فهرست مطالب
Annals of Bariatric Surgery
Volume:8 Issue: 2, Summer and Autumn 2019
- تاریخ انتشار: 1399/10/16
- تعداد عناوین: 8
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Pages 1-4Background
One of the therapeutic interventions after the onset of anastomotic leak is antibiotic administration, however, there is no clear evidence about the role of continued antibiotic administration after bariatric surgery in preventing wound infections and leak from the anastomosis, therefore, the purpose of this study was to examine this hypothesis.
Methods90 laparoscopic one anastomosis gastric bypass (OAGB) candidates were allocated into two equal groups. Both groups were matched regarding their age, sex, and preoperative body mass index (BMI). Group one received 1500 milligrams (mg) intravenous cefazolin and 750 mg metronidazole just before the surgery. The second group received the same cocktail before the surgery and continued for 48 hours after the surgery as follows: 1500 mg intravenous cefazolin every 6 hours and 750 mg metronidazole every 8 hours. Patients were followed for 30 days for detecting any early surgical wound infection and anastomose leakage. T-test, Chi-square, and ANCOVA model were used for statistical analysis.
ResultsWound infection was observed in 4.44% and 2.22% of the first and second groups, respectively (p=0.315). One leak was occurred in the second group (p=0.981). After the adjustment was made for confounding variables (age, sex, preoperative BMI, duration of the surgery, and length of hospital stay), anastomosis leak and wound infection rates were not significantly different between groups (0.64 and 0.49, respectively).
ConclusionIt seems that antibiotic therapy after the OAGB does not play a significant role in preventing leak or wound infection, and the surgical method is more important than antibiotic therapy.
Keywords: one anastomosis gastric bypass, bariatric, wound infection, anastomosis leak, antibiotic -
Pages 5-8Background and aims
Obesity is one of the challenging public health issues which can increase the risk of different morbidities like respiratory disorders. Some studies suggested that significant weight loss may be associated with the improvement of pulmonary function in morbid obese patients. Bariatric surgeries are the most effective was for significant weight loss in morbid obese patient. The aim of this study was to determine the effects of bariatric surgery on the pulmonary function in the morbid obese patients.
Materials and methodsThis prospective, before-after study was conducted on morbid obese patients who underwent bariatric surgery in Loghman Hakim hospital during 2019. All morbid obese patient (BMI ≥ 40) who presented to the hospital in the study period were included in the study by convenience sampling. Patient’s demographics and results of spirometry test variables were recorded in a questionnaire before the surgery and three months after the surgery. SPSS software version 25 was used for data analysis.
ResultsThirty-eight patients were entered in the final analysis. The mean age of patients was 39.2 ± 11.6 (range:15-65). Fifteen patients in this study were male (39.5%). There were significant relations in the values of BMI, FEV1, FEV1/FVC before and after the surgery. In addition, there were significant negative correlation between FEV1 and BMI. Furthermore, functional dyspnea and obstructive sleep apnea were seen in 50% and 21% of patients which completely improved after the study.
ConclusionBariatric surgery has significant effects on the improvement of pulmonary function in morbid obese patients.
Keywords: Bariatric Surgery, Obesity, Pulmonary Function Test, Spirometry -
Pages 9-13Background
According to the IFSO worldwide survey report in 2014, 579517 bariatric operations have been performed in a year, of which nearly half the procedures were SG followed by RYGB. This procedure is a proven successful treatment of patients with morbid obesity which induces considerable weight loss and improvement of type 2 diabetes mellitus, insulin resistance, inflammation, and vascular function. In the present study, we aimed to build a machine based on a decision tree to mimics the surgeonchr(chr(chr('39')39chr('39'))39chr(chr('39')39chr('39')))s pathway to select the type of bariatric surgery for patients.
Material and methodsWe used patient’s data from the National Bariatric Surgery registry between March 2009 and October 2020. A decision tree was constructed to predict the type of surgery. The validation of the decision tree confirmed using 4-folds cross-validation.
