| 1. |
- Bauraite, K., et al.
(författare)
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Factors associated with quality of life and weight regain 12 years after Roux-en-Y gastric bypass
- 2022
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Ingår i: Surgical Endoscopy and Other Interventional Techniques. - : Springer Science and Business Media LLC. - 0930-2794. ; 36:6, s. 4333-4341
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Tidskriftsartikel (refereegranskat)abstract
- Background Scarce evidence exists in the literature about the factors influencing the long-term quality of life (QoL) and weight regain (WR) after Roux-en-Y gastric bypass (RYGB). The aim of the present study was to investigate factors associated with WR and QoL, measured by obesity specific Moorehead-Ardelt Quality of Life Questionnaire II (M-A QoLQ II), 12 years after RYGB. Methods This prospective longitudinal cohort study included 74 patients with obesity who had RYGB at the Lithuanian University of Health Sciences hospital Surgery department in 2005. Gastrointestinal and dumping symptoms, hypoglycemia, depression and anxiety disorders, hunger, satiety after meals, portion size, and grazing were assessed in the patients who agreed to participate in the study. General linear models were constructed to estimate the effect of variables on the WR and QoL. Results 12-year follow-up data were available for 50 patients (38 female, median body mass index (BMI) before surgery 42.4). The mean % excess BMI loss (%EBMIL) after 12 years was 63.1 (24.6) and the average %WR was 32.2 (19.4). The mean M-A QoLQ II score was 1.44 (1.3). Majority of the patients (76.6%) reported good or very good QoL. In multivariable analysis, only grazing (17.41% 95% CI 7.61-27.21; P = 0.001) was found to be a significant independent factor associated with WR. Factors independently associated with worse QoL were grazing (- 0.97 95% CI - 1.72, - 0.22; P = 0.013) and frequency of abdominal pain once or more per month (- 1.82 95% CI - 2.79, - 0.85; P = 0.001). Conclusion 12 years after RYGB majority of the patients report good or very good QoL and despite some WR have achieved and maintained significant weight loss. Grazing was associated with both WR and worse QoL, while the frequency of abdominal pain once or more per month was associated with only decreased QoL.
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| 2. |
- Bauraite, Karolina, et al.
(författare)
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The Impact of COVID-19 Pandemic on Weight Loss, Eating Behaviour and Quality of Life after Roux-en-Y Gastric Bypass
- 2023
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Ingår i: MEDICINA-LITHUANIA. - 1010-660X .- 1648-9144. ; 59:9
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: The global pandemic of coronavirus disease (COVID-19), declared on 11 March 2020, had an extensive impact on bariatric patients. The aim of this study was to evaluate short-term weight loss outcomes, changes in eating behaviour, and health-related quality of life (HRQoL) among patients who had Roux-en-Y gastric bypass (RYGB) before and during the COVID-19 pandemic. Materials and Methods: This cohort study included 72 patients (Group S) who underwent RYGB surgery in the Surgery Department of the Lithuanian University of Health Sciences during the COVID-19 pandemic in the years 2020-2022. Data for the control group (Group C) of 87 patients (operated on in 2010-2012) were collected from a prospective study. The data referred to the period before and a year after the RYGB. The information about patients' weight changes, hunger, satiety, fullness sensations, appetite, diet, and eating patterns was queried. Eating behaviour and HRQoL evaluation were conducted by the Three-Factor Eating Questionnaire (TFEQ-R18) and the medical outcomes study Short-Form-36 (SF-36), respectively. Results: One year after the surgery, % excess body mass index loss (%EBMIL) was 77.88 (26.33) in Group S, 76.21 (19.98) in Group C, p = 0.663. Patients in Group S tended more to choose snacks between main meals: 79.2% versus 28.7%, p < 0.0001. Cognitive restraint significantly increased in Group S from 45.93 (13.37) up to 54.48 (13.76), p = 0.001; additionally, significantly worse overall health status was found in Group S compared to Group C, 53.27 (24.61) versus 70.11 (31.63), p < 0.0001. Mental HRQoL (50.76 versus 60.52 score, p < 0.0001) and social functioning (44.79 versus 57.90, p < 0.0001) were worse in Group S. Conclusions: In this study, the COVID-19 pandemic had no impact on short-term weight loss after RYGB. However, one year after, RYGB patients tended to snack more, and mental HRQoL and social functioning were worse in the study group.
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| 3. |
- Björklund, Per, et al.
(författare)
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Roux Limb Motility in Gastric Bypass Patients with Chronic Abdominal Pain—Is There an Association to Prescribed Opioids?
