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Objective@#To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected. LGP and DJOS were performed in two-stages after completion of preoperative examinations. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI), insulin therapy, and long-term complications until December 2018. Count data were represented as absolute numbers.@*Results@#(1) Surgical and postoperative situations: the patient underwent LGP in the first stage and DJOS in the second stage successfully. For the LGP, the operation time, time of intestinal reconstruction, volume of intraoperative blood loss, time to first flatus, time to drainage tube removal, time to resume to normal diet, and duration of postoperative hospital stay were 96 minutes, 58 minutes, 210 mL, 32 hours, 48 hours, 42 days, and 3 days, respectively. For the DJOS, the above indicators were 148 minutes, 117 minutes, 260 mL, 47 hours, 72 hours, 21 days, and 7 days, respectively. There was no complication occurred in either LGP or DJOS. (2) Follow-up: the patient was followed up for 24 months after LGP. The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP, and decreased to 37.2 kg/m2 at 18 months after DJOS. Insulin therapy was discontinued. There was no long-term complication such as malnutrition, dumping syndrome, or biliary reflux.@*Conclusion@#LGP combined with DJOS can enrich treatment methods of obese patient with BMI >50 kg/m2, which offers a safer surgical procedure option for patients after gastric binding.
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Objective To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding.Methods The retrospective and descriptive study was conducted.The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected.LGP and DJOS were performed in two-stages after completion of preoperative examinations.Observation indicators:(1) surgical and postoperative situations;(2) follow-up.Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI),insulin therapy,and long-term complications until December 2018.Count data were represented as absolute numbers.Results (1) Surgical and postoperative situations:the patient underwent LGP in the first stage and DJOS in the second stage successfully.For the LGP,the operation time,time of intestinal reconstruction,volume of intraoperative blood loss,time to first flatus,time to drainage tube removal,time to resume to normal diet,and duration of postoperative hospital stay were 96 minutes,58 minutes,210 mL,32 hours,48 hours,42 days,and 3 days,respectively.For the DJOS,the above indicators were 148 minutes,117 minutes,260 mL,47 hours,72 hours,21 days,and 7 days,respectively.There was no complication occurred in either LGP or DJOS.(2) Follow-up:the patient was followed up for 24 months after LGP.The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP,and decreased to 37.2 kg/m2 at 18 months after DJOS.Insulin therapy was discontinued.There was no long-term complication such as malnutrition,dumping syndrome,or biliary reflux.Conclusion LGP combined with DJOS can enrich treatment methods of obese patient with BMI ＞50 kg/m2,which offers a safer surgical procedure option for patients after gastric binding.
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This study was performed to investigate the effect of gastric banding surgery on the improvement of glycated hemoglobin (HbA(1c)) of morbidly obese (MO) patients with type 2 diabetes mellitus (T2DM) with the consideration that obesity was associated with insulin resistance and T2DM. We retrospectively reviewed the medical records of 38 MO with T2DM patients and 50 MO patients. Pre-surgery and post-surgery data were analyzed a year later. The medical data from these patients, including sex, age, height, weight, body composition, HbA(1c), triglyceride, total cholesterol, aspartate transaminase (AST), and alanine transaminase (ALT) were measured. There were significant reductions of body weight and body mass index (BMI), body fat, body fat percentage, waist-hip ratio, visceral fat, and obesity in each group before and after gastric banding surgery. Results of AST, ALT, and HbA(1c) had significant reductions in each group. For HbA(1c), treatment rate was 71% in the MO group with T2DM with significant reduction of 22.8%. It is thought that a gastric banding surgery is one of the breakthrough methods not only for weight loss but also for the prevention of complication of the obese patients with T2DM. Thus, gastric banding surgery could be effective in controlling HbA(1c) in obese patients with type 2 diabetes mellitus.
