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Sökning: WFRF:(Marsk Richard)

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1.
  • Sundbom, Magnus, et al. (författare)
  • Substantial Decrease in Comorbidity 5 Years After Gastric Bypass: A Population-based Study From the Scandinavian Obesity Surgery Registry.
  • 2017
  • Ingår i: Annals of Surgery. - 0003-4932 .- 1528-1140. ; 265:6
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE:: To evaluate effect on comorbid disease and weight loss 5 years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort. BACKGROUND:: The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few. METHODS:: Data on 26,119 individuals [75.8% women, 41.0 years, and body mass index (BMI) 42.8?kg/m] undergoing primary RYGB between May 1, 2007 and June 30, 2012, were collected from 2 Swedish quality registries: Scandinavian Obesity Surgery Registry and the Prescribed Drug Registry. Weight, remission of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and sleep apnea, and changes in corresponding laboratory data were studied. Five-year follow-up was 100% (9774 eligible individuals) for comorbid diseases. RESULTS:: BMI decreased from 42.8?±?5.5 to 31.2?±?5.5?kg/m at 5 years, corresponding to 27.7% reduction in total body weight. Prevalence of type 2 diabetes mellitus (15.5%–5.9%), hypertension (29.7%–19.5%), dyslipidemia (14.0%–6.8%), and sleep apnea (9.6%–2.6%) was reduced. Greater weight loss was a positive prognostic factor, whereas increasing age or BMI at baseline was a negative prognostic factor for remission. The use of antidepressants increased (24.1%–27.5%). Laboratory status was improved, for example, fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4?mmol/mol and 41.8% to 37.7%, respectively. CONCLUSIONS:: In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a 5-year period. The increased use of antidepressants warrants further investigation.
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3.
  • Backman, Olof, et al. (författare)
  • Gastric Bypass Surgery Reduces De Novo Cases of Type 2 Diabetes to Population Levels : A Nationwide Cohort Study From Sweden
  • 2019
  • Ingår i: Annals of Surgery. - Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 269:5, s. 895-902
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>OBJECTIVE:</strong> The aim of this study was to determine long-term changes in pharmacological treatment of type 2 diabetes after primary Roux-en-Y gastric bypass (RYGB) surgery, in patients with and without pharmacological treatment of diabetes preoperatively.</p><p><strong>SUMMARY OF BACKGROUND DATA:</strong> Several studies have shown that gastric bypass has good effect on diabetes, at least in the short-term. This study is a nationwide cohort study using Swedish registers, with basically no patients lost to follow-up during up to 7 years after surgery.</p><p><strong>METHODS:</strong> The effect of RYGB on type 2 diabetes drug treatment was evaluated in this nationwide matched cohort study. Participants were 22,047 adults with BMI ≥30 identified in the nationwide Scandinavian Surgical Obesity Registry, who underwent primary RYGB between 2007 and 2012. For each individual, up to 10 general population comparators were matched on birth year, sex, and place of residence. Prescription data were retrieved from the nationwide Swedish Prescribed Drug Register through September 2015. Incident use of pharmacological treatment was analyzed using Cox regression.</p><p><strong>RESULTS:</strong> Sixty-seven percent of patients with pharmacological treatment of type 2 diabetes before surgery were not using diabetes drugs 2 years after surgery and 61% of patients were not pharmacologically treated up to 7 years after surgery. In patients not using diabetes drugs at baseline, there were 189 new cases of pharmacological treatment of type 2 diabetes in the surgery group and 2319 in the matched general population comparators during a median follow-up of 4.6 years (incidence: 21.4 vs 27.9 per 10,000 person-years; adjusted hazard ratio 0.77, 95% confidence interval 0.67-0.89; P &lt; 0.001).</p><p><strong>CONCLUSIONS:</strong> Gastric bypass surgery not only induces remission of pharmacological treatment of type 2 diabetes but also protects from new onset of pharmacological diabetes treatment. The effect seems to persist in most, but not all, patients over 7 years of follow-up.</p>
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4.
