Bariatric surgery and diabetes:Current challenges and perspectives

Diabetes mellitus(DM)and obesity have become public issues of global concern.Bariatric surgery for the treatment of obesity combined with type 2 DM has been shown to be a safe and effective approach;however,there are limited studies that have systematically addressed the challenges of surgical treatment of obesity combined with DM.In this review,we summarize and answer the most pressing questions in the field of surgical treatment of obesity-associated DM.I believe that our insights will be of great help to clinicians in their daily practice.

Effect of bariatric surgery on metabolism in diabetes and obesity comorbidity:Insight from recent research

Obesity is a prevalent cause of diabetes mellitus(DM)and is a serious danger to human health.Type 2 DM(T2DM)mostly occurs along with obesity.Foodborne obesity-induced DM is caused by an excessive long-term diet and surplus energy.Bariatric surgery can improve the symptoms of T2DM in some obese patients.But different types of bariatric surgery may have different effects.There are some models built by researchers to discuss the surgical procedures’effects on me-tabolism in diabetes animal models and diabetes patients.It is high time to conclude all this effects and recommend procedures that can better improve metabolism.

Alcohol associated liver disease and bariatric surgery:Current perspectives and future directions

Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with obesity.However,bariatric sur-gery has also been linked to increased alcohol use with up to 30%of these patients developing alcohol use disorder(AUD).The mechanism of AUD after bariatric surgery is multifactorial and includes anatomic,metabolic,and neurohumoral changes associated with post-surgical anatomy.These patients are at increased risk of alcohol associated liver disease and,in some cases,require liver trans-plantation.In this article,we provide a scoping review of epidemiology,patho-physiology,and clinical outcomes of alcohol-related health conditions after bariatric surgery.

Long-term effectiveness,outcomes and complications of bariatric surgery

Dietary imbalance and overeating can lead to an increasingly widespread disease-obesity.Aesthetic considerations aside,obesity is defined as an excess of adipose tissue that can lead to serious health problems and can predispose to a number of pathological changes and clinical diseases,including diabetes;hypertension;atherosclerosis;coronary artery disease and stroke;obstructive sleep apnea;depression;weight-related arthropathies and endometrial and breast cancer.A body weight 20%above ideal for age,gender and height is a severe health risk.Bariatric surgery is a set of surgical methods to treat morbid obesity when other treatments such as diet,increased physical activity,behavioral changes and drugs have failed.The two most common procedures currently used are sleeve gastrectomy and gastric bypass.This procedure has gained popularity recently and is generally considered safe and effective.Although current data show that perioperative mortality is low and better control of comorbidities and short-term complications is achieved,more randomized trials are needed to evaluate the long-term outcomes of bariatric procedures.This review aims to synthesize and summarize the growing evidence on the long-term effectiveness,outcomes and complications of bariatric surgery.

Weight loss maintenance after bariatric surgery

Metabolic and bariatric surgery(MBS)is an effective treatment for patients with morbid obesity and its comorbidities.However,many patients experience weight regain(WR)after achieving their nadir weight.Establishing the definition of WR is challenging as postoperative WR has various definitions.Risk factors for WR after MBS include anatomical,racial,hormonal,metabolic,behavioral,and psychological factors,and evaluating such factors preoperatively is necessary.Long-term regular follow-up and timely treatment by a multidisciplinary team are important because WR after surgery is multi-factorial.Although 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 lacking.Antiobesity 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.

Fertility outcomes following bariatric surgery

Obesity impacts human health in more than one way.The influence of obesity on human reproduction and fertility has been extensively examined.Bariatric surgery(BS)has been used as an effective tool to achieve long-term weight loss in both sexes.BS improves hormonal profiling,increasing the odds of spontaneous pregnancy and success rates following assisted reproductive techniques in infertile females.For obese males,BS does improve sexual function and hormonal profile;however,conflicting reports discuss reduced sperm parameters following BS.Although the benefits of BS in the fertility field are acknowledged,many areas call for further research,like choosing the safest surgical techniques,determining the optimal timing to get pregnant,and resolving the uncertainty of sperm parameters.

