| 1. |
- Maret-Ouda, John, et al.
(författare)
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Esophageal adenocarcinoma after obesity surgery in a population-based cohort study
- 2015
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Ingår i: Surgery for Obesity and Related Diseases. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1550-7289. ; 13:1, s. 28-34
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obesity is strongly associated with esophageal adenocarcinoma (EAC), yet whether weight loss reduces the risk of EAC is unclear. Objectives: To test the hypothesis that the risk of EAC decreases following weight reduction achieved by obesity surgery. Setting: Nationwide register-based cohort study. Methods: This study included a majority of individuals who underwent obesity surgery in Sweden in 1980-2012. The incidence of EAC following obesity surgery was compared to the incidence in the corresponding background population of Sweden by means of calculation of standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). The risk of EAC after obesity surgery was also compared with the risk in non-operated obese individuals by means of multivariable Cox regression, providing hazard ratios (HRs) with 95% CIs, adjusted for potential confounders. Results: Among 34,437 study participants undergoing obesity surgery and 239,775 person- 15" years of follow-up, 8 cases of EAC occurred (SIR 1.6, 95% CI 0.7-3.2). No clear trend of decreased SIRs was seen in relation to increased follow-up time after surgery. The SIR of EACs (n=53) among 123,695 non-operated obese individuals (673,238 person-years) was increased to a similar extent as in the obesity surgery cohort (SIR=1.9, 95% CI 1.4-2.5). Cox regression showed no difference in risk of EAC between operated and non-operated participants (adjusted HR=0.9, 95% CI 0.4-1.9). Conclusions: The risk of EAC might not decrease following obesity surgery, but even larger studies with longer follow-up are needed to establish this association.
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| 2. |
- Abdeen, G. N., et al.
(författare)
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Vertical sleeve gastrectomy in adolescents reduces the appetitive reward value of a sweet and fatty reinforcer in a progressive ratio task
- 2019
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 15:2, s. 194-199
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adolescent obesity is challenging to treat even if good multidisciplinary approaches are started early. Vertical sleeve gastrectomy (VSG) is an effective intervention for long-term weight loss, but the underlying mechanisms that result in reduced calorie intake are controversial. Anecdotal evidence from the clinic and evidence in rodents after VSG suggest a decrease in the reward value of high-calorie dense foods. Objectives: To determine changes in appetitive behavior of candies (high in sugar and fat) after VSG in adolescents with obesity. Setting: University hospital. Methods: Sixteen adolescents with obesity (age 15.3 ±.5 yr) who had VSG and 10 control patients (age 13.8 ±.6 yr) who had not undergone surgery were studied. Both groups completed a progressive ratio task by clicking a computer mouse on a progressive ratio schedule to receive a candy high in sugar and fat. In the task, patients were required to expend an increasing amount of effort to obtain the reinforcer until they reach a breakpoint (measure of the reward value of the reinforcer). The task was performed before VSG and 12 and 52 weeks after VSG. Results: The VSG group's bodyweight decreased from the baseline 136.6 ± 5.1 to 110.9 ± 5.2 to 87.4 ± 3.7 kg after 12 and 52 weeks, respectively (P <.001). The median breakpoint for candies decreased after VSG from the baseline 320 (160–640) to 80 (50–320) to 160 (80–560) after 12 and 52 weeks, respectively (P =.01). Breakpoints for the control patients did not change (480 [160–640] versus 640 [280–640], P =.17). Conclusion: VSG resulted in a reduction in the reward value of a candy, as suggested by the reduced amount of effort adolescents were prepared to expend to obtain the high-sugar and high-fat candy. The effect was most pronounced 12 weeks after surgery but was largely maintained at 1 year. Long-term attenuation of appetitive behavior may be the key to weight loss and weight loss maintenance after VSG in adolescents. © 2018
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| 3. |
- Al-Tai, Saif, 1978-, et al.