Subject(s)
Humans , Adipose Tissue , Alanine Transaminase , Aspartate Aminotransferases , Body Mass Index , Body Weight , Cholesterol , Diabetes Mellitus, Type 2 , Glycated Hemoglobin , Insulin Resistance , Intra-Abdominal Fat , Medical Records , Obesity , Retrospective Studies , Triglycerides , Waist-Hip Ratio , Weight LossABSTRACT
ABSTRACT Background: Roux-en-Y gastric bypass (RYGB) is a standard therapy in bariatric surgery. Sleeve gastrectomy and gastric banding, although with good results in the literature, are showing higher rates of treatment failure to reduce obesity-associated morbidity and body weight. Other problems after bariatric may occur, as band erosion, gastroesophageal reflux disease and might be refractory to medication. Therefore, a laparoscopic conversion to a RYGB can be an effective alternative, as long as specific indications for revision are fulfilled. Objective: The objective of this study was to analyse own and literature data on revisional bariatric procedures to evaluate best alternatives to current practice. Methods: Institutional experience and systematic review from the literature on revisional bariatric surgery. Results: Endoscopic procedures are recently applied to ameliorate failure and complications of bariatric procedures. Therapy failure following RYGB occurs in up to 20%. Transoral outlet reduction is currently an alternative method to reduce the gastrojejunal anastomosis. The diameter and volume of sleeve gastrectomy can enlarge as well, which can be reduced by endoscopic full-thickness sutures longitudinally. Dumping syndrome and severe hypoglycemic episodes (neuroglycopenia) can be present in patients following RYGB. The hypoglycemic episodes have to be evaluated and usually can be treated conventionally. To avoid partial pancreatectomy or conversion to normal anatomy, a new laparoscopic approach with remnant gastric resection and jejunal interposition can be applied in non-responders alternatively. Hypoglycemic episodes are ameliorated while weight loss is sustained. Conclusion: Revisional and endoscopic procedures following bariatric surgery in patients with collateral symptomatic or treatment failure can be applied. Conventional non-surgical approaches should have been applied intensively before a revisional surgery will be indicated. Former complex surgical revisional procedures are evolving to less complicated endoscopic solutions.
RESUMO Racional: Bypass gástrico em Y-de-Roux (BGYR) é procedimento padrão em cirurgia bariátrica. Gastrectomia vertical e banda gástrica, embora com bons resultados na literatura, estão mostrando taxas mais elevadas de insucesso no tratamento para reduzir a morbidade associada à obesidade e peso corporal. Outros problemas pós-operatórios podem ocorrer, como a erosão da banda, e doença do refluxo gastroesofágico refratária à medicação. Portanto, conversão laparoscópica para BGYR pode ser alternativa eficaz, desde que indicações específicas para a revisão sejam cumpridas. Objetivo: Analisar os nossos dados e os da literatura sobre procedimentos bariátricos revisionais para avaliar melhores alternativas para a prática atual. Métodos: Foram efetuados experiência institucional e revisão sistemática da literatura sobre cirurgia bariátrica revisional. Resultados: Procedimentos endoscópicos estão sendo aplicados recentemente para melhorar a falha e complicações de procedimentos bariátricos. Falha terapêutica após BGYR ocorre em até 20%. A redução transoral é atualmente um método alternativo para reduzir a anastomose gastrojejunal. A gastrectomia vertical pode apresentar aumento de volume e do diâmetro do pouch , o qual podem ser reduzidos por meio de sutura total endoscópica longitudinal. Síndrome de dumping e episódios de hipoglicemia grave (neuroglicopenia) podem estar presentes nos pacientes com BGYR. Os episódios hipoglicêmicos devem ser avaliados e geralmente podem ser tratados convencionalmente. Para evitar pancreatectomia parcial ou conversão à anatomia normal, uma nova abordagem laparoscópica com ressecção do remanescente gástrico e interposição de jejuno, pode ser aplicada como alternativa em não-respondedores. Episódios de hipoglicemia melhoram, enquanto a perda de peso é mantida. Conclusão: Procedimentos revisionais endoscópicos podem ser aplicados após cirurgia bariátrica em pacientes com sintomas colaterais ou na falha do tratamento. Abordagens convencionais não-cirúrgicas devem ser aplicadas intensivamente antes que uma operação revisional seja indicada. Antigos procedimentos cirúrgicos revisionais complexos estão evoluindo para soluções endoscópicas menos complicadas.