ResultsWe rich a decision tree with a depth of 5 that is able to classify 77% of patients into correct surgery groups. In addition, using this model we are able to predict 99% of bypass cases (Sensitivity) correctly. The waist circumference less than 126 cm and BMI equal to or more than 43 kg/m2, age equal to or greater than 30 years old, and being hypertensive or diabetes are the most important separators.
DiscussionThe effects of all nodes have been studied before and the references confirmed the relations of them and surgery type.
Keywords: Bariatric surgery, Machine learning, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Mini-gastric Bypass, One-Anastomosis Gastric Bypass -
Pages 14-16
A number of candidates of bariatric surgery may have a concomitant ventral hernia. Simultaneous repair of ventral hernia with bariatric surgery remains a subject of controversy in surgical practice. We present a morbid obese patient who underwent single anastomosis sleeve ileal (SASI) bypass while having a ventral hernia. The procedure for the repair of hernia was postponed until after the bariatric surgery was done. The untreated ventral hernia caused bowel incarceration and anastomosis leakage during the postoperative days. So it seems that patients with small size ventral hernia with no intestinal or omental adhesions may benefit from hernia repair at the same time with bariatric surgery, however, in patients with large or complex ventral hernia and severe bowel and omental adhesions, it is advisable not to release adhesions and that the hernia repair be carried out after the patientchr(chr(chr('39')39chr('39'))39chr(chr('39')39chr('39')))s weight loss is achieved, to prevent iatrogenic bowel injury and minimize the risk of hernia recurrence and incarceration.
Keywords: SASI bypass- ventral hernia- weight loss -
Pages 17-20Introduction
Bariatric surgery causes anatomical changes in the digestive system that can alter the distribution of gut microbes. We aim to evaluate the changes of Firmicutes after the laparoscopic one anastomosis gastric bypass/mini gastric bypass (OAGB/ MGB) surgery.
Methods50 patients with morbid obesity were operated on with OAGB/ MGB. Demographic data and Firmicutes counts in stool samples were obtained before, 6, and 12 months after the surgery. The logarithm of Firmicutes colony count based on 10 was used for analysis. Paired T-test, ANCOVA model, and Pearson correlation tests were used for statistical analysis.
Results70.6% of our patients were female. The percentage of Excess weight loss (%EWL) and excess BMI loss (%EBMIL) were 44.06%±9.84 and 42.56%±5.29 respectively at the 6-month follow-up and 67.55%±5.56 and 70.81%±7.25 respectively at the 12-month follow-up. The Firmicutes count was dropped from 1.57 to 1.44 at 6-month (p=0.01) and 1.32 at 12-month (p=0.02) follow-up. ANCOVA model after adjustment for age, sex, preoperative BMI, and delta-BMI did not show a significant difference for either the 6 or 12 months data (p=0.74 and 0.59, respectively). Pearson correlation test did not found any relationship between Firmicutes count change any weight-related variables.
ConclusionThe Firmicutes count was significantly decreased after OAGB/MGB. However, no significant relationship was found between weight loss and Firmicutes count.
Keywords: Gastric Bypass, Firmicutes, Bacteroidetes, Obesity, Microbiota, Bariatric surgery -
Pages 21-25Background/ Aim
One anastomosis gastric bypass (OAGB) is considered as a surgical treatment option for patients with morbid obesity. However, significant decreases in dietary intake and nutrient malabsorption after OAGB may potentially lead to nutritional deficiencies. This study was therefore conducted to assess and compare the mean values of dietary intake over 12 months following OAGB in patients with different pre-operative body mass index (BMI).
MethodsThe study was performed on 60 patients with morbid obesity (88.3% female) who underwent OAGB between January 2011 and November 2018. The average daily nutrient intake values were obtained from food frequency questionnaires. Other data were drawn from the National Obesity Surgery Database.
