reflux disease (GERD). RESULTSPercentage excess weight loss (EWL%) was similar in LRYGB and LSG groups at one year follow-up (70.5% vs 66.5%, P = 0.36) while it was significantly greater for LRYGB group after two years as compared to LSG group (76.5% vs 67.9%, P = 0.04). The complication rate after LRYGB and LSG was similar (10% vs 7.5%, P = 0.99). The median duration of T2DM and mean number of oral hypoglycemic agents were higher in LRYGB group than LSG group (7 years vs 5 years and 2.2 vs 1.8 respectively, P < 0.05). Both LRYGB and LSG had significant but similar improvement in T2DM, HTN, OSAS and hypothyroidism. However, GERD resolved in all patients undergoing LRYGB while it resolved in only 50% cases with LSG. Eight point three percent patients developed new-onset GERD after LSG. CONCLUSIONLRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.

关键词： Bariatric surgery laparoscopic sleeve gastrectomy laparoscopic Roux-en-Y gastric bypass Weight loss Comorbidities

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Practices concerning sleeve gastrectomy in Turkey: A survey of surgeons

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World Journal of Gastrointestinal Surgery 2021年第5期13卷 452-460页

作者： Burhan Mayir Department of General Surgery Antalya Training and Research HospitalAntalya 07010Turkey

BACKGROUND laparoscopic sleeve gastrectomy(LSG)is the most common bariatric surgical *** is a restrictive procedure and in this operation stomach volume is greatly *** the details of the procedure are examined,it is seen that there are many different methods *** To analyze approaches of surgeons performing *** A questionnaire consist of 44 questions was sent by e-mail to the surgeons performing bariatric *** of surgery about preoperative period,surgical techniques and postoperative period was *** Different approaches about antibiotic prophylaxis,stapler line reinforcement utilization,application of intraoperative and postoperative leakage test,approach to the crus and hiatal hernia repair were *** was observed that a few partipicipants applied contrary to the guidelines of antibiotic prophlaxis and thromboembolism *** about other subjects were generally *** In this study,approaches about LSG that most common bariatric surgical procedure in our country was *** to these results,knowing the approaches in our country will be beneficial in terms of determining the training programs in bariatric surgery,improving surgical results and reducing the complications.

关键词： Bariatric surgery Obesity laparoscopic sleeve gastrectomy Complications Leak Surgery practices

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Weight loss maintenance after bariatric surgery

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World Journal of Clinical Cases 2023年第18期11卷 4241-4250页

作者： Young-Hye Cho Youngin Lee Jung In Choi Sae Rom Lee Sang Yeoup Lee Department of Family Medicine Pusan National University School of MedicineYangsan 50612South Korea Department of Family Medicine Pusan National University Yangsan HospitalYangsan 50612South Korea Family Medicine and Biomedical Research Institute Pusan National University Yangsan HospitalYangsan 50612South Korea Department of Medical Education Pusan National University School of MedicineYangsan 50612South Korea

Metabolic and bariatric surgery(MBS)is an effective treatment for patients with morbid obesity and its ***,many patients experience weight regain(WR)after achieving their nadir *** the definition of WR is challenging as postoperative WR has various *** factors for WR after MBS include anatomical,racial,hormonal,metabolic,behavioral,and psychological factors,and evaluating such factors preoperatively is ***-term regular follow-up and timely treatment by a multidisciplinary team are important because WR after surgery is *** lifestyle interventions that focus on appropriate dietary education,physical activity education or interventions,and behavioral psychological interventions are suggested,more well-designed studies are needed because studies evaluating intervention methods and the effectiveness of WR prevention are *** drugs can be used to prevent and manage patients with WR after MBS;however,more research is needed to determine the timing,duration,and type of anti-obesity drugs used to prevent WR.

关键词： Metabolic and bariatric surgery Weight regain Obesity Roux-en-Y gastric bypass laparoscopic sleeve gastrectomy

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Roux-en-Y gastric bypass or sleeve gastrectomy for obstructive sleep apnea:A systematic review and meta-analysis

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laparoscopic, Endoscopic and Robotic Surgery 2019年第3期2卷 53-58页

作者： Hussein Al-Rubaye Emma Rose McGlone Borna Farzaneh Livyar Mustafa Mae Johnson Ajit Kayal Caroline-Louise English Vasha Kaur Myutan Kalendran Marcus Reddy Omar A.Khan St George's University of LondonLondonSW170REUK Department of Metabolic and Investigative Medicine Hammersmith Hospital CampusImperial College LondonLondonW120HSUK Department of Anaesthetic St George's HospitalLondonSW170QTUK St George's Hospital LondonSW170QTUK Department of Upper Gastrointestinal and Bariatric Surgery St George's HospitalLondonSW170QTUK Population Health Research Institute St George'sUniversity of LondonLondonSW170REUK

Objective:Bariatric surgery has been shown to be an effective method of treatment for obstructive sleep apnea(OSA)with long-term benefits,however,the mechanisms of action and the optimum operative procedure remains *** aim of this systemic review was to compare the efficacy of laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(RYGB)in resolving ***:A comprehensive search of MEDLINE,Pubmed,Embase,and OVID was *** that reported OSA resolution in obese patients with BMI>30 kg/m2 were included in the ***,comparative prospective and matched cohort studies comparing RYGB with LSG were considered for this ***:Five studies(309 participants)were included:4 cohort studies and 1 RCT;all with low risk of *** 12 months follow-up,there was a trend towards improved resolution of OSA with LSG(OR 0.47,95%CI[0.20 to 1.06];p=0.07)when compared to *** contrast,there was a trend to poorer weight loss in the LSG group(SMD 3.83,95%CI[-1.82 to 9.48];p=0.18).Similarly,at 36 months follow-up,there was a trend towards better resolution of OSA with LSG(OR 0.52,95%CI[0.16 to 1.71];p=0.28)and a significantly poorer weight loss in LSG when compared to RYGB(SMD 8.25,95%CI[2.91 to 13.58];p=0.002).Conclusion:Despite poorer weight loss following LSG,there is a trend towards increased resolution of sleep apnea *** findings suggest the possibility of weight loss independent factors causing OSA resolution,which should be further ***:PROSPERO:CRD42018090367.

关键词： Obesity laparoscopic sleeve gastrectomy laparoscopic Roux-en-Y gastric bypass Obstructive sleep apnea Meta-analysis

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