Impact of Ursodeoxycholic Acid on Gall Stone Formation Post Bariatric Surgery

Introduction: Bariatric surgery is identified as highly effective therapy for obesity and help to loss wight that is become important public health priority because it increases the risk of condition including diabetes, cardiovascular disease, and several types of cancer whether by accomplishing mini-gastric bypass, Gastric bypass (Roux-en-Y) and sleeve gastrectomy [1] rapid weight loss increased incidence risk of gall stone formation [2]. Ursodeoxycholic acid is a bile acid which affect a reduction in cholesterol in biliary fluid primary by dispersing the cholesterol and forming a liquid-crystal phase [2], it’s can play a significant role in preventing of gall stone formation. Objective: Study potential effect of Ursodeoxycholic acid (UDCA) on gall stone formation after bariatric surgery. Methods: This study Cross-sectional Trials, review of all patient underwent bariatric surgery November 2021-Jun 2022, Taif Military Hospital in the department of surgery, the sample of study will be around 143 participants or more, data collection all patient underwent bariatric surgery. Results: A Total of 160 patients underwent bariatric surgery in Taif Armed Forces Hospitals from 2015 to 2021. Of these, 53 were male (33.1%) and 107 were female (66.9%). only 33 patients (20.6%) received Ursodeoxycholic acid, and 127 patients (79.4%) weren’t proscribed for them. However, 40 patients (25%) develop gall stone and underwent cholecystectomy, three of them were on Ursodeoxycholic acid (9%) and 37 patients weren’t on Ursodeoxycholic acid (29%). which shows that Ursodeoxycholic acid remarkable reduce the risk of gall stone formation post wight reduction surgery. Conclusion: In conclusion, bariatric procedures come with the risk of leading to the formation of gallstones. This is especially in the stage when a patient experiences rapid loss of weight. This is why a preventive measure is necessary and UDCA have been considered for this purpose. This study has shown that patients who use UDCA are less bound to have gallstone formations.

More than Meets the Eye: A Qualitative Investigation of the Complex Weight History Constructions of Brazilian Women Who Underwent Bariatric Surgery

Most studies on bariatric surgery identify personal factors such as“non-compliance”to lifestyle changes as the cause of weight gain and subsequent inability to lose weight.Prior qualitative studies suggest that weight loss patients have complicated relationships with both self and weight,with significant emotional and psychological implications.But how do patients themselves understand the trajectories of their weight gain as related to intrinsic versus extrinsic factors?A qualitative analysis examined the aspects involved in the construction of higher body weight from the perspectives and life experiences of Brazilian women who underwent bariatric surgery,considering that Brazil has previously been reported as a highly anti-fat society.Individual,semi-structured interviews were conducted with thirty women(15 aged 33-59 and 15 aged 63-72).Data were analyzed identifying the regular,expressive,and meaningful significance units identified through the interviews.Although it was expected that different life events were reported as crucial to the perceived aetiology of individual weight gain stories,the participants reported that the emotional aspects had more impact.The extremely high value attached to having a particular body weight negatively influenced the participants’concept of identity and harmed their interactions and understanding of what it meant to be fully loved and accepted.Most of the participants underscored the importance of food in women’s lived experiences and explanations of weight gain.Despite this somatic response being dysfunctionally directed to food,this mechanism seemed to be vital to keeping them alive and engaged in the world.Finally,the participants faced layered vulnerabilities,which decreased their opportunities to access resources aimed at better body weight management.Broad approaches that consider emotional and physical care strategies must be proposed to this population.