- 2019
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 29:12, s. 3860-3867
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: A number of patients continue to suffer from chronic abdominal pain of unknown origin, which may also lead to a prolonged use of opioid analgesics. Symptoms of abdominal pain, nausea and vomiting in this patient group resemble the characteristics of the Roux stasis Syndrome. The aim was to elucidate relationships between chronic abdominal pain, Roux limb motor activity and opioid analgesics. Methods: Roux limb high-resolution manometry and ratings of abdominal pain and quality of life were analysed in 15 gastric bypass patients reporting abdominal pain of unknown origin. Effect of acute opiate administration (morphine i.v.) on fasting Roux limb motor activity was assessed in asymptomatic and morphine-naïve gastric bypass patients (n = 9) and compared with an untreated control group (n = 11). Results: In the symptomatic patient group, we found disturbed Roux limb motor patterns in 10 out of 15 examinations, but no signs of Roux stasis syndrome. A high prevalence of prescribed opioid analgesics as well as a high number of reoperations in this group. The worst quality of life and the highest number of pain-killing medications were observed among the patients with distal pacemaker activity in Roux limb. In the morphine-naïve and asymptomatic patients, morphine increased the muscular tone in the Roux limb during phase III-like motor activity. Summary and Conclusions: A majority of the RYGBP patients with chronic abdominal pain had a disturbed Roux limb fasting motility, and there was a high prevalence of prescribed opioid analgesics. In opiate-naïve RYGBP patients, acute morphine intravenously increased the muscular tone of the Roux limb. © 2019, The Author(s).
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| 4. |
- Choromanska, B., et al.
(författare)
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Effects of age and gender on the redox homeostasis of morbidly obese people
- 2021
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Ingår i: Free Radical Biology and Medicine. - : Elsevier BV. - 0891-5849. ; 175, s. 108-120
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Tidskriftsartikel (refereegranskat)abstract
- Obesity is a chronic disease of complex etiology. Recent evidence suggests that obesity is caused by inflammation of adipose tissue leading to metabolic disorders, cardiovascular disease and cancer. This is the first study to evaluated the effects of age and gender on redox homeostasis, glutathione metabolism, and oxidative damage to plasma/serum lipids and proteins in morbidly obese patients. The study included 120 (60 men and 60 women) morbidly obese patients with class 3 obesity (BMI > 40 kg/m2), classified into three groups depending on age: 20-39 years (n = 20), 40-59 years (n = 20) and 60 years or older (n = 20). The number of patients was calculated a priori based on our previous experiment. We observed a reduction in serum activity of antioxidant enzymes (down arrow SOD) and plasma concentration of non-enzymatic antioxidants (down arrow GSH) in obese patients compared to the lean controls, which further decreased with age. Redox status (up arrow TAC, up arrow TOS and down arrow OSI) in morbidly obese men and women was shifted towards oxidation. Moreover, lipid (up arrow MDA and up arrow LOOH) and protein (up arrow AOPP, up arrow AGE and up arrow Amadori products) damage products of oxidation and nitrosylation/nitration (up arrow total NO, up arrow S-nitrosothiols, up arrow peroxynitrite and up arrow nitrotyrosine) were elevated in both genders of morbidly obese patients and were higher in the elderly. Interestingly, the concentrations of oxidative and nitrosative stress markers were generally higher in obese men compared to obese women at the same age. Summarizing, we showed that the total antioxidant/ oxidant potential of obese patients is significantly increased and shifted towards oxidation. Obese patients have increased lipid and protein oxidation, glycation and nitration as compared to the lean controls. Disturbances in redox homeostasis increase with age in obese patients. Oxidative and nitrosative stress are more intense in men than in women at the same age.
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| 5. |
- Gudaityte, R., et al.
(författare)
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Laparoscopic Gastric Greater Curvature Plication: Intermediate Results and Factors Associated with Failure
- 2018
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 28:12, s. 4087-4094
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundLaparoscopic gastric greater curvature plication (LGGCP) is a novel bariatric procedure. Few studies have presented intermediate or long-term results. The aim of this prospective study was to investigate intermediate results and factors associated with failure to achieve satisfactory weight loss after LGGCP.MethodsBetween October 2011 and November 2013, 61 patients underwent LGGCP and were followed up to 36months after operation. Demographics, comorbidities, complications, and percentage of excess body mass index loss (%EBMIL) were analyzed. Logistic regression analysis was used to determine independent risk factors for weight loss failure 3years after LGGCP.ResultsForty-eight women and 13 men with an average age of 47.710.3years and preoperative BMI of 46.3 +/- 5.8 underwent LGGCP. Postoperative complications were observed in three patients (4.9%) and two of them (3.3%) underwent reoperations. Follow-up rate was 95%, 91.7, and 88.3% after 1, 2, and 3years, respectively. Average %EBMIL after 1year was 47.25 +/- 21.6, 44.8 +/- 25.9 after 2years, and 41.9 +/- 25.6 after 3years. Gastroscopy 3years after LGGCP demonstrated intact plication fold in 55% of cases. Preoperatively, GERD was present in 46% of patients. Prevalence of GERD 3years after LGGCP was 34.6%. Remission rates of type 2 diabetes mellitus and hypertension were 27.8 and 38.3%, respectively. Higher postoperative hunger sensation was found to be an independent factor (OR 1.6, 95% 1.141-2.243; p=0.002) associated with unsatisfactory weight loss after LGGCP.Conclusions Patients with LGGCP had postoperative complication rate 4.9% and achieved only modest weight loss after 3years. Increased hunger was an independent risk factor associated with unsatisfactory weight loss after LGGCP. Long-term follow-up data are needed to define the role of LGGCP in the treatment of morbid obesity.
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| 6. |
- Gudaityte, R., et al.
