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| 2. |
- Bekhali, Zakaria, 1969-, et al.
(author)
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Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients
- 2020
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In: Obesity Surgery. - : Springer Nature. - 0960-8923 .- 1708-0428. ; 30:11, s. 4422-4427
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Journal article (peer-reviewed)abstract
- Purpose: Marginal ulcer (MU) is well-known complication in bariatric surgery. Several studies are available in Roux-en-Y gastricbypass (RYGBP), while data on the incidence in duodenal switch (DS) is limited. We aimed to compare the incidence of MUbetween DS and RYGBP in a well-defined cohort and to identify associative factors.Methods: A cohort of 732 patients with BMI ≥ 48 who had undergone primary DS or RYGBP during 2008–2018 received aquestionnaire concerning ulcers, PPI therapy, and smoking habits; hereafter, patient charts were reviewed. Incidence rates (IRs)for MU were calculated in our survey and on previous registered data in the national quality register for bariatric surgery(SOReg). A multivariate regression analysis was performed to identify predictive risk factors for MU.Results: After a mean follow-up of 6.1 years, 472 (64%) patients responded (47 ± 11 years old, 65% women and 42% DS). Of 41MUs identified, 23 were endoscopically verified. Gastrointestinal bleeding, abdominal pain, and dysphagia were the mostcommon symptoms. IR for MU was 1.4% (DS 1.3% and RYGBP 1.5%) per patient-year, compared with 0.9% according toSOReg-data. Persisting PPI treatment was seen in about three quarter of formerMUpatients (OR 11.2 [3.6–34.7], p < 0.001), butno other associative factors were found.Conclusion: The overall risk for MU was low, about 1% per patient-year, without difference between DS and RYGBP. OngoingPPI treatment was frequent in many former MU patients. This study on MU after DS provides reassuring results for futurebariatric surgery candidates.
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| 3. |
- Blöndal, Viiu, et al.
(author)
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Study of atopic multimorbidity in subjects with rhinitis using multiplex allergen component analysis
- 2020
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In: Clinical and Translational Allergy. - : BMC. - 2045-7022. ; 10:1
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Journal article (peer-reviewed)abstract
- Background Rhinitis is a common problem within the population. Many subjects with rhinitis also have atopic multimorbidity, such as asthma and eczema. The purpose of this investigation was to compare subjects with only rhinitis to those that have rhinitis, asthma and/or eczema in relation to immunoglobulin E (IgE) sensitization, inflammatory markers, family history, lung function and body mass index (BMI). Methods A total of 216 adult subjects with rhinitis from the European Community Respiratory Health Survey II were investigated with multiplex component allergen analysis (103 allergen components), total IgE, C-reactive protein, eosinophilic cationic protein, fractional exhaled nitric oxide and spirometry. Rhinitis, eczema, asthma and parental allergy were questionnaire-assessed. Results Of the 216 participants with rhinitis, 89 also had asthma and/or eczema. Participants with rhinitis that also had asthma or eczema were more likely to be IgE-sensitized (3.44, odds ratio, OR: 95% CI 1.62-7.30, adjusted for sex, age, mother's allergy, total IgE and forced expiratory volume (FEV1)). The number of IgE-positive components was independently associated with atopic multimorbidity (1.11, OR: 95% Cl 1.01-1.21) adjusted for sex, age, mother's allergy, total IgE and FEV1. When analysing different types of sensitization, the strongest association with atopic multimorbidity was found in participants that were IgE-sensitized both to perennial and seasonal allergens (4.50, OR: 95% CI 1.61-12.5). Maternal allergy (2.75, OR: 95% CI 1.15-4.46), high total IgE (2.38, OR: 95% CI 1.21-4.67) and lower FEV1 (0.73, OR: 95% CI 0.58-0.93) were also independently associated with atopic multimorbidity, while no association was found with any of the other inflammatory markers. Conclusion IgE polysensitization, to perennial and seasonal allergens, and levels of total IgE seem to be the main determinants of atopic multimorbidity in subjects with rhinitis. This indicates that disease-modifying treatment that targets IgE sensitization may be of value when decreasing the risk of developing atopic multimorbidity.
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| 4. |
- Elias, Khalid, et al.