  • Backman, Olof, et al. (författare)
  • Gastric Bypass Surgery Reduces De Novo Cases of Type 2 Diabetes to Population Levels A Nationwide Cohort Study From Sweden
  • 2019
  • Ingår i: Annals of Surgery. - Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 269:5, s. 895-902
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Objective: The aim of this study was to determine long-term changes in pharmacological treatment of type 2 diabetes after primary Roux-en-Y gastric bypass (RYGB) surgery, in patients with and without pharmacological treatment of diabetes preoperatively.</p><p>Summary of Background Data: Several studies have shown that gastric bypass has good effect on diabetes, at least in the short-term. This study is a nationwide cohort study using Swedish registers, with basically no patients lost to follow-up during up to 7 years after surgery.</p><p>Methods: The effect of RYGB on type 2 diabetes drug treatment was evaluated in this nationwide matched cohort study. Participants were 22,047 adults with BMI ≥30 identified in the nationwide Scandinavian Surgical Obesity Registry, who underwent primary RYGB between 2007 and 2012. For each individual, up to 10 general population comparators were matched on birth year, sex, and place of residence. Prescription data were retrieved from the nationwide Swedish Prescribed Drug Register through September 2015. Incident use of pharmacological treatment was analyzed using Cox regression.</p><p>Results: Sixty-seven percent of patients with pharmacological treatment of type 2 diabetes before surgery were not using diabetes drugs 2 years after surgery and 61% of patients were not pharmacologically treated up to 7 years after surgery. In patients not using diabetes drugs at baseline, there were 189 new cases of pharmacological treatment of type 2 diabetes in the surgery group and 2319 in the matched general population comparators during a median follow-up of 4.6 years (incidence: 21.4 vs 27.9 per 10,000 person-years; adjusted hazard ratio 0.77, 95% confidence interval 0.67–0.89; <em>P</em> &lt; 0.001).</p><p>Conclusions: Gastric bypass surgery not only induces remission of pharmacological treatment of type 2 diabetesbut also protects from new onset of pharmacological diabetes treatment. The effect seems to persist in most, but not all, patients over 7 years of follow-up.</p>
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5.
  • Backman, Olof, et al. (författare)
  • Laparoscopic Roux-en-Y Gastric Bypass Without Division of the Mesentery Reduces the Risk of Postoperative Complications
  • 2019
  • Ingår i: Surgical Endoscopy. - Springer. - 0930-2794 .- 1432-2218. ; 33:9, s. 2858-2863
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Anastomotic complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) including leaks, ulceration, and stenosis remain a significant cause of post-operative morbidity and mortality. Our objective was to compare two different surgical techniques regarding short-term anastomotic complications.</p><p>Methods: A retrospective analysis of all patients operated with a primary LRYGB from 2006 to June 2015 in one institution, where prospectively collected data from an internal quality registry and medical journals were analyzed.</p><p>Results: In total, 2420 patients were included in the analysis. 1016 were operated with a technique where the mesentery was divided during the creation of the Roux-limb (DM-LRYGB) and 1404 were operated with a method where the mesentery was left intact (IM-LRYGB). Leakage in the first 30 days [2.6% vs. 1.1% (p &lt; 0.05)], and ulceration or stenosis occurring during the first 6 months after surgery [5.6% vs. 0.1% (p &lt; 0.05)] was significantly higher in the DM-LRYGB group. Adjusted odds ratio for anastomotic leak was 0.46 (95% CI 0.24-0.87) and for stenosis/ulceration 0.01 (95% CI 0.002-0.09).</p><p>Conclusion: IM-LRYGB seems to reduce the risk of complications at the anastomosis. A plausible explanation for this is that the blood supply to the anastomosis is compromised when the mesentery is divided.</p>
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6.