(författare)
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Mid-Term Outcomes of Laparoscopic Gastric Greater Curvature Plication versus Roux-en-Y Gastric Bypass: Weight Loss, Gastrointestinal Symptoms, and Health-Related Quality of Life
- 2022
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Ingår i: Medicina (Lithuania). - : MDPI AG. - 1010-660X .- 1648-9144. ; 58:1
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: Laparoscopic gastric greater curvature plication (LGGCP) is considered to be less invasive, technically simpler, and less costly. Few studies have compared LGGCP to gastric bypass. The aim of this prospective study was to evaluate the mid-term outcomes of LGGCP such as weight loss, gastrointestinal symptoms, and health-related quality of life (HRQoL) in comparison to laparoscopic Roux-en-Y gastric bypass (LRYGB). Materials and Methods: Between 2017 April and 2018 December, 112 patients were included in the study. Fifty patients had LGGCP, and sixty-two patients underwent LRYGB. Demographics, comorbidities, complications, percentage of excess body mass index loss (%EBMIL), gastrointestinal symptoms (GSRS questionnaire), and HRQoL (EQ-5D-3L questionnaire) were analysed. Gastrointestinal symptoms and HRQoL data are presented as the mean and median with the interquartile range (25th–75th percentile). Follow-up at 1 year and 3 year was performed. Results: The follow-up rate was 96.4% and 92.9%, 1 year and 3 year after surgery, respectively. Mean (SD) %EBMIL 1 year after surgery was 59.05 (25.34) in the LGGCP group and 82.40 (19.03) in the LRYGB group (p < 0.001) and 3 year after was 41.44 (26.74) and 75.59 (19.14), respectively (p < 0.001). The scores of all gastrointestinal symptoms measured by the GSRS questionnaire significantly decreased 3 year after both procedures, except reflux after LGGCP. Patients 3 year after LGGCP had a significantly lower abdominal pain score as compared to patients after LRYGB (1.01; 1.0 (1.0–1.0) and 1.20; 1.0 (1.0–1.33), respectively (p < 0.001); however, LGGCP resulted in significantly more GERD symptoms (1.79; 1.25 (1.0–2.5) and 1.18; 1.0 (1.0–1.0), respectively (p < 0.001)). Three years after surgery, the quality of life was significantly lower in the LGGCP group (0.762; 0.779 (0.690–0.794) and 0.898; 1.000 (0.783–1.000), respectively (p < 0.001)). Conclusions: Three years after surgery, LGGCP patients lost significantly less weight, had less abdominal pain and more reflux symptoms, and a lower quality of life as compared to LRYGB patients. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
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| 7. |
- Hedberg, Suzanne, et al.
(författare)
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The Jejunojejunostomy: an Achilles Heel of the Roux-en-Y Gastric Bypass Construction
- 2021
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 31, s. 5141-5147
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Tidskriftsartikel (refereegranskat)abstract
- Background Laparoscopic Roux-en-Y gastric bypass (RYGB) has for long been the gold standard technique in bariatric surgery, especially in the Scandinavian countries. In a tertiary hospital setting, we observed an increasing number of patients with postprandial abdominal pain and nausea, often associated with complex hypoglycemia. Objectives The present study aimed to characterize the clinical patterns, patient characteristics, and clinical outcomes after surgical revision of dysfunctional RYGB at Sahlgrenska University Hospital in Gothenburg, Sweden. Methods This cohort study included patients with RYGB who underwent revision of the jejunojejunostomy (JJ) after 2013. Information was obtained by reviewing medical records and performing complementary interviews. Results Laparoscopic revisional surgery was performed in 115 cases with either adhesiolysis or total revision of the JJ (mean age 41 years, range 19-67 years; 90% women). The median time to assessment after the last revision was 33 months (range 12-75 months). Forty-four (38%) patients reported that they were symptom-free long-term after the intervention, and 32 (28%) patients experienced an improvement in the symptoms that were the indication for revision. However, 31 (27%) patients reported no long-term improvement, and half of them (n = 16) subsequently had a reversal of the anatomy. Eight (7%) patients were lost to follow-up. Conclusions Dysfunction of the JJ appears to be a relatively common cause of postprandial pain and nausea after ante-colic/ante-gastric RYGB. Most patients with symptoms of dysfunction experienced partial or total relief following revisional surgery, but a substantial minority had persistent problems, with one in five eventually undergoing reversal of the anatomy.
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| 8. |
- Laurenius, Anna, et al.
(författare)
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Laparoscopic biliopancreatic diversion/duodenal switch or laparoscopic Roux-en-Y gastric bypass for super-obesity-weight loss versus side effects.