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Recently, the number of laparoscopic adjustable gastric banding surgery is increasing as is the number of patients with morbid obesity rapidly. However, no anesthetic management including preoperative fasting strategy for patients with laparoscopic adjustable gastric banding exists. Hereby, we report a case of a 22-year-old woman with laparoscopic adjustable gastric banding who suffered pulmonary aspiration during the anesthetic induction for appendectomy, despite a preoperative fasting period longer than 14 h. This case strongly suggests that guidelines for anesthetic management including the appropriate fasting period for patients with laparoscopic adjustable gastric banding are desperately required.
Subject(s)
Female , Humans , Young Adult , Appendectomy , Fasting , Obesity, Morbid , Patient Safety , Pneumonia, AspirationABSTRACT
PURPOSE: This study aimed to compare amount of weight loss, serum laboratory results, and bariatric analysis and reporting outcome system (BAROS) scores obtained before surgery with those obtained 1 year after laparoscopic adjustable gastric banding (AGB). MATERIALS AND METHODS: From January 2013 to November 2014, 32 consecutive patients who underwent AGB were enrolled in this study. This study was a retrospective analysis of our prospectively collected database. The BAROS score included BAROS weight, medical condition, quality of life, and complications recorded 1 year after AGB. Demographic and post-operative data were also collected and analyzed. RESULTS: Thirty-two patients were enrolled in this study, comprising 26 women and 6 men, with an average body mass index of 39.0±6.1 kg/m². The total BAROS score 1 year post AGB was 4.6±1.7, and it was classified as excellent grade. Among them, the quality of life score was 1.8±0.6. Four minor complications were noted. The serum laboratory values improved 1 year post surgery, including hemoglobin A1c, c-peptide, insulin, Homeostatic model assessment of estimated insulin resistance (HOMA IR), Homeostatic model assessment of beta-cell function (HOMA B), triglyceride, total protein, and uric acid. CONCLUSION: AGB showed that it is acceptable in aspect of BAROS outcome as well as weight loss, and serum laboratory result in short-term period.
Subject(s)
Female , Humans , Male , Bariatric Surgery , Body Mass Index , C-Peptide , Insulin , Insulin Resistance , Prospective Studies , Quality of Life , Retrospective Studies , Triglycerides , Uric Acid , Weight LossABSTRACT
As the epidemic of morbid obesity has been rising globally over the decade, bariatric surgery has also been grown to manage obesity and its comorbidities. Besides of its safety, laparoscopic adjustable gastric banding (LAGB) has been known to be more effective in handling obesity with regard to weight loss and its long-term sustainability, compared to medical treatments. Failure of LAGB, defined as either the unsatisfactory weight loss or the development of major long-term complications, results in revision or removal of gastric band. After explantation of gastric band, rebanding or conversion into other bariatric surgeries such as Roux-en-Y gastric bypass or sleeve gastrectomy is required in terms of maintaining weight loss. Major cause of band removal alone is psychogenic factors like patients' anxiety or feeing discomfort without anatomic problems. In Korea there has been grown of patients' vague demand to remove their gastric band regarding the death of a celebrity. Considering such trend, in order to prevent indiscriminate finish of the treatment, suggestion of appropriate time for gastric band removal on the basis of analyzing the course of weight loss and the occurrence of complications is essential.