Analysis of Changes in BDNF Levels Before and After Bariatric Surgery in Obese Patients

Objectives:The rate of obesity has been increasing globally,so is the number of obese patients undergoing bariatric surgery.The relationship between brain-derived neurotrophic factor(BDNF)and body weight has been highlighted in recent years,but there are few related studies in China.The purpose of this study was to investigate the changes of BDNF in obese patients before and after bariatric surgery and to provide evidence for obesity-related mechanisms.Methods:The BDNF levels in 44 obese patients who underwent bariatric surgery were measured by enzyme-linked immunosorbent assay(ELISA)before and 4.5 months after surgery.SPSS 27.0 was used for statistical analysis.Results:Among the 44 patients,30 were female and 14 were male.The body mass index(BMI)decreased significantly after bariatric surgery(P<0.001);the serum BDNF of the patients significantly increased(P<0.001)after surgery.There was no significant difference in BDNF among patients with different degrees of obesity before and after surgery(P>0.05).There were no significant differences in BMI and BDNF levels between different sexes before and after surgery(P>0.05).Conclusion:The BDNF levels of obese patients increased significantly after bariatric surgery,which proved that bariatric surgery has an effect on BDNF levels.

Impact of bariatric surgery on glucose and lipid metabolism and liver and kidney function in food-induced obese diabetic rats

BACKGROUND Obesity usually causes diabetes mellitus(DM)and is a serious danger to human health.Type 2 DM(T2DM)mostly occurs along with obesity.Foodborne obesityinduced DM is caused by an excessive long-term diet and surplus energy.Bariatric surgery can improve the symptoms of T2DM in some obese patients.But different types of bariatric surgery may have different effects.AIM To investigate the effect of bariatric surgery on glucose and lipid metabolism and liver and kidney function in rats.METHODS Male Sprague-Dawley rats aged 6-8 wk underwent Roux-en-Y gastric bypass surgery(RYGB),sleeve gastrectomy(SG),or gastric banding(GB).Glucose and insulin tolerance tests,analyses of biochemical parameters,histological examination,western blot,and quantitative real-time polymerase chain reaction were conducted.RESULTS In comparison to the sham operation group,the RYGB,SG,and GB groups had decreased body weight and food intake,reduced glucose intolerance and insulin insensitivity,downregulated biochemical parameters,alleviated morphological changes in the liver and kidneys,and decreased levels of protein kinase Cβ/P66shc.The effect in the RYGB group was better than that in the SG and GB groups.CONCLUSION These results suggest that RYGB,SG and GB may be helpful for the treatment of foodborne obesity-induced DM.

Bariatric surgery and long-term nutritional issues

Bariatric surgery is recognized as a highly effective therapy for obesity since it accomplishes sustained weight loss, reduction of obesity-related comorbidities and mortality, and improvement of quality of life. Overall, bariatric surgery is associated with a 42% reduction of the cardiovascular risk and 30% reduction of all-cause mortality. This review focuses on some nutritional consequences that can occur in bariatric patients that could potentially hinder the clinical benefits of this therapeutic option. All bariatric procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract; this alteration makes these patients more susceptible to developing nutritional complications, namely, deficiencies of macro-and micro-nutrients, which could lead to disabling diseases such as anemia, osteoporosis, protein malnutrition. Of note is the evidence that most obese patients present a number of nutritional deficits already prior to surgery, the most important being vitamin D and iron deficiencies. This finding prompts the need for a complete nutritional assessment and, eventually, an adequate correction of pre-existing deficits before surgery. Another critical issue that follows bariatric surgery is post-operative weight regain, which is commonly associated with the relapse of obesity-related comorbidities. Nu-tritional complications associated with bariatric surgery can be prevented by life-long nutritional monitoring with the administration of multivitamins and mineral supplements according to the patient's needs.

Bariatric surgery in patients with non-alcoholic fatty liver disease-from pathophysiology to clinical effects