- 2010
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Ingår i: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. - : Elsevier BV. - 1878-7533. ; 6:4, s. 408-14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Laparoscopic biliopancreatic diversion/duodenal switch (LDS) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the main surgical options for super-obese patients (body mass index >50 kg/m(2)). METHODS: We performed a medium long-term evaluation of 13 super-obese patients who had undergone LDS compared with a control group of 19 patients who had undergone LRYGB. The patients were assessed 31 months (range 17-38) and 34 months (range 26-62) after LDS and LRYGB, respectively, for body mass index changes, relief of co-morbidities, nutrition, quality of life, postoperative bowel function, and accumulated healthcare consumption. RESULTS: The mean body mass index decreased from 54.9 to 30.0 kg/m(2) in the LDS group and 57.8 to 39.8 kg/m(2) in the LRYGB group (P = .005). The hemoglobin A1c level was lower in the LDS group than in the LRYGB group (3.8 +/- .31% versus 4.3 +/- .43%, respectively; P = .01). The LDS patients reported greater energy intake than the LRYGB patients (3132 +/- 1392 kcal versus 2014 +/- 656 kcal, respectively; P = .021). The number of stools daily was 4.1 +/- 3.3 in the LDS group and 1.9 +/- 1.1 in the LRYGB group, P = .0482). Of the 12 patients in the LDS group, 6 reported fecal incontinence or soiling compared with 2 of 16 in the LRYGB group (P = .034). The number of outpatient visits was 5.6 +/- 4.6 for the LDS group and 2.0 +/- 1.9 for the LRYGB group (P = .016), and the number of telephone consultations was 5.0 +/- 5.6 and 1.4 +/- 1.6 for the LDS and LRYGB groups, respectively (P = .043). CONCLUSION: LDS resulted in greater weight loss than LRYGB in super-obese patients. However, the LDS patients in our series had more frequent gastrointestinal side effects, required greater doses of calcium and vitamin supplementation, and required more postoperative monitoring. Patient satisfaction was high in both groups.
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| 9. |
- Laurenius, Anna, et al.
(författare)
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Resolution of diabetes, gastrointestinal symptoms, and self-reported dietary intake after gastric bypass versus sleeve gastrectomy: a randomized study
- 2023
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289 .- 1878-7533. ; 19:5, s. 440-448
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a lack of randomized studies examining diabetes remission and dietary intake between patients undergoing Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG). Objective: To examine longitudinal differences in diabetes resolution, dietary intake, and gastrointestinal (GI) symptoms in patients with obesity and type 2 diabetes (T2D) randomized to either RYGB or SG and according to remission of T2D. Setting: Four hospitals in Sweden, 2 of which are university hospitals. Methods: Dietary intake and GI symptoms were calculated from questionnaires and morphometric differences between surgical methods and T2D remission were compared using the Student t test, effect size (ES) for parametric parameters, and Mann-Whitney U test for nonparametric parameters. Results: Five years after RYGB or SG there was no significant difference in the rate of remission of T2D between RYGB and SG (43% versus 20%, P = .176). RYGB (n = 19) patients had greater weight loss than SG patients (n = 14) (26.4 [9.5] versus 13.1 [9.6] kg, P < .001), despite reporting higher daily caloric intake (Δ 669 kcal, P = .059, ES .67) and food weight (Δ 1029 g/d, P = .003, ES 1.11). RYGB patients, compared with SG patients, also ate 1 more fruit per day (P = .023). Pooled data showed no differences between patients with and without T2D remission regarding weight loss, but those in remission drank more nonalcoholic drinks and milk. Conclusions: Five years postoperatively, patients randomized to RYGB reported considerably higher food intake compared with SG despite lower body weight. The reason and importance of the higher food intake after RYGB compared with SG needs to be further studied.
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| 10. |
- Maleckas, Almantas, et al.
(författare)
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Surgery in the treatment of type 2 diabetes mellitus.
- 2015
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Ingår i: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. - : SAGE Publications. - 1799-7267. ; 104:1, s. 40-47
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Tidskriftsartikel (refereegranskat)abstract
- The prevalence of diabetes is increasing worldwide, and most of the cases are type 2 diabetes mellitus. The relationship between type 2 diabetes mellitus and obesity is well established, and surgical treatment is widely used for obese patients with type 2 diabetes mellitus. The aim was to present current knowledge about the possible mechanisms responsible for glucose control after surgical procedures and to review the surgical treatment results.
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| 11. |
- Maleckas, Almantas, et al.
(författare)
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Weight regain after gastric bypass: etiology and treatment options
- 2016
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Ingår i: Gland Surgery. - : AME Publishing Company. - 2227-684X .- 2227-8575. ; 5:6, s. 617-624
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Tidskriftsartikel (refereegranskat)abstract
- Roux-en-Y gastric bypass (RYGB) is one of the most common operations performed for the patients with morbid obesity. Weight regain (WR) is a complication that may decrease efficiency of the surgical treatment and demand further interventions. Different factors including lifestyle, mental health, hormonal/metabolic and surgical plays role in WR after RYGB. Various treatment options have been proposed for WR. Conservative treatment is less effective than surgery. Endoscopic refashioning of gastric pouch/stoma fails to achieve sustainable weight loss. Surgical reduction of pouch has acceptable short-term results, but WR after 3 years is substantial. Banded gastric bypass achieves good short-term results, but long-term follow-up data are needed. Distalization of RYGB has a high risk of protein calorie malnutrition (PCM) and conversion to BP diversion (BPD)/duodenal switch (DS) is a technically demanding procedure. Both procedures achieve sustainable long-term weight loss. More studies are needed to explore long-term results of various surgical interventions for WR after RYGB.
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| 12. |
- Merkevicius, K., et al.
