| 1. |
- Biörserud, Christina, et al.
(författare)
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Experience of excess skin after gastric bypass or duodenal switch in patients with super obesity.
- 2014
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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. ; 10:5, s. 891-896
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of knowledge about the patient's experience of excess skin after bariatric surgery in patients with body mass index, (BMI)>50 kg/m(2). The objective of this study was to evaluate experience of excess skin after laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) or laparoscopic Roux-en-Y gastric bypass (LRYGB) and explore possible gender differences. Another aim was to analyze possible correlation between the reported experiences of excess skin with changes in weight, BMI, and hip and waist circumference after surgery.
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| 2. |
- Biörserud, Christina, et al.
(författare)
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Patients' Experience of Surplus Skin After Laparoscopic Gastric Bypass.
- 2011
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Ingår i: Obesity surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies have described that many obese patients who undergo bariatric surgery develop surplus skin. However, there is a lack of knowledge about where on the body the problems are located and to what extent surplus skin affects the person. The aim of this study was to examine whether and where patients develop surplus skin after laparoscopic gastric bypass and if there is any relation between surplus skin and the patient's sex, age, weight loss, or activity level. MATERIALS AND METHODS: A questionnaire was constructed which included questions about surplus skin. The questionnaire was sent to 148 patients who had been operated with laparoscopic gastric bypass. One hundred and twelve (76%) responded of whom 77 were women and 35 men. RESULTS: At follow-up, 94 persons (84%) reported problems with surplus skin. The surplus skin was situated most commonly on the abdomen, the upper arms, and the inside of the thighs, but also on the back, the cheek and over the knees. Significantly, more women than men reported complications with surplus skin (p = 0.018), distributed over more body parts, specifically on the upper arms, medial thigh, and lateral back (p < 0.05). The surplus skin caused problems with fungal infections and itching, physical unpleasantness and complicated physical activity. There was no correlation between degree of problems with surplus skin and age, weight loss, or activity rate. DISCUSSION: Weight loss after gastric bypass reduces the medical risks of obesity but the psychosocial problems remain in many patients due to problems with surplus skin.
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| 3. |
- Biörserud, Christina, et al.
(författare)
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Sahlgrenska Excess Skin Questionnaire (SESQ): A reliable questionnaire to assess the experience of excessive skin after weight loss.
- 2013
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Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 47:1, s. 50-59
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Tidskriftsartikel (refereegranskat)abstract
- Abstract There is a lack of knowledge and reliable measurement instruments to assess excess skin after massive weight loss. The purpose of this study was to test the reliability of a new self-administered questionnaire. A self-administered questionnaire, the Sahlgrenska Excess Skin Questionnaire (SESQ) was designed to assess excess skin after weight loss. The questionnaire includes 30 questions about demographic data, activity and daily life and excess skin on specific body parts and the body as a whole. Forward and backward translations were made by two independent professional translators, from Swedish to English and then back to Swedish. The questionnaire was tested on 10 patients from Sweden and England and was followed by an interview with each patient. Minor corrections were made. A test-retest was carried out to evaluate the reliability by sending the Swedish questionnaire to 46 subjects with weight loss after obesity surgery, dieting, or medication. The test-retest reliability of questions concerning activity and daily life between the two occasions had a Percentage Of Agreement (POA) of 49%-76% and a weighted Kappa of 0.44-0.78. The questions about the degree of excess skin on specific body parts had a POA of 50%-76% and a weighted Kappa of 0.53-0.81. Excess skin perceived as causing problems had a POA of 32%-57 %, an adjusted POA of 63%-87%, and an Intra-Class Correlation of 0.72-0.92. The SESQ is reliable for evaluating patients' experience of excess skin after massive weight loss.
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| 4. |
- Björklund, Per, et al.
(författare)
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Is the roux limb a determinant for meal size after gastric bypass surgery?
- 2010
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Ingår i: Obesity surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 20:10, s. 1408-14
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Tidskriftsartikel (refereegranskat)abstract
- The Roux-Y gastric bypass (RYGBP) is an effective weight-reducing procedure but the involved mechanisms of action are obscure. The Roux limb is the intestinal segment that following surgery is the primary recipient for food intake. The aims of the study were to explore the mechanosensory and biomechanical properties of the Roux limb and to make correlations with preferred meal size. Ten patients participated and were examined preoperatively, 6weeks and 1year after RYGBP. Each subject ingested unrestricted amounts of a standardized meal and the weight of the meal was recorded. On another study day, the Roux limb was subjected to gradual distension by the use of an intraluminal balloon. Luminal volume-pressure relationships and thresholds for induction of sensations were monitored. At 6weeks and 1year post surgery, the subjects had reduced their meal sizes by 62% and 41% (medians), respectively, compared to preoperative values. The thresholds for eliciting distension-induced sensations were strongly and negatively correlated to the preferred meal size. Intraluminal pressure during Roux limb distension, both at low and high balloon volumes, correlated negatively to the size of the meal that the patients had chosen to eat. The results suggest that the Roux limb is an important determinant for regulating food intake after Roux-Y bypass bariatric surgery.