Subject(s)
Anxiety , Bariatric Surgery , Comorbidity , Fees and Charges , Gastrectomy , Gastric Bypass , Korea , Obesity , Obesity, Morbid , Weight LossABSTRACT
Esophageal and gastric pouch dilatations are common complications that occur after laparoscopic adjustable gastric banding, often performed to treat morbid obesity. Most cases are treated by a gastric band deflation or a removal of band. Nevertheless, additional surgical procedures are rarely ever needed to treat persistent dysphagia and pouch dilatation. We report here, the case of a 38-year-old woman with constant vomiting and severe persistent epigastric pain despite the gastric band deflation, and a band scar stenosis, treated via laparoscopic conversion sleeve gastrectomy. Surgical band scar revision, or revision sleeve gastrectomy, may be considered if gastric pouch dilation and dysphagia are not treated by gastric band deflation.
Subject(s)
Adult , Female , Humans , Cicatrix , Constriction, Pathologic , Deglutition Disorders , Dilatation , Esophagitis, Peptic , Gastrectomy , Obesity, Morbid , VomitingABSTRACT
Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure which has a low morbidity and mortality rate in the immediate postoperative period along with a good weight loss. It is necessary for weight loss to adjust gastric band with calibration. Sometimes, patients performed LAGB experienced vomiting, regurgitation, and epigastric discomfort by over-filling. But to the contrary, we may meet patients who do not feel early satiety in the face of over-filling. We report here, the case of a 24-year-old woman with a failure of adjusting gastric band despite of over-filling, and unbuckled band, treated via removal of unbuckled band. Surgical band removal and change, or conversion to other procedures should be considered when unbuckled gastric band are encountered.
Subject(s)
Female , Humans , Young Adult , Calibration , Mortality , Postoperative Period , Vomiting , Weight LossABSTRACT
Surgery for obesity is the last option but it is the most effective. Resolution of comorbid diseases with obesity occurs depending upon the amount of weight loss, age of the patients, duration of comorbid disorders. After malabsorptive surgeries, patient has to be on life-long vitamin supplements. Various types of surgeries done in morbid obesity with their merits and demerits have been described in this review.
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Objective To compare the short-term efficacies of laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity and type 2 diabetes mellitus,and to investigate the relationship between the body weight loss and the decrease of glucose of the 2 treatment methods.Methods The clinical data of 40 patients with obesity combined with type 2 diabetes mellitus who were admitted to the Changhai Hospital of the Second Military Medical University from January 2010 to December 2011 were retrospectively analyzed.There were 14 patients treated by LAGB (LAGB group) and 26 by LSG (LSG group).The body weight loss and the decrease of glucose at postoperative year 1 of the 2 groups were compared.The differences in the body weight and glucose before and after operation within groups were compared using the paired t test,and the differences in the body weight and glucose between the 2 groups were compared using the multiple analysis of variance.The correlation between the body weight loss and the decrease of glucose was analyzed using the linear regression analysis.Results Laparoscopic surgery was successfully done without conversion to open surgery or intraoperative complications.The operation time and volume of blood loss were (69 ± 16)minutes and (31 ± 14)mL in the LAGB group,(120 ± 15) minutes and (148 ± 48) mL in the LSG group.Complications including postoperative malnutrition,electrolyte disturbance,delayed gastric emptying,bleeding,anastomotic leakage did not occurr in the 2 groups.Two patients were complicated with abdominal incision fat liquefaction,and were cured by symptomatic treatment.