(författare)
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Microbiome Changes after Type 2 Diabetes Treatment: A Systematic Review
- 2021
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Ingår i: Medicina-Lithuania. - : MDPI AG. - 1010-660X. ; 57:10
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Tidskriftsartikel (refereegranskat)abstract
- Background and objectives: Although the role of the gut microbiome in type 2 diabetes (T2D) pathophysiology is evident, current systematic reviews and meta-analyses analyzing T2D treatment mainly focus on metabolic outcomes. The objective of this study is to evaluate the microbiome and metabolic changes after different types of treatment in T2D patients. Materials and Methods: A systematic search of PubMed, Wiley online library, Science Direct, and Cochrane library electronic databases was performed. Randomized controlled clinical trials published in the last five years that included T2D subjects and evaluated the composition of the gut microbiome alongside metabolic outcomes before and after conventional or alternative glucose lowering therapy were selected. Microbiome changes were evaluated alongside metabolic outcomes in terms of bacteria taxonomic hierarchy, intestinal flora biodiversity, and applied intervention. Results: A total of 16 eligible studies involving 1301 participants were reviewed. Four trials investigated oral glucose-lowering treatment, three studies implemented bariatric surgery, and the rest analyzed probiotic, prebiotic, or synbiotic effects. The most common alterations were increased abundance of Firmicutes and Proteobacteria parallel to improved glycemic control. Bariatric surgery, especially Roux-en-Y gastric bypass, led to the highest variety of changed bacteria phyla. Lower diversity post-treatment was the most significant biodiversity result, which was present with improved glycemic control. Conclusions: Anti-diabetic treatment induced the growth of depleted bacteria. A gut microbiome similar to healthy individuals was achieved during some trials. Further research must explore the most effective strategies to promote beneficial bacteria, lower diversity, and eventually reach a non-T2D microbiome.
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| 13. |
- Olbers, Torsten, 1964, et al.
(författare)
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Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial.
- 2006
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Ingår i: Annals of surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0003-4932. ; 244:5, s. 715-22
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess body composition, eating pattern, and basal metabolic rate in patients undergoing obesity surgery in a randomized trial. INTRODUCTION: There is limited knowledge regarding how different bariatric surgical techniques function in terms of altering body composition, dietary intake, and basic metabolic rate. METHODS: Non-superobese patients were randomized to laparoscopic Roux-en-Y gastric bypass (LGBP, n = 37) or laparoscopic vertical banded gastroplasty (LVBG, n = 46). Anthropometry, dual-energy x-ray absorptiometry (DEXA), computed tomography (CT), indirect calorimetry, and reported dietary intake were registered prior to and 1 year after surgery. RESULTS: Follow-up rate was 97.6%. LGBP patients had significantly greater reduction of waist circumference and sagittal diameter compared with LVBG. DEXA demonstrated a larger reduction of body fat in all compartments after LGBP, especially at the trunk (P<0.001). CT demonstrated more reduction of the visceral fat (P=0.016). Patients were able to eat all types of food after LGBP, although about 30% claimed they avoided fats. LGBP patients decreased their proportion of dietary fat significantly more than those operated on with LVBG (P = 0.005), who consumed more sweet foods and avoided whole meat and vegetables. Lean tissue mass (LTM) was proportionally less reduced, especially in men, after LGBP. The decreases in BMR postoperatively reflected the lower body mass in a pattern that did not differ among the groups. CONCLUSION: LGBP patients demonstrated better outcomes compared with LVBG patients in terms of body composition. Energy expenditure developed as expected postoperatively. A "steering" away from fatty foods after LGBP may be an important mechanism of action in gastric bypass.
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| 14. |
- Olbers, Torsten, 1964, et al.
(författare)
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Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty for obesity.
- 2005
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Ingår i: The British journal of surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 92:5, s. 557-62
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Laparoscopic techniques have been developed for performing Roux-en-Y gastric bypass (LRYGBP) and vertical banded gastroplasty (LVBG) in patients with morbid obesity. It is not certain, however, which is the better technique in non-superobese patients (body mass index less than 50 kg/m(2)). METHODS: Eighty-three patients (LRYGBP 37, LVBG 46) were assessed in a randomized clinical trial. Perioperative complications were recorded together with preoperative and postoperative respiratory function and mobilization rate. Patients were monitored for 2 years after operation with regard to weight change and the need for remedial surgery. RESULTS: There were no conversions to open surgery. The mean operating time was longer for LRYGBP than LVBG (138 versus 105 min). Five early reoperations were performed after LRYGBP (three for haemorrhage, one for ileus and one suspected leak) and one after LVBG (suspected leak). There were no differences in postoperative respiratory function or mobilization. Weight reduction was greater after LRYGBP (excess weight loss 78.3 versus 62.9 per cent 1 year after surgery, P = 0.009; 84.4 versus 59.8 per cent at 2 years, P < 0.001). Remedial surgical intervention was required in eight patients after LVBG (conversion to Roux-en-Ygastric bypass) and none after LRYGBP. CONCLUSION: LRYGBP and LVBG were comparable in terms of operative safety and postoperative recovery, but weight reduction was better after LRYGBP.
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| 15. |
- Ospanov, O., et al.
