| 1. |
- Jacobsen, Hedin, et al.
(författare)
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Tensile Strength After Closure of Mesenteric Gaps in Laparoscopic Gastric Bypass: Three Techniques Tested in a Porcine Model.
- 2013
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Ingår i: Obesity surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 23:3, s. 320-324
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Internal hernias occur frequently after laparoscopic gastric bypass. We have found no data on the relative strength of the various techniques available for closing these defects. The present study was performed to obtain such data to form a theoretical basis for clinical studies. METHODS: Six piglets were operated laparoscopically and four loops of small bowel created in each. These mesenteric gaps were closed over a distance of 40mm using (1) running 2-0 Ethibond® suture, (2) Endo Hernia stapler, (3) fibrin glue (Tisseel®) and (4) controls, where the mesenteric surfaces were rubbed with a sponge and approximated without further intervention. After 6weeks, the different segments of the mesentery were excised. The tensile strength was measured using continuously increased traction until the closure ruptured. The ordinary mesentery served as the control. The breaking tension and total amount of energy transferred to the tissue were registered. RESULTS: Control areas with rubbed areas developed no adhesions. Suture and staple lines contracted by 30% in length, whereas the fibrin glued lines were even shorter. Median tensile strength was greatest for the sutured lines (14,293mN) and stapled lines (10,798mN). Fibrin glued lines were significantly weaker (6,780mN, p=0.013 and p=0.026), but as strong as ordinary mesentery (4,165mN). CONCLUSIONS: If ongoing controlled randomized trials show closure to be beneficial, further studies should include staples as one of the options for the closure of mesenteric defects. The role of fibrin glue needs to be further investigated.
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| 2. |
- Andersson, Roland, et al.
(författare)
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Akut gastroenterologi i fokus
- 2002
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Ingår i: Svensk kirurgi. - 0346-847X. ; 60, s. 336-336
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Arvidsson, A, et al.
(författare)
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Water with Food Intake Does Not Influence Caloric Intake After Gastric Bypass (GBP): a Cross-Over Trial.
- 2015
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 25:2, s. 249-253
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Tidskriftsartikel (refereegranskat)abstract
- Bariatric patients seeking information meet very different recommendations on postoperative diet and eating behaviour. A reason for variability may be lack of hard evidence. A national survey on current dietary advice was conducted to serve as background for the present study on how drinking during a meal influenced caloric consumption.
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| 4. |
- Berggren, Johan, et al.
(författare)
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GASTRIC BYPASS SURGERY HAS GREATER EFFECT THAN CALORIE RESTRICTION ON INCRETIN RELEASE AND INSULIN SECRETION ALREADY ON POSTOP. DAY 1
- 2015
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Ingår i: Obesity Surgery. - 1708-0428. ; 25:Suppl 1, s. 85-85
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Gastric bypass surgery (GBP) provokes rapid improvement of type 2 diabetes (T2D) prior to significant weight loss. Thishas been attributed to altered secretion of the two incretin hormones glucagon-like peptide 1 (GLP-1) and glucose-dependentinsulinotropic polypeptide (GIP). Here we studied the effects of very low calorie diet (VLCD) vs. the immediate effects of GBP onglycaemia and incretin release.Methods: Eight T2D obese women and 8 obese controls (C) underwent mixed meal tests (MMT) 4 w before (MMT-4w), 1 day before(MMT-1d), 1 day after (MMT+1d) and six weeks after (MMT+6w) gastric bypass. MMT-4w was performed before VLCD and MMT+1dconstituted the first postoperative meal. Glucose, insulin and incretins were analyzed. Gastric bypass surgery was standardized to a 50cm biliary limb and 150 cm alimentary limb and a 5 cm gastric pouch.OBES SURG (2015) 25 (Suppl 1):S1–S364 S85Results: Despite similar glucose levels, the insulin response was markedly increased at MMT+1d, compared to MMT-4w and MMT-1d(2.4- and 2.8-fold). At MMT+6w a more rapid rise was evident. GLP-1 levels were similar in all MMTs except MMT+6w where anincreased response was seen; this was stronger in T2D vs. C. The GIP-response was higher at MMT+1d, compared to MMT-4w andMMT-1d (1.6- and 1.4-fold). The increased GIP-response was attenuated in C at MMT+6w, but still evident in T2D.Conclusions: VLCD has minor impact on the parameters analyzed; rather GBP per se elicits an immediate stimulatory effect on insulinand GIP levels in response to an MMT as first meal on day 1 after surgery.
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| 5. |
- BERGGREN, JOHAN, et al.
(författare)
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Roux-en-Y gastric bypass versus calorie restriction: support for surgery as the direct contributor to aloncltered responses of insulin and incretins to a mixed meal
- 2017
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 13:2, s. 234-242
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Tidskriftsartikel (refereegranskat)abstract
- AbstractObjectiveTo study the immediate effects of Roux-en-Y gastric bypass (RYGB) on glucose homeostasis, insulin, and incretin responses to mixed-meal tests compared with the effects of calorie restriction (CR).SettingUniversity-affiliated bariatric surgery clinic.BackgroundRYGB induces remission of type 2 diabetes (T2 D) long before significant weight loss occurs. The time course and underlying mechanisms of this remission remain enigmatic. A prevailing theory is that secretory patterns of incretin hormones are altered due to rearrangement of the gastrointestinal tract. To what extent reduced calorie intake contributes to the remission of T2 D is unknown.MethodsNine normoglycemic patients and 10 T2 D patients were subjected to mixed-meal tests (MMT) 4 weeks before surgery before initiation of a very low calorie diet regimen (MMT-4 w), 1 day before surgery on a very low calorie diet regimen (MMT-1 d), on the morning of the first day after surgery (MMT+1 d; first postsurgical meal), and 6 weeks after surgery (MMT+6 w). Insulin, glucose, active glucagon-like peptide 1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) were measured.ResultsCR lowered insulin in T2 D patients, whereas glucose, GIP, and GLP-1 were unaffected. RYGB immediately increased plasma insulin and GIP. The GLP-1 response was delayed compared with the GIP response. T2 D patients exhibited lower insulin responses after RYGB compared with normoglycemic patients. GIP responses were similar in both groups at all occasions, whereas T2 D patients displayed markedly elevated GLP-1 responses 6 weeks after RYGB. Glucose was unaffected by CR and RYGB in both groups. Insulin sensitivity was unaffected by CR but improved with RYGB.ConclusionRYGB exerts powerful and immediate effects on insulin and incretin responses to food, independently of changes caused by CR.