Non-alcoholic fatty liver disease(NAFLD) is increasingly recognized as a significant liver disease,and it covers the disease spectrum from simple steatosis with a risk of development of non-alcoholic steatohepatitis(NASH) to fibrosis,subsequent cirrhosis,end-stage liver failure,and liver cancer with a potential need for liver transplantation.NAFLD and NASH are closely related to obesity,metabolic syndrome,and type 2 diabetes(T2 D).The role of gut hormones,especially glucagon-like peptide 1(GLP-1),is important in NAFLD.Bariatric surgery has the potential for inducing great weight loss and may improve the symptoms of metabolic syndrome and T2 D.Recent data demonstrated significant effects of bariatric surgery on GLP-1 and other gut hormones and important lipid metabolic and inflammatory abnormalities in the pathophysiology of NAFLD.Therefore,bariatric surgery may reverse the pathological liver changes in NAFLD and NASH patients.In the present review,we describe NAFLD and NASH pathophysiology and the primary effects of bariatric surgery on metabolic pathways.We performed a systematic review of the beneficial and harmful effects and focused on changes in liver disease severity in NAFLD and NASH patients.The specific focus was liver histopathology as assessed by the invasive liver biopsy.Additionally,we reviewed several non-invasive methods used for the assessment of liver disease severity following bariatric surgery.

Progress in treatment of type 2 diabetes by bariatric surgery

The incidence of type 2 diabetes(T2D)is increasing at an alarming rate worldwide.Bariatric surgical procedures,such as the vertical sleeve gastrectomy and Roux-en-Y gastric bypass,are the most efficient approaches to obtain substantial and durable remission of T2D.The benefits of bariatric surgery are realized through the consequent increased satiety and alterations in gastrointestinal hormones,bile acids,and the intestinal microbiota.A comprehensive understanding of the mechanisms by which various bariatric surgical procedures exert their benefits on T2D could contribute to the design of better non-surgical treatments for T2D.In this review,we describe the classification and evolution of bariatric surgery and explore the multiple mechanisms underlying the effect of bariatric surgery on insulin resistance.Based upon our summarization of the current knowledge on the underlying mechanisms,we speculate that the gut might act as a new target for improving T2D.Our ultimate goal with this review is to provide a better understanding of T2D pathophysiology in order to support development of T2D treatments that are less invasive and more scalable.

Early Clinical Efficacy of Laparoscopic Sleeve Gastrectomy as a Bariatric Surgery for Obese Patients: A Uni-center Report in China

Objective To report the experience with laparoscopic sleeve gastrectomy as a bariatric surgery in our center. Methods Twenty obese patients were followed up for i year after receiving laparoscopic sleeve gastrectomy as a bariatric surgery in our center from January 2009 to October 2010, during which their general conditions, complications, and improvement of obesity-related diseases were assessed. Results Of the 20 patients, 19 underwent laparoscopic sleeve gastrectomy and 1 underwent open sleeve gastrectomy with no death occurred. The average weight loss was 36.4＋10.0 kg, the average BMI decreased from 46.1＋11.5 to 33.6＋5.6 kg/m2, and the excess weight loss was 55.9%＋14.2% one year after the operation. The majority of obesity-related diseases were improved. In one year after the operation, excellent, good, fairly good and poor scores were achieved in 2 （10.0%）, 8 （40.0%）, 7 （35.0%）, and 3 patients （15.0%）, respectively. Conclusion Laparoscopic sleeve gastrectomy as a bariatric surgery is a safe and feasible procedure for obesity with excellent short-term effects. More studies with a long-term follow-up are needed to validate its benefits.

Metabolic bariatric surgery and type 2 diabetes mellitus:an endocrinologist's perspective

Traditional treatment of T2 DM consisting of modification of diet,an exercise regimen,and pharmacotherapy has problems of poor lifestyle modifications and fail tend of treatment over time,now bariatric surgery is recommended for treatment of obese patients with T2 DM because its great improvements on weight loss and metabolic.In this article,effects of bariatric surgery on diabetes and diabetes-related complications are reviewed.

