Obesity and type-2 diabetes mellitus(T2DM)are metabolic disorders.Obesity increases the risk of T2DM,and as obesity is becoming increasingly common,more individuals suffer from T2DM,which poses a considerable burden o...Obesity and type-2 diabetes mellitus(T2DM)are metabolic disorders.Obesity increases the risk of T2DM,and as obesity is becoming increasingly common,more individuals suffer from T2DM,which poses a considerable burden on health systems.Traditionally,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 expectancy.Bariatric 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 regain.The bariatric surgery options have markedly changed recently,and laparoscopic sleeve gastrectomy(LSG)is gradually gaining popularity.LSG has become an effective and safe treatment for type-2 diabetes and morbid obesity,with a high cost-benefit ratio.Here,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.展开更多
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 PCOS.However,the efficacy ...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 PCOS.However,the efficacy of laparoscopic sleeve gastrectomy(LSG)for obesity with PCOS are unclear.AIM The purpose of the study was to investigate the effect of LSG on related variables in obese patients with PCOS.METHODS 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 2020.The 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 analyzed.RESULTS 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 operation.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,respectively.The PCOS-related indices,such as insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH)and menstrual cycle,were improved to varying degrees.During 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 surgery.During 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 surgery.CONCLUSION 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,although the mechanism is not clear.Laparoscopic sleeve gastrectomy is expected to become a backup choice for patients with polycystic ovaries in the future.展开更多
Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and effic...Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass(LRYGB) and sleeve gastrectomy(LSG) in patients aged more than 55 years.We performed2 a retrospective review of a prospectively collected database.All patients with body mass index(BMI) §32 kg/mand aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis.Demography,peri-operative data,weight loss and surgical complications were all recorded and analyzed.Mean age and BMI of these 68 patients22(22 males and 46 female) were 58.8 years(55-79 years) and 39.5 kg/m(32.00-60.40 kg/m).LRYGB was performed in 44 patients and LSG in 24 patients.The two groups were comparable in their preoperative BMI,American Society of Anaesthesia(ASA) score and gender distribution.LSG patients were significantly older than patients receiving LRYGB.The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients(88.63% vs.50%; P,0.01).The prevalence of other co-morbidities was similar and comparable2 between the groups.Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/mand228.2 kg/m,respectively,and there was no statistically significant difference in mean percentage of excess weight loss(%EWL) at 1 year.The percentage of resolution of diabetes was significantly higher in LRYGB(69.2%) as compared to LSG(33.3%).On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver hepatitis.The overall morbidity and re-operation rate was higher in LRYGB patients.In morbidly elderly patients,both surgeries achieved good weight loss and resolution of comorbidities.LRYGB is superior to LSG in terms of diabetes remission but carries higher complication rates even at high volume centres.展开更多
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 ...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 worldwide.However,it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure.AIM To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients.METHODS We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution.Review manager 5.3 was used for data analysis,and the overall effect summary was represented in a forest plot.RESULTS From 1,650 titles retrieved by an initial search,we selected nine studies for this research.We 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 LSG.This study reports a T2DM remission rate of 82.3%by LRYGB and 80.7%by LSG.CONCLUSION This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up.However,long-term follow-up of 10 years is needed to further substantiate these findings.展开更多
AIM 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...AIM 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.METHODS Forty 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., T2 DM, hypertension(HTN), obstructive sleep apnea syndrome(OSAS), hypothyroidism and gastroesophageal reflux disease(GERD).RESULTS Percentage 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 T2 DM 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 T2 DM, 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.CONCLUSION LRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2 DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.展开更多