(författare)
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The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy : results from the Scandinavian Obesity Surgery Registry
- 2024
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 20:2, s. 139-145
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial.OBJECTIVES: To evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG.SETTING: Nationwide registry-based study.METHODS: This study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35-36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30-32 Fr), shorter distances (1-4 cm), and extended distances (6-8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG. RESULTS: The study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17-1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed.CONCLUSIONS: Using a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.
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| 5. |
- Anveden, Åsa, et al.
(författare)
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Long-term incidence of gallstone disease after bariatric surgery: results from the nonrandomized controlled Swedish Obese Subjects study
- 2020
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 16:10, s. 1474-1482
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Tidskriftsartikel (refereegranskat)abstract
- Background: Gallstone disease is a known short-term complication of bariatric surgery; little is known of the long-term incidence. Objectives: The aim of this study was to investigate the association between bariatric surgery and long-term incidence of gallstone disease. Settings: A total of 25 surgery departments and 480 primary healthcare centers in Sweden. Methods: The Swedish Obese Subjects study is a prospective, controlled study comparing the effects of bariatric surgery with usual care with a follow-up of 20 years, including 4047 individuals. The current report includes all participants without previous or concomitant cholecystectomy (n = 3597). Operative techniques used in the surgery group (n = 1755) were gastric bypass (n = 236), vertical banded gastroplasty (n = 1202), and gastric banding (n = 317). The control group (n = 1842) received customary treatment for obesity. Gallstone disease was a predefined secondary endpoint in the Swedish Obese Subjects study and the primary endpoint of this report. Data were obtained by cross-checking our study database with the Swedish National Patient Register of diagnosis and procedures. Results: In the surgery and control groups, respectively, there were 307 and 252 first-time events of symptomatic gallstone disease and 230 and 170 cholecystectomies (log-rank P <.001, both outcomes). Bariatric surgery was associated with an increased risk of symptomatic gallstone disease, with a more pronounced risk during the first years of follow-up (P =.002) and an increased risk for cholecystectomy but with no time-varying effect (P =.213). Conclusions: Bariatric surgery increases the risk for symptomatic gallstone disease and cholecystectomy, especially during the first years following treatment. © 2020 American Society for Bariatric Surgery
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| 6. |
- Axer, Stephan, 1971-, et al.
(författare)
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Predictive factors of complications in revisional gastric bypass surgery : results from the Scandinavian Obesity Surgery Registry
- 2019
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 15:12, s. 2094-2100
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Tidskriftsartikel (refereegranskat)abstract
- Background: Roux-en-Y gastric bypass is the most common procedure for revisional bariatric surgery. This study is an analysis of revisional gastric bypass operations (rGBP) compared with primary gastric bypass (pGBP) performed in Sweden between 2007 and 2016.Objective: The aim was to compare the incidence of adverse events in primary and revisional gastric bypass surgery and to identify predictive factors of intraoperative, early, and late complications in revisional gastric bypass surgery.Setting: Forty-four hospitals.Methods: Registered study from the Scandinavian Obesity Surgery Registry. The study group (rGBP) comprised 1795 patients, and the control group (pGBP) comprised 46,055 patients.Results: Median follow-up time was 28 months. The rate of open procedures was significantly higher in the rGBP group (39.1% versus 2.4%; P < .001) decreasing from 70.8% in 2007 to 8.5% in 2016. Intraoperative complications (15.5% versus 3.0%, P < .001), early complications (24.6% versus 8.7%; P < .001), and late complications (17.7% versus 8.7%; P < .001) occurred more often in the rGBP group. Open access in revisional surgery was an independent risk factor for intraoperative complications (odds ratio 3.87; 95% confidence interval: 2.69-5.57, P < .001), early complications (odds ratio 2.08; 95% confidence interval: 1.53-2.83, P < .001), and late complications (odds ratio 1.91; 95% confidence interval: 1.31-2.78, P = .001). Indication for revision or type of index operation were not associated with complications.Conclusion: RGBP was associated with a higher incidence of intraoperative, early, and late complications compared with pGBP. Open access in revisional surgery was predictive of complications regardless of the index operation or indication for revision.
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| 7. |
- Axer, Stephan, 1971-, et al.