(författare)
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Gastric greater curvature plication combined with Nissen fundoplication in the treatment of gastroesophageal reflux disease and obesity
- 2016
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Ingår i: Medicina-Lithuania. - : MDPI AG. - 1010-660X. ; 52:5, s. 283-290
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Tidskriftsartikel (refereegranskat)abstract
- Background and aim: Established anti-reflux procedures such as fundoplications are less efficient in obese patients. The aim of this study was to investigate clinical effectiveness of the fundoplication combined with gastric greater curvature plication in the treatment of gastroesophageal reflux disease (GERD) in obese patients. Materials and methods: During the period from June 2010 to September 2014, patients operated for GERD with BMI from 30 to 39.9 kg/m(2) were included into the prospective study. Laparoscopic Nissen fundoplication (LNF, n = 58) was performed until February 2013 and later laparoscopic Nissen fundoplication was combined with gastric greater curvature plication (LNFGP, n = 56). The groups were compared according to the control of GERD and weight loss. Results: In LNF group there were significantly more males, patients had lower BMI and longer duration of GERD symptoms. Duration of surgery was significantly longer in LNFGP group, 96.5 (17.3) min vs. 59.8 (16.1) min (P < 0.0001). Postoperative morbidity was similar, 3.6% and 3.4% in LNFGP and LNF groups, respectively (P = 0.9539). The average percentage of excess BMI loss after 12 months was 45.3 (5.8) in LNFGP group as compared to 18.4 (4.6) in LNF group (P < 0.0001). Significantly more patients experienced remission or improvement of type 2 diabetes mellitus (P = 0.03) and hypercholesterolemia (P = 0.0001) in LNFGP group. No significant differences between the groups in postoperative DeMeester score, GERD-HRQL mean score, overall satisfaction and healing of esophagitis were observed. Conclusions: LNFGP took significantly longer time to perform, but resulted in significantly higher weight reduction and remission/improvement of comorbidities. Both procedures produced similar anti-reflux effect. (C) 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Sp. z o.o.
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| 16. |
- Petereit, R., et al.
(författare)
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Gastrointestinal symptoms and eating behavior among morbidly obese patients undergoing Roux-en-Y gastric bypass
- 2014
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Ingår i: Medicina-Lithuania. - : MDPI AG. - 1010-660X. ; 50:2, s. 118-123
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Tidskriftsartikel (refereegranskat)abstract
- Background and objective: Roux-en-Y gastric bypass (RYGB) changes anatomy and physiology of the gastrointestinal tract, and is followed by gastrointestinal side effects, changes in bowel function and eating behavior. The aim of the present study was to investigate the severity of gastrointestinal symptoms and changes in eating behavior preoperatively and one year after RYGB. Materials and methods: A total of 180 morbidly obese patients who underwent RYGB were included into the prospective study. Gastrointestinal symptoms were evaluated with Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) questionnaire and Gastrointestinal Symptom Rating Scale (GSRS), eating behavior with Three-Factor Eating Questionnaire before and one year after RYGB. For all patients routine gastroscopy before surgery was performed. Results: A total of 99 patients (55%) completed one-year follow-up; 79 (43.9%) patients had no pathological findings on preoperative gastroscopy. GERD-HRQL score and GSRS scores of indigestion, constipation, abdominal pain and reflux decreased significantly after surgery. Male gender (OR = 2.47,95% CI 1.11-5.50, P = 0.026), GERD-HRQL score (OR = 1.28, 95% CI 1.16-1.41, P < 0.001) and GSRS diarrhea score (OR = 1.89, 95% CI 1.10-3.17, P = 0.020) were significant predictors of pathological findings on gastroscopy. Eating behavior one year after RYGB changed significantly as compared to baseline. Cognitive Restraint postoperatively has increased from 42.6 to 55.9 (P <0.001). Uncontrolled Eating and Emotional Eating one year after surgery significantly decreased (59.1 vs. 20.6, P < 0.001 and 28.2 vs. 17.2, P < 0.001, respectively). Conclusions: In morbidly obese patients endoscopic findings correlate well with gastrointestinal complain. RYGB significantly improves gastrointestinal complains and eating behavior one year postoperatively. (c) 2014 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
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| 17. |
- Ramoniene, G., et al.
(författare)
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Maternal obesity and obstetric outcomes in a tertiary referral center
- 2017
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Ingår i: Medicina-Lithuania. - : MDPI AG. - 1010-660X. ; 53:2, s. 109-113
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Tidskriftsartikel (refereegranskat)abstract
- Background and aim: Obese women are at an increased risk of various adverse pregnancy outcomes. The aim of our study was to evaluate the impact of obesity on maternal and neonatal outcomes in a tertiary referral center and to compare obstetric outcomes by the level of maternal obesity. Materials and methods: A cohort study included 3247 women with singleton gestations who gave birth at the Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, in 2010. Pregnancy complications and neonatal outcomes were identified using the hospital Birth Registry database in normal weight (body mass index [BMI] 18.5-24.9 kg/m(2), n = 3107) and prepregnancy obese (BMI >= 30 kg/m(2), n = 140) women. Pregnancy outcomes were compared according to the level of obesity (BMI 30-34.9 kg/m(2), n = 94 and BMI kg/m(2), n = 46). Results: Obese women were significantly more likely to have gestational hypertension (OR = 8.59; 95% CI, 5.23-14.14; P < 0.0001), preeclampsia (OR = 2.06; 95% CI, 1.14-3.73; P < 0.0001), gestational diabetes (OR = 5.56; 95% CI, 3.66-8.49; P < 0.0001), dystocia (OR = 2.14; 95% CI, 1.36-3.38; P < 0.0001), induced labor (OR = 2.64; 95% CI, 1.83-3.80; P < 0.0001), failed induction of labor (OR = 18.06; 95% CI, 8.85-36.84; P < 0.0001), cesarean delivery (OR = 1.76; 95% CI, 1.25-2.49; P = 0.001), large-for-gestational-age newborns (OR = 3.68; 95% CI, 2.51-5.39; P < 0.0001). Significantly increased risk of gestational diabetes, preeclampsia, dystocia and newborns with Apgar score <= 7 after 5 min was only observed in women with BMI >= 35 kg/m(2). Conclusions: Maternal obesity is significantly associated with an increased risk of gestational hypertension, preeclampsia, gestational diabetes, dystocia, labor induction, failed induction of labor, large-for-gestational-age newborns and cesarean delivery. (C) 2017 The Lithuanian University of Health Sciences.