(1) The body weight,body mass index (BMI) and waistline had a decrease trend.The body weight,BMI and waistline in the LAGB group were decreased from (117 ± 28)kg,(40 ± 8)kg/m2 and (118 ± 15) cm before operation to (94 ± 28) kg,(33 ± 8) kg/m2 and (92 ± 15) cm at postoperative week 48.The body weight,BMI and waistline in the LSG group were decreased from (119 ± 25)kg,(42 ± 6)kg/m2 and (123 ± 14)cm before operation to (74± 16)kg,(26± 4)kg/m2 and (86 ± 13)cm at postoperative week 48.The EWL had an increase trend in the 2 groups.The EWL in the LAGB group was increased from 7％ ± 2％ at postoperative week 1 to 53％± 24％ at postoperative week 48,and the EWL in the LSG group was increased from 11％ ± 4％ at postoperative week 1 to 90％ ± 20％ at postoperative week 48.There were significant differences in the changes of body weight,BMI,waistline and EWL between the 2 groups (F =60.660,74.490,57.650,90.020,P ＜ 0.05).(2) The levels of glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,triglyceride,total cholesterol,low-density lipoprotein and high density lipoprotein in the LAGB group were decreased from 8.1％± 0.8％,(8.4±0.6)mmol/L,(21±8)μmol/L,7.9 ±2.9,(1.68±0.50)mmol/L,(6.0±1.1)mmol/L (4.1 ± 0.8) mmol/L,(1.09 ±0.15)mmol/L to 6.4％ ±0.8％,(6.3 ±0.3) mmol/L,(10 ± 3) μmol/L,2.7 ±0.9,(1.04 ± 0.09) mmol/L,(4.3 ± 0.8) mmol/L,(2.3 ± 0.4) mmol/L,(1.22 ± 0.09) mmol/L at postoperative week 48 ; the levels of glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,triglyceride,total cholesterol,low-density lipoprotein and high density lipoprotein in the LSG group were changed from 7.9％ ± 1.0％,(9.0±1.0)mmol/L,(21 ±9) μ mol/L,8.5 ±3.5,(2.09 ± 0.70) mmol/L,(6.0 ± 1.2)mmol/L,(3.9 ± 1.1) mmol/L,(1.06 ± 0.21) mmol/L before operation to 5.1％ ± 0.8％,(5.2 ± 0.4) mmol/L,(4 ± 1)μmol/L,0.9±0.2,(1.22±0.17)mmol/L,(4.2±0.8)mmol/L,(2.3 ±0.6)mmol/L,(1.30±0.13)mmol/L at postoperative week 48.There was a decrease trend of the glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,trigluceride,total cholesterol and low density lipoprotein and a increase trend of the high density lipoprotein in the 2 groups.There were significant differences in the levels of glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,triglyceride,total cholesterol,low-density lipoprotein and high density lipoprotein between the 2 groups (F =57.650,74.270,36.750,42.960,10.870,30.650,32.560,11.490,P ＜0.05).The levels of glucose of the LAGB group at postoperative month 1 and 3 were influenced by BMI (b =0.543,0.753,P ＜ 0.05),while the levels of glucose of the LAGB group did not be influenced by BMI at postoperative month 6 and year 1 (b =0.130,0.222,P ＞0.05).The levels of glucose of the LSG group did not be influenced by BMI at postoperative month 1,3,6 and year 1 (b =0.185,0.035,0.212,0.126,P ＞0.05).Conclusions The efficacy of LSG is superior to LAGB for the treatment of obesity combined with type 2 diabetes mellitus.The efficacy of LAGB is correlated with the change of body weight,while the efficacy of LSG does not correlated with the change of body weight.
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Objective To compare the effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) on excess weight loss (EWL) and type 2 diabetes mellitus (T2DM),then to evaluate which one is superior to the other.Methods PubMed,Embase,Wanfang Database and HowNet database were searched for publications concerning LAGB and LSG from 2000 to 2012,with the last search on August 17,2012.EWL and T2DM improvement over 6 and 12 months were pooled and compared by meta-analysis.Odds ratios (ORs) and mean differences were calculated with 95％ confidence intervals （ CI).Results Eleven studies involving 1004 patients in total met the inclusion criteria.The mean percentage EWL for LAGB was 33.9％ after 6 months in studies and 37.8％ after 12 months; for LSG,EWL was 50.6％ after 6 months and 51.8％ after 12 months,T2DM was improved in 42 of 68 patients (61.8％) after LAGB and 66 of 80 (82.5％) after LSG.Conclusions LSG is more effective than LAGB in morbid obesity,with higher percentage EWL and greater improvement in T2DM.