(författare)
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Weight loss and alterations in co-morbidities after revisional gastric bypass : A case-matched study from the Scandinavian Obesity Surgery Registry
- 2017
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 13:5, s. 796-800
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Sweden, Roux-en-Y gastric bypass is the most common procedure when revising a previous bariatric procedure. This study is an analysis of all revisional gastric bypass operations (rGBP) compared with a matched group of primary gastric bypass (pGBP) operated between 2007 and 2012.Objective: The aim was to determine whether improvement of obesity-related co-morbidity and changes in weight after revisional gastric bypass surgery were comparable with those seen after primary surgery.Setting: 44 hospitals in SwedenMethods: Retrospective data were retrieved from the Scandinavian Obesity Surgery Registry. The study group (rGBP) comprised 1224 patients, and the control group (pGBP) comprised 3612 patients matched for age and gender.Results: The indication for revision was weight failure in 512 patients (42%), a late complication of the initial procedure in 330 patients (27%), and a combination of weight failure and complication in 303 patients (25%). A total of 66% of patients in the rGBP group and 67% in the pGBP group completed the 2-year follow-up in the Scandinavian Obesity Surgery Registry.The rGBP-group had significantly less excess BMI loss (%EBMIL, 59.4 +/- 147.0 versus 79.5 +/- 24.7, P < .001) and a lower dyslipidemia remission rate (42.9% versus 62.0%, P = .005) at the time of the 2-year follow-up. Remission rates of sleep apnea, hypertension, type 2 diabetes, and depression were similar. The effects on obesity-related co-morbidity were not related to the indication for revisional surgery or the initial bariatric procedure.Conclusion: Even if weight results might be inferior compared with primary bypass procedures, the improvement of co-morbidity is similar. (C) 2017 American Society for Metabolic and Bariatric Surgery. All right reserved
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| 8. |
- Beamish, A. J., et al.
(författare)
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Changes in adipose tissue distribution and relation to cardiometabolic risk factors after Roux-en-Y in adolescents
- 2023
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Ingår i: Surgery for Obesity and Related Diseases. - : ELSEVIER SCIENCE INC. - 1550-7289 .- 1878-7533. ; 19:10, s. 1154-1161
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Tidskriftsartikel (refereegranskat)abstract
- Background: Roux-en-Y gastric bypass (RYGB) among adolescents with obesity results in signif-icant weight loss; however, depot-specific changes have been understudied.Objective: We hypothesized that visceral adipose tissue (VAT) reduction in adolescents undergoing RYGB would be greater than other depots and associated with improvement in cardiometabolic risk factors.Setting: Three specialized treatment centers in Sweden. Methods: Fifty-nine adolescents underwent dual x-ray absorptiometry before surgery and at 1, 2, and 5 years after RYGB. Changes in body composition in multiple depots (total fat, lean body, gynoid fat, android fat, subcutaneous adipose tissue, and VAT) and cardiometabolic risk factors were assessed using multiple linear regression analysis and generalized estimating equations adjusting for age, sex, and baseline risk factor levels. Data are presented as percent change (95% CI) with regression models showing slopes and estimated P values.Results: At 1 year post-RYGB, a significant reduction was observed across all body composition measures (P , .001) with the greatest reduction observed in VAT (-65.1% [-68.7, -61.8]). From year 1 to 5 years post-RYGB, a regain was observed in all depots except lean body mass (1.2% [.3, 2.7], P 5 .105). A sex-specific difference in overall trajectories was only observed in lean body mass with males consistently having higher mean levels. Change in VAT at 1 year correlated with change in triglycerides (slope: .21 mg/dL/kg, P = .034) and fasting plasma insulin (slope: 44 pmol/L/kg, P = .027). Conclusions: Adiposity measures all decreased after RYGB but poorly predicted change in cardio-metabolic risk. Despite significant reductions at 1 year, a steady regain was observed out to 5 years, with values still well below baseline. Further research should consider control group comparison and extended follow-up.
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| 9. |
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| 10. |
- 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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