BACKGROUND It has been established that bariatric surgery,including laparoscopic sleeve gastrectomy(LSG),has a positive impact on type 2 diabetes mellitus(T2DM).However,less frequently T2DM is reported as a risk facto...BACKGROUND It has been established that bariatric surgery,including laparoscopic sleeve gastrectomy(LSG),has a positive impact on type 2 diabetes mellitus(T2DM).However,less frequently T2DM is reported as a risk factor for complications with this type of surgery.AIM To evaluate the safety of LSG in T2DM.METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015.Data was collected through digitized records.Any deviation from normal postoperative care within the first 60 d was defined as an early complication,and further categorized into mild or severe.RESULTS Nine hundred eighty-four patients underwent LSG,among these 143(14.5%)were diagnosed with T2DM.There were 19 complications in the T2DM group(13.3%)compared to 59 cases in the non-T2DM(7.0%).Out of 19 complications in the T2DM group,12 were mild(8.4%)and 7 were severe(4.9%).Compared to the non-T2DM group,patients had a higher risk for mild complications(Odds-ratio 2.316,CI:1.163-4.611,P=0.017),but not for severe ones(P=0.615).An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications(P=0.013,CI:1.074-1.843)but not for mild ones.CONCLUSION Our data suggest that LSG is relatively safe for patients with T2DM.Whether preoperative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family...<b><span style="font-family:Verdana;">Introduction:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Postoperative nausea and vomiting (PONV) are prevalent symptoms after laparoscopic surgeries with an incidence rate of (54</span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">79%) in bariatric procedures. Despite its popularity, limited studies assessed the effect of antiemetics for PONV prophylaxis after laparoscopic sleeve gastrectomy (LSG). The aim of this trail is to compare the effectiveness of a single pre-induction intravenous dose of Palonosetron versus Ondansetron for prophylaxis of PONV, 24 hours after LSG</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This prospective randomized controlled double-blind parallel-group study was</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">conducted from May till December 2019. Recruited patients were consented and randomized using a closed envelop method into two groups with fifty patients each.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The total number of nausea and vomiting attacks in the 24 hours postoperatively was considered as a primary end point. The secondary end points were the frequency of nausea, retching and vomiting attacks in the 24 hours post-surgery.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The severity of nausea was evaluated using a 10 cm visual analogue scale (VAS).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This RCT included 100 patients divided into 2 groups of 50 patients each. Patients received either 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron (Group I) or Ondansetron 4 mg (group II).</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Group I had statistically significant fewer episodes of nausea, retching and vomiting in the first 4 hours (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.022)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">and from 4 to 12</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hours</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.024)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">but not after 12 hours post</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">LSG. Total episodes of nausea, retching and vomiting in 24 hours postoperative were significantly less in group I</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.021).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">A single dose of intravenous 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron is superior to Ondansetron 4 mg in preventing PONV for patients after LSG.</span>展开更多
<strong>Background:</strong> Coincidental pleural effusion has been observed by computed tomography (CT) scans in individual patients with gastric leaks after laparoscopic sleeve gastrectomy;however, the f...<strong>Background:</strong> 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. <strong>Objectives:</strong> This study aimed to assess the diagnostic accuracy of left pleural effusion as an indicator of gastric leaks after laparoscopic sleeve gastrectomy. <strong>Setting:</strong> University hospital and bariatric surgery center of excellence. <strong>Methods:</strong> 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. <strong>Results:</strong> 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/m<sup>2</sup>) 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/m<sup>2</sup>). 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%. <strong>Conclusion:</strong> Left pleural effusion exhibits good diagnostic accuracy for gastric leaks after laparoscopic sleeve gastrectomy. Notably, the specificity (91.2%) was very high.展开更多
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 surgery.At present,the mechanism of ...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 surgery.At 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 surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS 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 analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS 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 significant.Operative position should be carefully considered for obese patients before surgery.展开更多