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| 18. |
- Sinclair, P., et al.
(författare)
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First Inventory of Access and Quality of Metabolic Surgery Across Europe
- 2021
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 31, s. 5196-5206
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Europe consists of 51 independent countries. Variation in healthcare regulations results in differing challenges faced by patients and professionals. This study aimed to gain more insight into the accessibility, patient pathway and quality indicators of metabolic and body contouring surgery. Methods and Materials Expert representatives in the metabolic field from all 51 countries were sent an electronic self-administered online questionnaire on their data and experiences from the previous year exploring accessibility to and quality indicators for metabolic surgery and plastic surgery after weight loss. Results Forty-five responses were collected. Sixty-eight percent of countries had eligibility criteria for metabolic surgery; 59% adhered to the guidelines. Forty-six percent had reimbursement criteria for metabolic surgery. Forty-one percent had eligibility criteria for plastic surgery and 31% reimbursement criteria. Average tariffs for a metabolic procedure varied (sic)800 to 16,000. MDTs were mandated in 78%, with team members varying significantly. Referral practices differed. In 45%, metabolic surgery is performed by pure metabolic surgeons, whilst re-operations were performed by a metabolic surgeon in 28%. A metabolic training programme was available in 23%. Access to metabolic surgery was rated poor to very poor in 33%. Thirty-five percent had a bariatric registry. Procedure numbers and numbers of hospitals performing metabolic surgery varied significantly. Twenty-four percent of countries required a minimum procedure number for metabolic centres, which varied from 25 to 200 procedures. Conclusion There are myriad differences between European countries in terms of accessibility to and quality indicators of metabolic surgery. Lack of funding, education and structure fuels this disparity. Criteria should be standardised across Europe with clear guidelines.
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| 19. |
- Venclauskas, Linas, et al.
(författare)
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Is transcatheter arterial embolization a safer alternative than surgery when endoscopic therapy fails in bleeding duodenal ulcer?
- 2010
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 45:3, s. 299-304
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Emergency surgery after unsuccessful endoscopic therapy for bleeding duodenal ulcer has been reported to have a high mortality. Transcatheter arterial embolization (TAE) of the gastroduodenal artery is an alternative strategy when endoscopic therapy fails. This study is a retrospective analysis comparing these two treatment strategies. MATERIAL AND METHODS: Patients who underwent TAE (n = 24) or open surgery (n = 50) after unsuccessful endoscopic therapy for bleeding duodenal ulcers at two university hospitals between 2000 and 2007 were compared. Mortality, morbidity, length of hospital stay, age, number of endoscopic interventions and acute physiology and chronic health evaluation (APACHE) II score were evaluated. RESULTS: The groups were comparable concerning gender and length of hospital stay. The mean age (69.6 +/- 16.1 versus 61.9 +/- 14.1 years; P = 0.043), APACHE II score (17.0 +/- 5.1 versus 12.8 +/- 5.7; P = 0.004) and number of gastroscopies (P = 0.009) were significantly higher in the embolization group. Five patients (20.8%) died in the embolization group compared to 11 (22%) in the surgery group. However, mortality in high-risk patients (APACHE II score >or= 16.5) was lower in the TAE group (23.1% versus 50.0%; P = 0.236). Method-related as well as other complications were not significantly different between the two groups. There was, however, a higher re-bleeding rate in the TAE group. CONCLUSIONS: TAE of the gastroduodenal artery appears to be a safe alternative when endoscopic therapy for bleeding duodenal ulcer fails, at least in high-risk patients. The role of TAE in low-risk patients with bleeding from duodenal ulcer needs to be defined by means of a prospective controlled trial.
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| 20. |
- Wallenius, Ville, 1970, et al.