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| 5. |
- Bueter, Marco, et al.
(författare)
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Gastric bypass increases energy expenditure in rats.
- 2010
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Ingår i: Gastroenterology. - : Elsevier BV. - 1528-0012 .- 0016-5085. ; 138:5, s. 1845-53
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Mechanisms underlying weight loss maintenance after gastric bypass are poorly understood. Our aim was to examine the effects of gastric bypass on energy expenditure in rats. METHODS: Thirty diet-induced obese male Wistar rats underwent either gastric bypass (n = 14), sham-operation ad libitum fed (n = 8), or sham-operation body weight-matched (n = 8). Energy expenditure was measured in an open circuit calorimetry system. RESULTS: Twenty-four-hour energy expenditure was increased after gastric bypass (4.50 +/- 0.04 kcal/kg/h) compared with sham-operated, ad libitum fed (4.29 +/- 0.08 kcal/kg/h) and sham-operated, body weight-matched controls (3.98 +/- 0.10 kcal/kg/h, P < .001). Gastric bypass rats showed higher energy expenditure during the light phase than sham-operated control groups (sham-operated, ad libitum fed: 3.63 +/- 0.04 kcal/kg/h vs sham-operated, body weight-matched: 3.42 +/- 0.05 kcal/kg/h vs bypass: 4.12 +/- 0.03 kcal/kg/h, P < .001). Diet-induced thermogenesis was elevated after gastric bypass compared with sham-operated, body weight-matched controls 3 hours after a test meal (0.41% +/- 1.9% vs 10.5% +/- 2.0%, respectively, P < .05). The small bowel of gastric bypass rats was 72.1% heavier because of hypertrophy compared with sham-operated, ad libitum fed rats (P < .0001). CONCLUSIONS: Gastric bypass in rats prevented the decrease in energy expenditure after weight loss. Diet-induced thermogenesis was higher after gastric bypass compared with body weight-matched controls. Raised energy expenditure may be a mechanism explaining the physiologic basis of weight loss after gastric bypass.
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| 6. |
- Bueter, Marco, et al.
(författare)
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Vagal sparing surgical technique but not stoma size affects body weight loss in rodent model of gastric bypass.
- 2010
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Ingår i: Obesity surgery. - : Springer Science and Business Media LLC. - 1708-0428 .- 0960-8923. ; 20:5, s. 616-22
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to evaluate whether gastric bypass with or without vagal preservation resulted in a different outcome. METHODS: Body weight, food intake and postprandial peptide YY (PYY) and glucagon-like peptide (GLP-1) levels were compared between gastric bypass (n = 55) and sham-operated rats (n = 27) in three groups. In group 1 (n = 17), the vagal nerve was not preserved, while in group 2 the vagal nerve was preserved during gastric bypass (n = 10). In group 3, gastric bypass rats (n = 28) were randomised for either one of the two techniques. RESULTS: Rats in which the vagal nerve was preserved during gastric bypass showed a lower body weight (p < 0.001) and reduced food intake (p < 0.001) compared to rats in which the vagal nerve was not preserved during the gastric bypass operation. Levels of PYY and GLP-1 were significantly increased after gastric bypass compared to sham-operated controls (p < 0.05), but there was no difference between gastric bypass rats with and without vagal preservation. Differences in food intake and body weight were not related to the size of the gastro-jejunostomy in gastric bypass rats. There were no signs of malabsorption or inflammation after gastric bypass. CONCLUSION: We propose that the vagal nerve should be preserved during the gastric bypass operation as this might play an important role for the mechanisms that induce weight loss and reduce food intake in rats. In contrast, the gastro-jejunal stoma size was found to be of minor relevance.
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| 7. |
- Delling, Lotta, et al.
(författare)
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Feasibility of bariatric surgery as a strategy for secondary prevention in cardiovascular disease: a report from the Swedish obese subjects trial.