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 un...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 unclear.The aim of this systemic review was to compare the efficacy of laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(RYGB)in resolving OSA.Methods:A comprehensive search of MEDLINE,Pubmed,Embase,and OVID was performed.Studies that reported OSA resolution in obese patients with BMI>30 kg/m2 were included in the study.RCTs,comparative prospective and matched cohort studies comparing RYGB with LSG were considered for this study.Results:Five studies(309 participants)were included:4 cohort studies and 1 RCT;all with low risk of bias.At 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 RYGB.In 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 post-LSG.These findings suggest the possibility of weight loss independent factors causing OSA resolution,which should be further investigated.Registration:PROSPERO:CRD42018090367.展开更多
BACKGROUND Laparoscopic sleeve gastrectomy(LSG)is the most common bariatric surgical procedure.LSG is a restrictive procedure and in this operation stomach volume is greatly reduced.When the details of the procedure a...BACKGROUND Laparoscopic sleeve gastrectomy(LSG)is the most common bariatric surgical procedure.LSG is a restrictive procedure and in this operation stomach volume is greatly reduced.When the details of the procedure are examined,it is seen that there are many different methods surgery.AIM To analyze approaches of surgeons performing LSG.METHODS A questionnaire consist of 44 questions was sent by e-mail to the surgeons performing bariatric surgery.Approaches of surgery about preoperative period,surgical techniques and postoperative period was questioned.RESULTS 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 detected.It was observed that a few partipicipants applied contrary to the guidelines of antibiotic prophlaxis and thromboembolism prophylaxis.Approaches about other subjects were generally similar.CONCLUSION In this study,approaches about LSG that most common bariatric surgical procedure in our country was learned.According 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.展开更多
Bariatric surgeries have been demonstrated to be safe and effective treatment options for morbid obesity patients, but operative risks and high health care costs limit their clinical application. Endoscopic bariatric ...Bariatric surgeries have been demonstrated to be safe and effective treatment options for morbid obesity patients, but operative risks and high health care costs limit their clinical application. Endoscopic bariatric therapies are emerging as valuable alternatives for patients with doubts about bariatric surgery or ineligible for it. Endoscopic sleeve gastroplasty(ESG), a relatively novel technique of endoscopic bariatric therapies, has gained standing in the past few years. The safety, feasibility, repeatability, and potential for reversibility of ESG have been proven by multicenter studies. Compared to other weight loss strategies, current evidence demonstrates that ESG offers satisfactory efficacy in weight loss. Even though it is inferior to laparoscopic sleeve gastrectomy, it has lower risks of adverse events than surgical interventions and intragastric balloon within oneyear follow-up. Furthermore, ESG may be the ideal weight control strategy for patients who have poor adherence to behavioral interventions. Even so, trends in decreased weight loss effect over time, post-procedure weight regain, postprocedure gut hormone alteration, and possible effects of race and ethnicity on ESG still remain undetermined due to very limited reports and very short followups. Further clinical trials are required to validate and answer these questions.展开更多
文摘Obesity and type-2 diabetes mellitus(T2DM)are metabolic disorders.Obesity increases the risk of T2DM,and as obesity is becoming increasingly common,more individuals suffer from T2DM,which poses a considerable burden on health systems.Traditionally,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 expectancy.Bariatric 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 regain.The bariatric surgery options have markedly changed recently,and laparoscopic sleeve gastrectomy(LSG)is gradually gaining popularity.LSG has become an effective and safe treatment for type-2 diabetes and morbid obesity,with a high cost-benefit ratio.Here,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.
基金Shanxi Province“136”Revitalization Medical Project Construction Funds,No.2019XY003.
文摘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 PCOS.However,the efficacy of laparoscopic sleeve gastrectomy(LSG)for obesity with PCOS are unclear.AIM The purpose of the study was to investigate the effect of LSG on related variables in obese patients with PCOS.METHODS 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 2020.The 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 analyzed.RESULTS 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 operation.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,respectively.The PCOS-related indices,such as insulin,testosterone,estradiol,follicle stimulating hormone(FSH),luteinizing hormone(LH)and menstrual cycle,were improved to varying degrees.During 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 surgery.During 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 surgery.CONCLUSION 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,although the mechanism is not clear.Laparoscopic sleeve gastrectomy is expected to become a backup choice for patients with polycystic ovaries in the future.