ResultsThe mean (SD) pre-operative age, weight and BMI were 41.08 (9.41) years, 121.43 (21.01) kg, and 46.77 (6.17) kg/ m2, respectively. Participants were divided into two groups based on their pre-operative BMI (1: BMI≤ 45 kg/m2, n=29; and 2: BMI> 45 kg/m2, n= 31). The mean %EWL at one year postoperatively was 52.37±8.63 and 50.82±8.75 in groups 1 and 2, respectively. However, there was no significant difference in %EWL between groups (P=0.49). Additionally, the percentage of energy consumption from carbohydrates, protein and fats after surgery was 55.49±6.19%, 16.18±2.60% and 32.05±5.97%, respectively. No significant difference was observed in average daily energy and macronutrient intakes between groups (P>0.05 for all).
ConclusionPre-operative BMI values probably had no significant effect on post-operative %EWL, nor on energy and macronutrient intake. Large-scale studies are needed to confirm these findings.
Keywords: Gastric bypass, bariatric surgery, nutritional status, weight loss -
Pages 26-29Background and aim
Vitamin D3 deficiency is associated with insulin resistance and metabolic syndrome. Although, the evidence was not conclusive. The aim of this study is to investigate the relationship between serum 25-hydroxy vitamin D3 (25(OH) D3) levels with some adiposity and metabolic indices related to metabolic syndrome.
MethodsIn this cross-sectional study, the anthropometric, body composition information, the clinical laboratory tests including fasting blood sugar (FBS), insulin, lipid profile, liver enzymes, and serum 25(OH) D3 of 3750 patients with morbid obesity are extracted from Iran National Obesity Surgery Database. HOMA-IR and QUICKI were computed based on the standard formula. Associations were tested using analysis of variance and Kruskal–Wallis test.
ResultsApproximately 69% of patients with morbid obesity had sub-optimal vitamin D3 levels (<20 ng/mL). An inverse significant relationship between serum 25(OH) D3 and body weight, body fat percentage, waist, and hip circumstance was observed (p<0.05 for all). Low serum 25(OH) D3 levels are significantly associated with higher FBS and A1C, dyslipidemia (higher LDL and TG), and also the elevated level of liver function enzymes (p<0.05 for all). Moreover, the patient with the higher serum 25(OH) D3 had a lower level of HOMA-IR and higher insulin sensitivity (QUICKI index); this association was not statistically significant, though.
ConclusionVitamin D3 deficiency has been associated with adiposity, impaired glucose metabolism, and metabolic disorders related to insulin resistance. Thus, vitamin D3 supplementation could be a potential approach in treatment or decrease of the metabolic complication of obesity before and after bariatric surgery.
Keywords: Vitamin D3, Morbid Obesity, Adiposity, Metabolic syndrome, Bariatric surgery -
Pages 30-33Introduction
Nowadays, bariatric surgery benefits from various surgical techniques. These surgical methods offer different advantages. This study compared laparoscopic gastric banding (LGB) with laparoscopic gastric plication (LGP) to determine their efficacy and complications.
MethodsThis comparison study was conducted in a university-affiliated hospital in Tehran, Iran. During 2018, patients who underwent LGB or LGP based on a shared decision making policy. Follow-up was performed at 3, 6, and 12 months after the surgery. The surgerychr(chr('39')39chr('39'))s efficacy was evaluated by monitoring changes in body mass index (BMI) and Excess weight loss percent (EWL%). Also, Surgical complications were recorded.
ResultsSeventy patients were enrolled in this study (35 patients underwent LGP, and 35 patients had LGB). Seventeen of which (24.3%) were male, and 53 (75.7%) were female. The mean ± SD age of the participants was 34.53 ± 10.03 years. Both groups had a significant BMI loss (mean ± SD of BMI change equals 12.46± 3.8 in LGP and 11.09 ± 5.5 in LGB) and EWL% rise (59.34± 12.35 in LGP and 58.2± 17.88 in LGB). Although the difference between the two procedures was not statistically significant, complications were more frequent in LGB patients. It is also noteworthy that major complications were only seen in the LGB group.
ConclusionsThe results showed that LGP and LGB were comparable in terms of the amount of weight loss. However, the absence of major surgical complications was an advantage to LGP.
Keywords: Obesity, gastric plication, gastric binding, Assessments, Patient outcome, Comparison Studies