(author)
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Prevalence and impact of acid-related symptoms and diarrhea in patients undergoing Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch
- 2020
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In: Surgery for Obesity and Related Diseases. - : ELSEVIER SCIENCE INC. - 1550-7289 .- 1878-7533. ; 16:4, s. 520-527
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Journal article (peer-reviewed)abstract
- Background: Gastrointestinal symptoms are common in the obese population. Objectives: To determine the prevalence and importance of acid-related symptoms and diarrhea in 3 different types of bariatric operations: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch (BPD/DS). Setting: National data from Sweden. Methods: A total of 58,823 primary bariatric procedures (RYGB: 87.5%, SG: 11.7%, and BPD/DS: .7%) performed from 2007 to 2017 were identified in the Scandinavian Obesity Surgery Registry. Associations between acid-related symptoms and diarrhea, both defined by continuous use of pharmacologic treatment, and predefined outcomes were studied in a multivariate model, adjusted for age, sex, body mass index, and year of surgery. Results: At baseline, acid-related symptoms were most common in RYGB (9.9%), while diarrhea was rare. In general, symptomatic patients were older, had more co-morbidities, and scored lower on quality of life compared with the remaining patients. In the multivariate analysis, RYGB patients with acid-related symptoms had reduced risk of prolonged operative time and length of stay, while postoperative complications and reoperations increased by 24% and 36%, respectively. In SG, both symptoms were associated with prolonged operative time and a doubled risk for complications. Symptomatic patients had reduced improvement in quality of life, while no association with the weight result was seen. Postoperatively, acid-related symptoms decreased in RYGB, while doubling in SG. Diarrhea increased 2- and 6-fold in RYGB and BPD/DS, respectively. Conclusion: The 2 gastrointestinal symptoms were associated with increased operative risks and reduced improvement in quality of life. Postoperatively, the respective anatomic alternations affected both gastrointestinal symptoms. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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- Katsogiannos, Petros, 1979-
(author)
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Bariatric surgery as treatment of type 2 diabetes – clinical and mechanistic aspects
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Bariatric surgery can rapidly improve glycemic control and cardiovascular risk factors in patients with T2D and obesity. These improvements appear to be partly independent of weight loss, however, the underlying mechanisms remain incompletely understood. A randomized controlled trial was designed where 19 patients with obesity and T2D were either operated with a Roux-en-Y gastric bypass (RYGB) operation or continued with standard-of-care treatment and followed up for 2 years, providing the data for Paper I-III.In paper I, we focused on changes in whole-body glucose metabolism in relation to changes in adipose tissue metabolism and morphology. We observed an early adipose tissue remodeling and a reduction in adipocyte size that however, did not correlate to the early improvements in metabolic control.In paper II, we analyzed the neuroendocrine changes after RYGB. We observed changes within 4 weeks with signs of enhanced parasympathetic outlow, reduced morning cortisol, and enhanced incretin and glucagon responses to glucose, suggesting that neurohormonal mechanisms can contribute to the rapid improvement of insulin resistance and glycemia following RYGB in T2D.In paper III the patients from the RYGB group were interviewed 2 years after surgery to examine the effects of surgery on health-related quality of life (HRQoL). We found that the improved HRQoL after RYGB was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness.In paper IV, we compared changes in circulating cytokine and adipokine levels in obese patients with- and without T2D. We observed that the cytokine profile of these patients is altered when compared to lean healthy control subjects and persist to a large extent after RYGB despite the weight loss and improved metabolic status.In conclusion, we observed that in the early post-operative period, neurohormonal changes appear to be more important than adipose tissue changes in improving insulin sensitivity and leading to diabetes remission.In the qualitative part of our study, we observed that the improved HRQoL was not solely explained by weight loss
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| 6. |
- Katsogiannos, Petros, et al.