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Objective To investigate the management of complications after laparoscopic adjustable gastric banding (LAGB).Methods The clinical data of 83 obese patients who were treated by LAGB at the Nankai Hospital from September 2005 to June 2011 were retrospectively analyzed.The complications after LAGB were analyzed.The adjustable gastric band was installed under laparoscope so as to form a small gastric pouch with a volume ranged between 20-30 ml.The water pump was fixed in the rectus abdominis anterior sheath under the appendix ensiformis.The gastric band was adjusted according to the changes of the body weight,symptoms after diet and results of imaging examination of upper gastrointestinal tract.Patients were followed up via out-patient examination and phone call till July 2013.Results The incidence of complications of the 83 patients was 44.6％ (37/83).Six patients had short-term complications and 31 patients had long-term complications.The short-term complication mainly presented as post-prandial vomiting.The symptoms of 5 patients were relieved by changing of eating habit.The condition of 1 patient was severe,and the symptom was relieved 5 days later after fasting and nutritional support.For the 31 patients with long-term complications,25 were complicated with band erosion into gastric lumen via gastric wall (6 patients were complicated with infection of the water pump site),and they were cured by removal of band laparoscopicly.Ten patients were complicated with water pump-related complications,including 6 with infection of the water pump site and 4 with pump migration.The water pumps of the 4 patients with pump migration were surgically removed.Two patients had band slipping to the stomach.The band was restored to the original place after removing the liquid from the band and reducing the food intake,and then the position of the band in 1 patient was restored to normal,and no change was observed in another patient,and the band was removed laparoscopicly.Conclusions The incidence of complications after LAGB is high,and it increases as the time passes by.Most of the long-term complications after LAGB need to be treated by reoperation.
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Objective To investigate the multidisciplinary modality for obesity treatment and evaluate the safety and long-term efficacy of laparoscopic adjustable gastric banding(LAGB) on weight loss and obesity related metabolic diseases in obesity patients.Methods The clinical and follow-up data of 28 consecutive morbid obesity patients receiving LAGB in Dept.General Surgery of PUMC hospital in a multidisciplinary modality from Oct 2009 to May 2012 were retrospectively analyzed.The strategy of perioperative and follow-up management was summarized and the safety and long-term efficacy of LAGB on weight loss and comorbidity were evaluated.Results Mean body weight of the subjects was 129.1kg and mean body mass index(BMI)44.9 kg/m2.All patients underwent LAGB successfully without perioperative mortality.Early postoperative complications included 1 case (3.6％) of pulmonary infection and long-term complications included 2 cases (7.1％)of port infection.Mean body weight and BMI decreased gradually after LAGB.The mean percentage of excess weight loss(％ EWL)at postoperative 24 months was 41.3％.％ EWL of the group with regular follow-up and good compliance was significantly better than the other group.Complete or partial remission was observed in obesity related metabolic diseases at the last follow-up.Conclusions LAGB is safe and has good long-term efficacy on weight loss and comorbidity improvement of obesity patients.Better services can be provided for obesity patients in a multidisciplinary modality,It is important for the patients to follow up regularly after surgery in order to maintain long-term weight loss.
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Objective To investigate what kind of obese patients appropriate to adopt the laparoscopic adjustable gastric banding volume reduction surgery.Methods A retrospective study was performed to review the clinical data of 40 patients who required reoperation to remove the gastric banding after LAGB from November 2003 to March 2013 at the Department of Minimally Invasive Surgery,Changhai Hospital.Selected 40 patients who required LAGB from January 2006 to October 2008 as control group.We conducted a case-control study to analyze.Chi-square test and multivariate and non-conditional Logistie regression analysis were used to identify the risk factors of removing of gastric banding.Results Age and gender were not statistically significant different (P ＞ 0.05).Multiple factors of Logistic regression showed that BMI≥35 kg/m2,postoperative clinic visits per year ＜ 3 and on the basis of gastrointestinal disease were risk factors for the removal of gastric banding (Wald =3.908,7.375,5.209,P ＜ 0.05).Conclusion The risk factors for the removal of gastric banding include BMI,postoperative clinic visits and the basis of gastrointestinal disease.In the treatment of obesity with LAGB should take full account of the above factors.