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| 6. |
- Borisenko, Oleg, et al.
(författare)
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Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model
- 2015
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 25:9, s. 1559-1568
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Tidskriftsartikel (refereegranskat)abstract
- The objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective. A decision analytic model using the Markov process was developed covering cardiovascular diseases, type 2 diabetes, and surgical complications. Clinical effectiveness and safety were based on the literature and data from the Scandinavian Obesity Surgery Registry. Gastric bypass, sleeve gastrectomy, and gastric banding were included in the analysis. Cost data were obtained from Swedish sources. Bariatric surgery was cost saving in comparison with conservative management. It also led to a substantial reduction in lifetime risk of events: from a 16 % reduction in the risk of transient ischaemic attacks to a 62 % reduction in the incidence of type 2 diabetes. Over a lifetime, surgery led to savings of a,not sign8408 and generated an additional 0.8 years of life and 4.1 quality-adjusted life years (QALYs) per patient, which translates into gains of 32,390 quality-adjusted person-years and savings of a,not sign66 million for the cohort, operated in 2012. Analysis of the consequences of a 3-year delay in surgery provision showed that the overall lifetime cost of treatment may be increased in patients with diabetes or a body mass index > 40 kg/m(2). Delays in surgery may also lead to a loss of clinical benefits: up to 0.6 life years and 1.2 QALYs per patient over a lifetime. Bariatric surgery, over a lifetime horizon, may lead to significant cost savings to health care systems in addition to the known clinical benefits.
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| 7. |
- Borisenko, Oleg, et al.
(författare)
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Clinical Indications, Utilization, and Funding of Bariatric Surgery in Europe
- 2015
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 25:8, s. 1408-1416
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to evaluate the current utilization, the level of endorsement by professional societies, and health technology assessment bodies, as well as the reimbursement levels for bariatric surgery in European countries. We performed an analysis of the indications for bariatric surgery based on national clinical and commissioning guidelines, current utilization of surgery, characteristics of patients who underwent surgery, and reimbursement tariffs in Belgium, Denmark, England, France, Germany, Italy, and Sweden. Data were obtained from national patient registries, administrative databases, and published literature for the year 2012. Despite clear consensus outlined in clinical guidelines, significant differences were found in the eligibility criteria for surgery. Patients with no significant comorbidities were deemed eligible if they had a body mass index (BMI) of 40 or 50 kg/m(2) in Denmark. Irrespective of the country, patients with comorbidities were eligible if they had a BMI of 35 kg/m(2). The highest utilization of bariatric surgery (number of surgeries per 1 M population) was observed in Belgium (928), Sweden (761), and France (571) while Italy (128), England (117), and Germany (72) had the lowest utilization. There was a strong negative correlation between utilization and average BMI level of the patient population (r = -.909, p = 0.005). The annual per capita spending on surgery differed significantly between countries, ranging from a,not sign0.54 in Germany to a,not sign4.33 in Belgium. There are significant variations in the clinical indications, utilization, and funding of bariatric surgery in European countries.
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| 8. |
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| 9. |
- Caesar, Y, et al.
(författare)
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Intraabdominal Pressure and Postoperative Discomfort in Laparoscopic Roux-en-Y Gastric Bypass (RYGB) Surgery: a Randomized Study.
- 2016
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923.
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Tidskriftsartikel (refereegranskat)abstract
- High intraabdominal pressure (IAP) during laparoscopic surgery has been associated with postoperative discomfort. Effects on nausea and access have not been subjected to randomized studies. In cholecystectomy, lower IAP may cause less pain, but nausea and surgical access in RYGB surgery have not been investigated. We studied the influence of two IAP levels on surgical access, operation time, postoperative pain, and nausea.
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| 10. |
- Carlsson, Martin, et al.
(författare)
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The T 54 allele of the intestinal fatty acid-binding protein 2 is associated with a parental history of stroke
- 2000
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - 1945-7197. ; 85:8, s. 2801-2804
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Tidskriftsartikel (refereegranskat)abstract
- To test the hypothesis that the A/T polymorphism of the fatty acid-binding protein 2 gene (FABP2) is associated with impaired lipid metabolism and cardiovascular disease, we compared clinical characteristics and a parental history of cardiovascular disease between 213 sibling pairs discordant for the polymorphism. Siblings with an excess of the T54 allele had higher triglyceride (P = 0.002) and cholesterol (P = 0.019) concentrations than siblings with the A54 allele. Parents of offspring with the T54T and T54A genotypes reported an increased prevalence of stroke compared to parents of offspring with the A54A genotype (P = 0.007). In summary, we have confirmed the association of the FABP2 T54 allele with increased concentrations of cholesterol and triglycerides in genotype-discordant sibling pairs. We also present novel evidence that genetic variation in the FABP2 gene may increase susceptibility to stroke.
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