文摘Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass(LRYGB) and sleeve gastrectomy(LSG) in patients aged more than 55 years.We performed2 a retrospective review of a prospectively collected database.All patients with body mass index(BMI) §32 kg/mand aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis.Demography,peri-operative data,weight loss and surgical complications were all recorded and analyzed.Mean age and BMI of these 68 patients22(22 males and 46 female) were 58.8 years(55-79 years) and 39.5 kg/m(32.00-60.40 kg/m).LRYGB was performed in 44 patients and LSG in 24 patients.The two groups were comparable in their preoperative BMI,American Society of Anaesthesia(ASA) score and gender distribution.LSG patients were significantly older than patients receiving LRYGB.The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients(88.63% vs.50%; P,0.01).The prevalence of other co-morbidities was similar and comparable2 between the groups.Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/mand228.2 kg/m,respectively,and there was no statistically significant difference in mean percentage of excess weight loss(%EWL) at 1 year.The percentage of resolution of diabetes was significantly higher in LRYGB(69.2%) as compared to LSG(33.3%).On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver hepatitis.The overall morbidity and re-operation rate was higher in LRYGB patients.In morbidly elderly patients,both surgeries achieved good weight loss and resolution of comorbidities.LRYGB is superior to LSG in terms of diabetes remission but carries higher complication rates even at high volume centres.
文摘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 worldwide.However,it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure.AIM To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients.METHODS We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution.Review manager 5.3 was used for data analysis,and the overall effect summary was represented in a forest plot.RESULTS From 1,650 titles retrieved by an initial search,we selected nine studies for this research.We 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 LSG.This study reports a T2DM remission rate of 82.3%by LRYGB and 80.7%by LSG.CONCLUSION This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up.However,long-term follow-up of 10 years is needed to further substantiate these findings.
文摘AIM 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.METHODS Forty 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., T2 DM, hypertension(HTN), obstructive sleep apnea syndrome(OSAS), hypothyroidism and gastroesophageal reflux disease(GERD).RESULTS Percentage 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 T2 DM 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 T2 DM, 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.CONCLUSION LRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2 DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.
文摘BACKGROUND It has been established that bariatric surgery,including laparoscopic sleeve gastrectomy(LSG),has a positive impact on type 2 diabetes mellitus(T2DM).However,less frequently T2DM is reported as a risk factor for complications with this type of surgery.AIM To evaluate the safety of LSG in T2DM.METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015.Data was collected through digitized records.Any deviation from normal postoperative care within the first 60 d was defined as an early complication,and further categorized into mild or severe.RESULTS Nine hundred eighty-four patients underwent LSG,among these 143(14.5%)were diagnosed with T2DM.There were 19 complications in the T2DM group(13.3%)compared to 59 cases in the non-T2DM(7.0%).Out of 19 complications in the T2DM group,12 were mild(8.4%)and 7 were severe(4.9%).Compared to the non-T2DM group,patients had a higher risk for mild complications(Odds-ratio 2.316,CI:1.163-4.611,P=0.017),but not for severe ones(P=0.615).An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications(P=0.013,CI:1.074-1.843)but not for mild ones.CONCLUSION Our data suggest that LSG is relatively safe for patients with T2DM.Whether preoperative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Postoperative nausea and vomiting (PONV) are prevalent symptoms after laparoscopic surgeries with an incidence rate of (54</span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">79%) in bariatric procedures. Despite its popularity, limited studies assessed the effect of antiemetics for PONV prophylaxis after laparoscopic sleeve gastrectomy (LSG). The aim of this trail is to compare the effectiveness of a single pre-induction intravenous dose of Palonosetron versus Ondansetron for prophylaxis of PONV, 24 hours after LSG</span><span style="font-family:Verdana;">. </span><b><span style="font-family:Verdana;">Subjects and Methods:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This prospective randomized controlled double-blind parallel-group study was</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">conducted from May till December 2019. Recruited patients were consented and randomized using a closed envelop method into two groups with fifty patients each.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The total number of nausea and vomiting attacks in the 24 hours postoperatively was considered as a primary end point. The secondary end points were the frequency of nausea, retching and vomiting attacks in the 24 hours post-surgery.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">The severity of nausea was evaluated using a 10 cm visual analogue scale (VAS).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">This RCT included 100 patients divided into 2 groups of 50 patients each. Patients received either 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron (Group I) or Ondansetron 4 mg (group II).</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Group I had statistically significant fewer episodes of nausea, retching and vomiting in the first 4 hours (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.022)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">and from 4 to 12</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hours</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.024)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">but not after 12 hours post</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">LSG. Total episodes of nausea, retching and vomiting in 24 hours postoperative were significantly less in group I</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.021).</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">A single dose of intravenous 75</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mcg Palonosetron is superior to Ondansetron 4 mg in preventing PONV for patients after LSG.</span>
文摘<strong>Background:</strong> 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. <strong>Objectives:</strong> This study aimed to assess the diagnostic accuracy of left pleural effusion as an indicator of gastric leaks after laparoscopic sleeve gastrectomy. <strong>Setting:</strong> University hospital and bariatric surgery center of excellence. <strong>Methods:</strong> 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. <strong>Results:</strong> 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/m<sup>2</sup>) 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/m<sup>2</sup>). 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%. <strong>Conclusion:</strong> Left pleural effusion exhibits good diagnostic accuracy for gastric leaks after laparoscopic sleeve gastrectomy. Notably, the specificity (91.2%) was very high.