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Objective@#To determine the effect of laparoscopic adjustable gastric banding (LAGB) on weight loss and the association between initial body mass index (BMI) and successful weight loss, defined as >50% excess weight loss (EWL) among obese Filipino adults at St. Luke’s Medical Center. @*Methodology@#Data from 97 patients who were at least 18 years old at the time of gastric banding were reviewed retrospectively. Patient follow-up was poor 2 years post-surgery, which precluded analysis of follow-up data beyond 2 years. Changes in weight loss parameters from baseline to the different observation periods were carried out using paired t- test. To determine the association of different factors with success in weight loss, Independent t-test and Chi-square tests were used. A p-value ≤0.05 was considered significant. @*Results@#Majority of the patients were female (61%) and Southeast Asian (77%). Ages ranged from 18 to 68 years. Mean BMI was 44.1 ± 0.1 kg/m2 and mean excess weight was 61.4 ± 26.5 kg. Excess weight loss of 43.84 ± 25.09% and BMI reduction of 21.54 ± 13.39% were attained at 2 years. Lower initial BMI with a mean of 38.12±3.28 kg/m2 was associated with successful weight loss, 1 year after gastric banding (p<0.001). @*Conclusion@#Patients attained 43.84% EWL 2 years after gastric banding. Those with higher initial BMI were less likely to achieve successful weight loss 1 year after gastric banding.
Subject(s)
Bariatric Surgery , Obesity , Weight LossABSTRACT
This study was aimed to compare the efficacy of gastric banding (GB), Roux en-Y gastric bypass (RYGBP) and biliopancreatic diversion (BPD) in the treatment of rats with type 2 diabetes mellitus (T2DM). Ani-mal models of T2DM were induced by streptozotocin (STZ) injection and high-sugar-fat diets. A total of 70 T2DM rats were randomly allocated into the GB group (G group, n = 20), RYGBP group (R group, n = 20), BPD group ( B group , n = 20 ) , and the sham operation group ( S group , n = 10 ) . The fasting blood glucose ( BG ) , triglyceride ( TG ) , total cholesterol ( TC ) and insulin ( INS ) content were determined before and 1 , 2 , 3 , 4 , 8 , 16 weeks after operation. The insulin sensitivity index (ISI) was calculated. The mortality and complications were ob-served in each group. The results showed that the fasting weight of the GB group, RYGBP group and BPD group were (324.4 ± 22.5) g, (338.9 ± 17.5) g, (333.3 ± 28.4) g, respectively. The BG content was (12.44 ± 1.29) mmol/L, (9.70 ± 0.81) mmol/L, (11.93 ± 2.39) mmol/L, respectively. The TC content was (2.32 ± 0.45) mmol/L, (2.22 ± 0.79) mmol/L, (2.13 ± 0.31) mmol/L, respectively. The TG content was (1.38 ± 0.32) mmol/L, (1.16± 0.41) mmol/L, (1.23 ± 0.35) mmol/L, respectively. The ISI were (-6.38 ± 0.29), (-6.67 ± 0.24), (-6.65 ±0.23), respectively. And the INS content of the RYGBP group were (69.43 ± 18.73) mU/L. There were signifi-cant differences between before and after operation on the 16th week ( P < 0 . 05 , P < 0 . 01 ) . The mortality rate was 5% in the GB group, 20% in the RYGBP group, and 35% in the BPD group. It was concluded that the GB, RYGBP and BPD are effective in reducing blood glucose and blood lipids in the treatment of rat with T2DM. The treatment effect is obvious in the improvement of insulin resistance ( IR ) .