Therapeutic endoscopy for the treatment of post-bariatric surgery complications

Obesity rates continue to climb worldwide.Obesity often contributes to other comorbidities such as type 2 diabetes,hypertension,heart disease and is a known risk factor for many malignancies.Bariatric surgeries are by far the most invasive treatment options available but are often the most effective and can result in profound,durable weight loss with improvement in or resolution of weight associated comorbidities.Currently performed bariatric surgeries include Rouxen-Y gastric bypass,sleeve gastrectomy,and laparoscopic gastric banding.These surgeries are associated with significant weight loss,but also with significant rates of major complications.The complexity of these patients and surgical anatomies makes management of these complications by a multidisciplinary team critical for optimal outcomes.Minimally invasive treatments for complications are typically preferred because of the high risk associated with repeat operations.Endoscopy plays a large role in both the diagnosis and the management of complications.Endoscopy can provide therapeutic interventions for many bariatric surgical complications including anastomotic strictures,anastomotic leaks,choledocholithiasis,sleeve stenosis,weight regain,and eroded bands.Endoscopists should be familiar with the various surgical anatomies as well as the various therapeutic options available.This review article serves to delineate the current role of endoscopy in the management of complications after bariatric surgery.

Endoluminal solutions to bariatric surgery complications:A review with a focus on technical aspects and results

Obesity is a growing problem in developed countries,and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients.Despite the advances in surgical techniques,some patients still develop acute and late postoperative complications,and an endoscopic evaluation is often required for diagnosis.Moreover,the high morbidity related to surgical reintervention,the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery,and,in many cases,a suitable first-line treatment of bariatric surgery complications.There is now evidence in the literature supporting endoscopic management for some of these complications,such as gastrointestinal bleeding,stomal and marginal ulcers,stomal stenosis,leaks and fistulas or pancreatobiliary disorders.However,endoscopic treatment in this setting is not standardized,and there is no consensus on its optimal timing.In this article,we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment.Based on a thorough review of the literature,we evaluated the performance and safety of different endoscopic options for every type of complication,highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

Metabolic syndrome and liver disease in the era of bariatric surgery: What you need to know!

Metabolic syndrome(MS)is defined as the constellation of obesity,insulin resistance,high serum triglycerides,low high-density lipoprotein cholesterol,and high blood pressure.It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare,cost,and quality of life associated consequences.MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease.Conservative treatment,which includes diet,exercise,and antidiabetic agents,is the mainstay of treatment,but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations.Bariatric surgery has recently emerged as an appropriate alternative treatment with promising longterm results.Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates.Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with nonalcoholic steatohepatitis has increased more than fivefold over the past 15 years.In this review,we summarize current state of evidence on the surgical treatment of MS.

Endoscopic therapy of weight regain after bariatric surgery

Weight regain following primary bariatric surgery occurs in a significant proportion of patients and is attributed to epidemiological,anatomical and metabolic factors.Surgical revision of these patients has significant risks and limited benefits.Endoscopic revisions that reduce gastric pouch size and diameter of the gastrojejunal anastomosis may offer an effective,safe,less invasive and even reproducible treatment.We herein discuss the indication,selection and feasibility of different endoscopic techniques that could be used in the management of weight regain following primary bariatric surgery.Future research could optimize a personalized approach not only in the endoscopic management but also in combination with other therapeutic modalities for weight regain after bariatric surgery.

Effect of Dexmedetomidine and Remifentanil on Renal Function in Patients Undergoing Bariatric Surgery

Background and Objectives: In anesthesia for bariatric surgery, alterations occur in several organs, including the kidney. The objective of this study was to compare the effect of dexmedetomidine and remifentanil on the renal function of morbidly obese patients submitted to bariatric surgery. Methods: Sixty-one patients were studied prospectively and divided randomly into two groups: remifentanil (R) and dexmedetomidine (D). Renal function was evaluated in three phases: before anesthesia (M0), after anesthetic induction (M1) and after surgical incision (M2). Plasma concentrations were determined for glucose, antidiuretic hormone, creatinine, urea, sodium, potassium and osmolarity and urinary concentrations for creatinine, urea, sodium, potassium and osmolarity. Results: Significant differences were found between groups for potassium at M1 (p Conclusions: In both groups, the clearance values fell from moments M0 to M2. This result indicates that renal function of obese patients submitted to bariatric surgery presented a physiological response compatible with the effect of anesthetic-surgical stress. In the group D, creatinine and sodium clearances were elevated at M1. Urinary volume was greater at M2. These results are suggestive of better preservation of renal function.