- 2010
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Ingår i: Journal of obesity (Online). - : Hindawi Limited. - 2090-0716 .- 2090-0708. ; 2010
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Forskningsöversikt (refereegranskat)abstract
- Aims. Evaluation of bariatric surgery as secondary prevention in obese patients with ischemic heart disease (IHD). Methods. Analysis of data from 4047 subjects in the Swedish Obese Subjects (SOSs) study. Thirty-five patients with IHD are treated with bariatric surgery (n = 21) or conventional treatment (n = 14). Mean follow-up is 10.8 years. Results. Bariatric surgery resulted in sustained weight loss during the study period. After 2 years, the surgery group displayed significant reductions in cardiovascular risk factors, relief from cardiorespiratory symptoms, increments in physical activity, and improved quality of life. After 10 years, recovery from hypertension, diabetes, physical inactivity, and depression was still more common in the surgery group. There were no signs of increased cardiovascular morbidity or mortality in the surgery group. Conclusion. Bariatric surgery appears to be a safe and feasible treatment to achieve long-term weight loss and improvement in cardiovascular risk factors, symptoms, and quality of life in obese subjects with IHD.
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| 8. |
- Elias, Erik, 1979, et al.
(författare)
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Bone mineral density and expression of vitamin D receptor-dependent calcium uptake mechanisms in the proximal small intestine after bariatric surgery
- 2014
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 101:12, s. 1566-1575
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Tidskriftsartikel (refereegranskat)abstract
- Background Roux-en-Y gastric bypass may lead to impaired calcium uptake. Therefore, operation-specific effects of gastric bypass and vertical banded gastroplasty on bone mineral density (BMD) were examined in a randomized clinical trial. Bone resorption markers and mechanisms of decreased calcium uptake after gastric bypass were investigated using blood and endoscopic samples from two additional patient cohorts. Methods Total BMD and non-weight-bearing skull BMD were measured by dual-energy X-ray absorptiometry at baseline, and 1 and 6years after gastric bypass or vertical banded gastroplasty in patients who were not receiving calcium supplements. Bone resorption markers in serum and calcium uptake mechanisms in jejunal mucosa biopsies were analysed after gastric bypass by proteomics including radioimmunoassay, gel electrophoresis and mass spectrometry. Results One year after surgery, weight loss was similar after gastric bypass and vertical banded gastroplasty. There was a moderate decrease in skull BMD after gastric bypass, but not after vertical banded gastroplasty (P<0·001). Between 1 and 6years after gastric bypass, skull BMD and total BMD continued to decrease (P=0·001). C-terminal telopeptide levels in serum had increased twofold by 18months after gastric bypass. Proteomic analysis of the jejunal mucosa revealed decreased levels of heat-shock protein 90β, a co-activator of the vitamin D receptor, after gastric bypass. Despite increased vitamin D receptor levels, expression of the vitamin D receptor-regulated calcium transporter protein TRPV6 decreased. Conclusion BMD decreases independently of weight after gastric bypass. Bone loss might be attributed to impaired calcium absorption caused by decreased activation of vitamin D-dependent calcium absorption mechanisms mediated by heat-shock protein 90β and TRPV6.
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| 9. |
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| 10. |
- Göthberg, Gunnar, et al.
(författare)
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Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid obesity-Surgical aspects and clinical outcome.
- 2014
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Ingår i: Seminars in pediatric surgery. - : Elsevier BV. - 1532-9453 .- 1055-8586. ; 23:1, s. 11-16
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Tidskriftsartikel (refereegranskat)abstract
- In this paper, we address surgical aspects on bariatric surgery in adolescents from a nationwide Swedish study. Laparoscopic gastric bypass surgery was performed for 81 adolescents with morbid obesity (13-18 years), while 81 adolescents with obesity-matched by age, sex, and BMI received conventional care. Another comparison group was adults undergoing gastric bypass at the same institution during the same time period. This report addresses the 2-year clinical outcome and five-year surgical adverse event rate. Body weight decreased from 133kg (SD = 22) at inclusion to 92kg (SD = 17) after 1 year and was 89 (SD = 18) after 2 years (p < 0·001) representing a 32% (-35 to -30) weight loss after 2 years, corresponding to 76% (-81 to -71) excess weight loss. Weight loss was similar in the adult gastric bypass patients (-31%) while weight gain (+3%) was seen in the conventionally treated obese adolescents. Significant improvement in cardiovascular and metabolic risk factors and inflammation was seen after surgery. The treatment was generally well tolerated and quality of life improved significantly. The surgical adverse events included cholecystectomies (10%) and operations for internal hernia (9%) but no postoperative mortality. Adolescents undergoing laparoscopic gastric bypass surgery achieve similar weight loss to adults. Improvements in risk factors and quality of life were substantial. There were surgical complications similar to the adult group, which may be preventable.
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