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La cirugía de la obesidad ha tenido un impresionante desarrollo en los últimos 20 años, debido a la necesidad de tratamiento efectivo y duradero para esta enfermedad crónica epidémica. La introducción de la técnica laparoscópica a las cirugías bariátricas contribuyó en forma importante a disminuir sus complicaciones y mortalidad. Las operaciones más frecuentes en el mundo son el bypass gástrico, la gastrectomía vertical, la banda gástrica ajustable y la derivación biliopancreática, aunque en la actualidad en nuestro país se utilizan solo las dos primeras. Se describen estas cirugías bariátricas, su técnica, complicaciones y resultados. El tratamiento quirúrgico de la obesidad logra bajas de peso y control de las comorbilidades muy superiores a las logradas por el tratamiento médico y terapia farmacológica. Por ello, el tratamiento quirúrgico es la terapia estándar para pacientes con obesidad.
Obesity surgery has had an impressive development in the last 20 years, due to the need for effective and lasting treatment for this epidemic cronic disease. The introduction of laparoscopic technique in bariatric surgical interventions contributed significantly on reducing surgical complications and mortality. The most common operations in the world are gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion, though only the first two mentioned are used in our country today. These bariatric surgery, their technique, complications and results are described. Surgical treatment of obesity achieves weight loss and comorbidities control far superior to those achieved by medical treatment and pharmacologic therapy. Therefore, surgical treatment is the standard therapy for obese patients.
Subject(s)
Humans , Gastrectomy , Gastric Bypass , Obesity/surgery , Postoperative Complications , Bariatric Surgery , Gastroesophageal RefluxABSTRACT
Objective To evaluate the different effects of gastric banding (GB) and sleeve gastrectomy (SG) on diet-induced obese rat model.Methods The obese rat model was established via the diet-induced method,and then underwent SG,GB,or sham-operation (SO) procedures.The different effects of SG,GB,and SO on these rats were evaluated at the 14th,28th and 56th day after operation.Results After 7 weeks' feeding,31rats in high-diet group reached the modeling standard.The model success rate was 88.6％ (31/35).GB and SG group showed significantly less cumulative food intake than SO group ( P ＜ 0.01).There was no significant difference between GB and SG group in cumulative food intake ( P ＞ 0.05 ).The average weight of rats in GB and SG group was (609.1±6.0) g and (591.6 ±4.3) g respectively at the 56th day after operation while it was (649.8 ± 10.0) g for SO group.The difference had statistical significance ( P ＜ 0.01).SG group showed better improvement effects on TC,TG,FFA,LDL-c and HDL-c than GB group (P ＜0.05).The postoperative ghrelin level in GB and SG group all decreased constantly and it decreased slower in GB group than in SG group.At the 56th day after operation,the ghrelin level in GB and SG group reduced from (1151.0 ± 144.2) pg/ml and (1148.2±127.2) pg,/ml to (992.0+121.9) pg/ml (P＜0.05) and (761.0+125.3) pg/ml (P＜0.01) respectively.The leptin level in GB and SG group all showed decreasing tendency.However,the leptin level of the 2 groups presented significant difference at the 56th day after operation.Conclusions There is no significant difference between GB and SG group in postoperative cumulative food intake.However,SG has better effects on controlling weight gain and improving blood lipids than GB.The different effects of GB and SG on the level of ghrelin and leptin in rats may account for the different curative effects.
ABSTRACT
More attention has been paid to bariatric surgery due to an increase in the obese population in Korea. Laparoscopic adjustable gastric banding (LAGB) is the most popular procedure for weight-loss but the complication rate may increase with time. Revision surgery is needed if there are complications or the weight is regained after LAGB, and a laparoscopic sleeve gastrectomy could be performed in the case of band failure. Successful band removal and sleeve gastrectomy wereperformed simultaneously without complications.