(författare)
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Glycemic Control after Sleeve Gastrectomy and Roux-En-Y Gastric Bypass in Obese Subjects with Type 2 Diabetes Mellitus
- 2018
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 28:6, s. 1461-1472
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Tidskriftsartikel (refereegranskat)abstract
- Roux-en-Y gastric bypass (LRYGB) has weight-independent effects on glycemia in obese type 2 diabetic patients, whereas sleeve gastrectomy (LSG) is less well characterized. This study aims to compare early weight-independent and later weight-dependent glycemic effects of LRYGB and LSG. Eighteen LRYGB and 15 LSG patients were included in the study. Glucose, insulin, GLP-1, and GIP levels were monitored during a modified 30 g oral glucose tolerance test before surgery and 2 days, 3 weeks, and 12 months after surgery. Patients self-monitored glucose levels 2 weeks before and after surgery. Postoperative fasting blood glucose decreased similarly in both groups (LRYGB vs. SG; baseline-8.1 +/- 0.6 vs. 8.2 +/- 0.4 mmol/l, 2 days-7.8 +/- 0.5 vs. 7.4 +/- 0.3 mmol/l, 3 weeks-6.6 +/- 0.4 vs. 6.6 +/- 0.3 mmol/l, respectively, P < 0.01 vs. baseline for both groups; 12 months-6.6 +/- 0.4 vs. 5.9 +/- 0.4, respectively, P < 0.05 for LRYGB and P < 0.001 for LSG vs. baseline, P = ns between the groups at all times). LSG, but not LRYGB, showed increased peak insulin levels 2 days postoperatively (mean +/- SEM; LSG + 58 +/- 14%, P < 0.01; LRYGB - 8 +/- 17%, P = ns). GLP-1 levels increased similarly at 2 days, but were higher in LRYGB at 3 weeks (AUC; 7525 +/- 1258 vs. 4779 +/- 712 pmol x min, respectively, P < 0.05). GIP levels did not differ. Body mass index (BMI) decreased more after LRYGB than LSG (- 10.1 +/- 0.9 vs. - 7.9 +/- 0.5 kg/m(2), respectively, P < 0.05). LRYGB and LSG show very similar effects on glycemic control, despite lower GLP-1 levels and inferior BMI decrease after LSG.
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| 21. |
- Wallenius, Ville, 1970, et al.
(författare)
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Sleeve gastrectomy and Roux-en-Y gastric bypass in the treatment of type 2 diabetes. Two-year results from a Swedish multicenter randomized controlled trial
- 2020
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier BV. - 1550-7289. ; 16:8, s. 1035-1044
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obesity is a world-wide epidemic and it is a risk factor for type 2 diabetes (T2D). Few randomized controlled studies have compared the 2 most common surgical procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in the treatment of obese patients with T2D. Objectives: To compare diabetes remission rates (glycosylated hemoglobin <= 6.0%, without diabetes medications) in obese T2D patients (body mass index, 35-50) undergoing RYGB or SG. Setting: Three University Hospital clinics and 1 Regional Hospital in Sweden. Methods: Forty-nine patients with T2D were included. Twenty-five were randomized to RYGB and 24 to SG. There was no difference between groups regarding patient characteristics, duration of T2D, overall usage of antidiabetic medications, or glycosylated hemoglobin levels. All patients (100%) completed 1-year follow-up and 47 (95.9%) 2-year follow-up. Results: Remission of T2D was not significantly different between the RYGB and SG, reaching 44% and 46% (n = 25 and n = 24, respectively, P = .897, power = .80) at 1 year, and 48% and 55% (n = 25 and n = 22, respectively, P = .654) at 2 years of follow-up. Similarly, mean glycosylated hemoglobin was improved in both groups at 1 and 2 years, with no significant differences between the groups (RYGB baseline versus 1 yr; mean +/- standard deviation: 7.9 +/- 1.5 versus 5.8 +/- .6%, P < .0001; versus 2 yr: 5.9 +/- .7%, P < .0001; SG baseline versus 1 yr: 8.2 +/- 1.9 versus 5.9 +/- .7%, P < .0001; versus 2 yr: 5.9 +/- 1.1%, P < .0001). Total weight loss was not different but percentage excess weight loss was higher after RYGB compared with SG both at 1 and 2 years; mean +/- standard deviation: 78 +/- 22 versus 60 +/- 22%, and 76 +/- 24 versus 54 +/- 21%, respectively (P < .01 for both). Waist circumference also decreased significantly more in the RYGB group. Conclusions: Despite superior excess weight loss after RYGB, T2D remission rates did not differ significantly between RYGB and SG after 2 years. Long-term follow-up data are needed to define the role of SG in the treatment of patients with obesity and T2D. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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| 22. |
- Zelenyte, V., et al.
(författare)
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Body size perception, knowledge about obesity and factors associated with lifestyle change among patients, health care professionals and public health experts
- 2021
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Ingår i: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background The attitudes towards obesity may have an important role on healthier behavior. The goal of the present study was to explore the attitudes towards obesity and to investigate how these attitudes were associated with lifestyle-changing behavior among the patients attending primary care centers, health care professionals and public health experts. Methods This cross-sectional survey study was performed in 10 primary care offices in different regions in Lithuania and in 2 public health institutions. Nine hundred thirty-four patients, 97 nurses, 65 physicians and 30 public health experts have filled the questionnaire about attitudes towards obesity and presented data about lifestyle-changing activities during last 12 months. The attitudes were compared between different respondent groups and factors associated with healthier behaviors were analyzed among overweight/obese individuals in our study population. Results Participants failed to visually recognize correct figure corresponding to male and female with obesity. Majority of respondents' perceived obesity as a risk factor for heart diseases and diabetes but had less knowledge about other diseases associated with weight. About one third of respondents changed their lifestyle during last 12 months. Overweight individuals with age < 45 years (OR 1.64, 1.06-2.55; p = 0.025) were more likely and those who overestimated current weight (OR 0.44, 0.20-0.96; p = 0.036) less likely to change their lifestyle. Disappointment with their current weight (OR 2.57, 1.36-4.84; p = 0.003) was associated with healthier behavior among participants with obesity. Conclusion Participants had similar body size perception and knowledge about obesity. Younger age had significant association with lifestyle changing behavior among overweight individuals and disappointment with current weight among obese participants.
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