  • Marsk, Richard (författare)
  • Morbidity and mortality after bariatric surgery in Sweden
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Overweight and obesity has increased in Sweden and in the rest of the world during the last decades, probably due to a more sedentary lifestyle and changes in diets. Body mass index (BMI) is a commonly used index of weight-for-height for classifying adult individuals. BMI is weight in kilograms divided by the square of the height in meters (kg/m²). BMI between 18.5 and 25 is called normal weight. Overweight is defined as a BMI over 25 and obesity as BMI over 30. A BMI over 40 is sometimes referred to as morbid obesity. Obesity is associated with several diseases such as diabetes type 2, hypertension, obstructive sleep apnea and different cancers. Obesity is also associated with an increased risk of preterm mortality. Intentional weight-loss, by any mean, may lead to resolution of the obesity related diseases and to a reduction in mortality risk. Weight-loss can be achieved by modification of life-style factors, diets, pharmacological treatment or surgery. For morbidly obese people surgical treatment is the most effective method to attain sustainable weight reduction. For this reason surgery has become increasingly popular with increasing number of operations being performed annually. The overall objective of the studies comprising this thesis work was to investigate morbidity and mortality after weight-loss (bariatric) surgery. Specific aims were to: 1) Study long-term outcome after laparoscopic Vertical Banded Gastroplasty with regards to weight-loss and long-term postoperative complications; 2) study short- and longterm mortality after bariatric surgery; 3) study if bariatric surgery could lower mortality in an obese group of men compared to an obese group of non-operated men; and, 4) to study morbidity- and mortality rates after the most common bariatric procedure in Sweden today, the gastric bypass. This thesis work is based on data from one quality registry held at Danderyd Hospital and on nationwide data sets created by record linkage between the Swedish inpatient care registry, the registry of the total population and other national registries. This thesis covers the time period 1980 to 2006. During these years there has been an increase in bariatric procedures with the most rapid increase seen during the last 5 years. Throughout the time-period early postoperative mortality in Sweden has been low, comparable to expert centers in the United States. Mortality within the first year after surgery was found to be higher among men raising the question whether any longterm gains in survival advantage attained through the weight-loss surgery would be wiped out by the increased early mortality. However, when comparing mortality between a cohort of surgically treated obese men and a cohort of obese non-operated men a survival advantage was seen in the surgical cohort. During years covered by the datasets used in this thesis work there has been a shift towards more complex procedures. Vertical banded gastroplasty is a restrictive procedure that was popular in the 1990:es and later on reintroduced with a laparoscopic approach. The long-term result regarding weight-loss was modest and rates of surgical reinterventions, either due to complications or insufficient weight-loss was high. With a failed vertical banded gastroplasty conversion to a gastric bypass gave the best results. Gastric bypass is the predominant procedure in Sweden today mostly conducted by a laparoscopic approach. The laparoscopic approach is considered technically more challenging than the open approach, which has raised concerns whether complication rates would be higher after laparoscopic surgery. There was no difference in mortality between the two approaches and no major differences regarding postoperative morbidity. However, much higher complication rates were noted after revisional procedures, when a previous bariatric procedure was converted to a gastric bypass. In summary, bariatric surgery can be performed safely on a national level. Men have a survival advantage after bariatric surgery compared to obese non-operated men yet it remains elevated compared to the general population. High revisional rates were seen after laparoscopic vertical banded gastroplasty. Laparoscopic gastric bypass is as safe as open gastric bypass; however revisional procedures, by any approach, have much higher complication rates. Therefore, it is important to make an evidence-based choice when bariatric surgery is conducted for the first time.
7.
  • Stenberg, Erik, 1979-, et al. (författare)
  • Closure of mesenteric defects in laparoscopic gastric bypass : a multicentre, randomised, parallel, open-label trial
  • 2016
  • Ingår i: The Lancet. - Elsevier. - 0140-6736 .- 1474-547X. ; 387:10026, s. 1397-1404
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Background</strong>: Small bowel obstruction due to internal hernia is a common and potentially serious complication after laparoscopic gastric bypass surgery. Whether closure of surgically created mesenteric defects might reduce the incidence is unknown, so we did a large randomised trial to investigate.</p><p><strong>Method</strong>: This study was a multicentre, randomised trial with a two-arm, parallel design done at 12 centres for bariatric surgery in Sweden. Patients planned for laparoscopic gastric bypass surgery at any of the participating centres were off ered inclusion. During the operation, a concealed envelope was opened and the patient was randomly assigned to either closure of mesenteric defects beneath the jejunojejunostomy and at Petersen's space or non-closure. After surgery, assignment was open label. The main outcomes were reoperation for small bowel obstruction and severe postoperative complications. Outcome data and safety were analysed in the intention-to-treat population. This trial is registered with ClinicalTrials. gov, number NCT01137201.</p><p><strong>Findings</strong>: Between May 1, 2010, and Nov 14, 2011, 2507 patients were recruited to the study and randomly assigned to closure of the mesenteric defects (n= 1259) or non-closure (n= 1248). 2503 (99.8%) patients had follow-up for severe postoperative complications at day 30 and 2482 (99.0%) patients had follow-up for reoperation due to small bowel obstruction at 25 months. At 3 years after surgery, the cumulative incidence of reoperation because of small bowel obstruction was signifi cantly reduced in the closure group (cumulative probability 0.055 for closure vs 0.102 for non-closure, hazard ratio 0.56, 95% CI 0.41-0.76, p= 0.0002). Closure of mesenteric defects increased the risk for severe postoperative complications (54 [4.3%] for closure vs 35 [2.8%] for non-closure, odds ratio 1.55, 95% CI 1.01-2.39, p= 0.044), mainly because of kinking of the jejunojejunostomy.</p><p><strong>Interpretation</strong>: The results of our study support the routine closure of the mesenteric defects in laparoscopic gastric bypass surgery. However, closure of the mesenteric defects might be associated with increased risk of early small bowel obstruction caused by kinking of the jejunojejunostomy.</p>
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8.