(author)
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Quality of life after gastric bypass surgery in patients with type 2 diabetes : patients’ experiences during 2 years of follow-up
- 2020
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In: Diabetology & Metabolic Syndrome. - : Springer Science and Business Media LLC. - 1758-5996. ; 12:1
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Journal article (peer-reviewed)abstract
- BackgroundTo examine the effects of gastric bypass surgery on health-related quality of life (HRQoL) in obese patients with type 2 diabetes, and to investigate their experiences of life adjustments using quantitative and qualitative methods.MethodsThirteen patients with type 2 diabetes and obesity, (body mass index, BMI > 30 kg/m2), participating in a randomized clinical trial, completed this sub-study. HRQoL was evaluated before, and at 6 months and 2 years after gastric bypass surgery, using the RAND- 36-item health survey. At 2 years, interviews for in-depth analysis of HRQoL changes were performed.ResultsSignificant improvement was observed from baseline to 6 months for 2 of the eight health concepts, general health, and emotional well-being. At 2 years, improvements were also seen in physical functioning, energy/fatigue, as well as sustained improvements in general health and emotional well-being. Multiple regression analyses showed mostly non-significant associations between the magnitude of decrease in weight, BMI, and HbA1c during follow-up and improvement in HRQoL. The analyses from qualitative interviews supported a common latent theme “Finding a balance between the experience of the new body weight and self-confidence”.ConclusionsThe improved HRQoL after gastric bypass surgery in obese patients with type 2 diabetes was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness.
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| 7. |
- Katsogiannos, Petros, et al.
(author)
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Rapid changes in neuroendocrine regulation may contribute to reversal of type 2 diabetes after gastric bypass surgery
- 2020
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In: Endocrine. - : SPRINGER. - 1355-008X .- 1559-0100. ; 67:2, s. 344-353
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Journal article (peer-reviewed)abstract
- Objective: To explore the role of hormones and the autonomic nervous system in the rapid remission of diabetes after Roux-en-Y Gastric Bypass (RYGB).Research design and methods: Nineteen obese patients with type 2 diabetes, 7 M/12 F, were randomized (2:1) to RYGB or standard-of-care medical treatment (control). At baseline and 4 and 24 weeks post surgery, fasting blood sampling, OGTT, intravenous arginine challenge, and heart-rate variability (HRV) assessments were performed.Results: At both 4 and 24 weeks post-RYGB the following effects were found: arginine-stimulated insulin secretion was reduced. GLP-1, GIP, and glucagon rise during OGTT was enhanced. IGF-1 and GH levels increased. In addition, total HRV and spectral components P-LF (power of low frequency) and P-HF (power of high frequency) increased. At 4 weeks, morning cortisol was lower than baseline and 24 weeks. At 24 weeks, NEFA levels during OGTT, and the P-LF/P-HF ratio decreased. None of these changes were seen in the control group.Conclusions: There were rapid changes within 4 weeks after RYGB: signs of enhanced parasympathetic nerve activity, reduced morning cortisol, and enhanced incretin and glucagon responses to glucose. The findings suggest that neurohormonal mechanisms can contribute to the rapid improvement of insulin resistance and glycemia following RYGB in type 2 diabetes.
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| 8. |
- Linder, Gustav, et al.
(author)
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Safe Introduction of Minimally Invasive Esophagectomy at a Medium Volume Center
- 2020
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In: Scandinavian Journal of Surgery. - : Sage Publications. - 1457-4969 .- 1799-7267. ; 109:2, s. 121-126
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Journal article (peer-reviewed)abstract
- Background and Aims: Minimally invasive esophagectomy is a favored alternative in high-volume centers. We evaluated the introduction of, and transition to, minimally invasive esophagectomy at a medium volume tertiary referral center (10-20 esophagectomies annually) with focus on surgical results. Material and Methods: Patients who underwent minimally invasive esophagectomy or open transthoracic surgery for carcinoma of the esophagus or gastroesophageal junction (Siewert I and II) during 2007-2016 were retrospectively studied. Sorted on surgical approach, perioperative data, surgical outcomes, and postoperative complications were analyzed and multivariate regression models were used to adjust for possible confounders. Results: One hundred and sixteen patients were included, 51 minimally invasive esophagectomy (21 hybrid and 30 totally minimally invasive) and 65 open resections. The groups were well matched. However, higher body mass index, neoadjuvant chemoradiotherapy, and cervical anastomosis were more frequent in the minimally invasive esophagectomy group. Minimally invasive esophagectomy was associated with less peroperative bleeding (384 vs 607 mL, p = 0.036) and reduced length of stay (14 vs 15 days, p = 0.042). Duration of surgery, radical resection rate, and postoperative complications did not differ between groups. Lymph node yield was higher in the minimally invasive esophagectomy group, 18 (13-23) vs 12 (8-16), p < 0.001, confirmed in a multivariate regression model (adjusted odds ratio 3.15, 95% class interval 1.11-8.98, p = 0.032). Conclusion: The introduction of minimally invasive esophagectomy at a medium volume tertiary referral center resulted in superior lymph node yield, less peroperative blood loss and shorter length of stay, without compromising the rate of radical resection, or increasing the complication rate.