文摘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 surgery.At 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 surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS 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 analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS 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 significant.Operative position should be carefully considered for obese patients before surgery.
基金The study was pre-registered with the Prospective Register of Systematic Reviews,PROSPERO identification code:CRD42018090367.
文摘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 unclear.The aim of this systemic review was to compare the efficacy of laparoscopic sleeve gastrectomy(LSG)and Roux-en-Y gastric bypass(RYGB)in resolving OSA.Methods:A comprehensive search of MEDLINE,Pubmed,Embase,and OVID was performed.Studies that reported OSA resolution in obese patients with BMI>30 kg/m2 were included in the study.RCTs,comparative prospective and matched cohort studies comparing RYGB with LSG were considered for this study.Results:Five studies(309 participants)were included:4 cohort studies and 1 RCT;all with low risk of bias.At 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 RYGB.In 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 post-LSG.These findings suggest the possibility of weight loss independent factors causing OSA resolution,which should be further investigated.Registration:PROSPERO:CRD42018090367.
文摘BACKGROUND Laparoscopic sleeve gastrectomy(LSG)is the most common bariatric surgical procedure.LSG is a restrictive procedure and in this operation stomach volume is greatly reduced.When the details of the procedure are examined,it is seen that there are many different methods surgery.AIM To analyze approaches of surgeons performing LSG.METHODS A questionnaire consist of 44 questions was sent by e-mail to the surgeons performing bariatric surgery.Approaches of surgery about preoperative period,surgical techniques and postoperative period was questioned.RESULTS 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 detected.It was observed that a few partipicipants applied contrary to the guidelines of antibiotic prophlaxis and thromboembolism prophylaxis.Approaches about other subjects were generally similar.CONCLUSION In this study,approaches about LSG that most common bariatric surgical procedure in our country was learned.According 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.
文摘Bariatric surgeries have been demonstrated to be safe and effective treatment options for morbid obesity patients, but operative risks and high health care costs limit their clinical application. Endoscopic bariatric therapies are emerging as valuable alternatives for patients with doubts about bariatric surgery or ineligible for it. Endoscopic sleeve gastroplasty(ESG), a relatively novel technique of endoscopic bariatric therapies, has gained standing in the past few years. The safety, feasibility, repeatability, and potential for reversibility of ESG have been proven by multicenter studies. Compared to other weight loss strategies, current evidence demonstrates that ESG offers satisfactory efficacy in weight loss. Even though it is inferior to laparoscopic sleeve gastrectomy, it has lower risks of adverse events than surgical interventions and intragastric balloon within oneyear follow-up. Furthermore, ESG may be the ideal weight control strategy for patients who have poor adherence to behavioral interventions. Even so, trends in decreased weight loss effect over time, post-procedure weight regain, postprocedure gut hormone alteration, and possible effects of race and ethnicity on ESG still remain undetermined due to very limited reports and very short followups. Further clinical trials are required to validate and answer these questions.