  • Sundbom, Magnus, et al. (författare)
  • Substantial Decrease in Comorbidity 5 Years After Gastric Bypass : A Population-based Study From the Scandinavian Obesity Surgery Registry.
  • 2017
  • Ingår i: Annals of Surgery. - 0003-4932 .- 1528-1140. ; 265:6, s. 1166-1171
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>OBJECTIVE:</strong> To evaluate effect on comorbid disease and weight loss 5 years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort.</p><p><strong>BACKGROUND:</strong> The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few.</p><p><strong>METHODS:</strong> Data on 26,119 individuals [75.8% women, 41.0 years, and body mass index (BMI) 42.8 kg/m] undergoing primary RYGB between May 1, 2007 and June 30, 2012, were collected from 2 Swedish quality registries: Scandinavian Obesity Surgery Registry and the Prescribed Drug Registry. Weight, remission of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and sleep apnea, and changes in corresponding laboratory data were studied. Five-year follow-up was 100% (9774 eligible individuals) for comorbid diseases.</p><p><strong>RESULTS:</strong> BMI decreased from 42.8 ± 5.5 to 31.2 ± 5.5 kg/m at 5 years, corresponding to 27.7% reduction in total body weight. Prevalence of type 2 diabetes mellitus (15.5%-5.9%), hypertension (29.7%-19.5%), dyslipidemia (14.0%-6.8%), and sleep apnea (9.6%-2.6%) was reduced. Greater weight loss was a positive prognostic factor, whereas increasing age or BMI at baseline was a negative prognostic factor for remission. The use of antidepressants increased (24.1%-27.5%). Laboratory status was improved, for example, fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4 mmol/mol and 41.8% to 37.7%, respectively.</p><p><strong>CONCLUSIONS:</strong> In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a 5-year period. The increased use of antidepressants warrants further investigation.</p>
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9.
  • Sundbom, Magnus, et al. (författare)
  • Substantial Decrease in Comorbidity 5 Years After Gastric Bypass : A Population-based Study From the Scandinavian Obesity Surgery Registry
  • 2017
  • Ingår i: Annals of Surgery. - Philadelphia PA, USA : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 265:6, s. 1166-1171
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>OBJECTIVE:</strong> To evaluate effect on comorbid disease and weight loss 5 years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort.</p><p><strong>BACKGROUND:</strong> The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few.</p><p><strong>METHODS:</strong> Data on 26,119 individuals [75.8% women, 41.0 years, and body mass index (BMI) 42.8 kg/m] undergoing primary RYGB between May 1, 2007 and June 30, 2012, were collected from 2 Swedish quality registries: Scandinavian Obesity Surgery Registry and the Prescribed Drug Registry. Weight, remission of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and sleep apnea, and changes in corresponding laboratory data were studied. Five-year follow-up was 100% (9774 eligible individuals) for comorbid diseases.</p><p><strong>RESULTS:</strong> BMI decreased from 42.8 ± 5.5 to 31.2 ± 5.5 kg/m at 5 years, corresponding to 27.7% reduction in total body weight. Prevalence of type 2 diabetes mellitus (15.5%-5.9%), hypertension (29.7%-19.5%), dyslipidemia (14.0%-6.8%), and sleep apnea (9.6%-2.6%) was reduced. Greater weight loss was a positive prognostic factor, whereas increasing age or BMI at baseline was a negative prognostic factor for remission. The use of antidepressants increased (24.1%-27.5%). Laboratory status was improved, for example, fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4 mmol/mol and 41.8% to 37.7%, respectively.</p><p><strong>CONCLUSIONS:</strong> In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a 5-year period. The increased use of antidepressants warrants further investigation.</p>
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