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| 9. |
- Poelemeijer, Youri Q. M., et al.
(author)
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Gastric Bypass Versus Sleeve Gastrectomy Patient Selection and Short-term Outcome of 47,101 Primary Operations From the Swedish, Norwegian, and Dutch National Quality Registries
- 2020
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In: Annals of Surgery. - : LIPPINCOTT WILLIAMS & WILKINS. - 0003-4932 .- 1528-1140. ; 272:2, s. 326-333
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to compare the use and short-term outcome of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Sweden, Norway, and the Netherlands. Background: Although bariatric surgery is performed in high volumes worldwide, no consensus exists regarding the choice of bariatric procedure for specific groups of patients. Methods: Data from 3 national registries for bariatric surgery were used. Patient selection, perioperative data (severe complications, mortality, and rate of readmissions within 30 days), and 1-year results (follow-up rate and weight loss) were studied. Results: A total of 47,101 primary operations were registered, 33,029 (70.1%) RYGB and 14,072 (29.9%) SG. Patients receiving RYGB met international guidelines for having bariatric surgery more often than those receiving SG (91.9% vs 83,0%,P< 0.001). The 2 procedures did not differ in the rate of severe complications (2.6% vs 2.4%,P= 0.382), nor 30-day mortality (0.04% vs 0.03%,P= 0.821). Readmission rates were higher after RYGB (4.3% vs 3.4%,P< 0.001). One-year post surgery, less RYGB-patients were lost-to follow-up (12.1% vs 16.5%,P< 0.001) and RYGB resulted in a higher rate of patients with total weight loss of more than 20% (95.8% vs 84.6%,P< 0.001). While the weight-loss after RYGB was similar between hospitals, there was a great variation in weight loss after SG. Conclusion: This study reflects the pragmatic use and short-term outcome of RYGB and SG in 3 countries in North-Western Europe. Both procedures were safe, with RYGB having higher weight loss and follow-up rates at the cost of a slightly higher 30-day readmission rate.
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| 10. |
- Skogar, Martin, 1983-, et al.
(author)
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Early complications, long-term adverse events, and quality of life after duodenal switch and gastric bypass in a matched national cohort
- 2020
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In: Surgery for Obesity and Related Diseases. - : ELSEVIER SCIENCE INC. - 1550-7289 .- 1878-7533. ; 16:5, s. 614-619
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Journal article (peer-reviewed)abstract
- Background: Insufficient weight loss is common in super-obese patients (body mass index >50) after Roux-en-Y gastric bypass (RYGB). Duodenal switch (DS) is more effective; however, it is considered to have an increased complication rate.Objectives: To compare early complications (<= 30 d), long-term adverse events, and quality of life (QoL) between primary DS and RYGB. Setting: Sweden.Methods: National cohort-study of super-obese patients after primary DS or RYGB in Sweden 2007 to 2017. Propensity-score matching was used to reduce confounders. Five national registers were cross-matched.Results: The study population consisted of 333 DS and 1332 RYGB (body mass index 55 +/- 5 kg/m(2), 38.5 +/- 11 yr, and 60.7% females). Laparoscopic approach was used in 25% of DS and 91% of RYGB. Early complications were more common after DS (15.3% versus 8.1%, P < .01), mainly because of more open surgery and related surgical site infections. During 4.6 +/- 2.3 years mean follow-up, hospital admission rate was 1.4 +/- 2.3 versus 1.1 +/- 3.3 (P = .18), with 6.7 +/- 18.3 versus 7.0 +/- 43.0 in-hospital days, for DS and RYGB, respectively. An increased risk of malnutrition/malabsorption requiring inpatient care (2.8% versus .2%, odds ratio 12.3 [3.3-45.7]) and greater need for additional abdominal surgery (25.8% versus 15.3%, odds ratio 2.0 [1.5-2.7]) was observed for DS. However, QoL was more improved after DS.Conclusion: DS was associated with more early complications because of more open surgery, but long-term requirement of inpatient care was similar to RYGB. The increased risk of malnutrition/ malabsorption and need for additional abdominal surgeries was contrasted with a greater improvement in QoL for DS.
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