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Obesity is a global epidemic. According to the World Health Organization (WHO), it is an abnormal or excessive accumulation of fat that can harm health. Its incidence is increasing alarmingly in developing countries. It is also a significant risk factor for developing chronic diseases such as type 2 diabetes mellitus, arterial hypertension, coronary disease, non-alcoholic fatty liver disease, and musculoskeletal disorders such as osteoarthritis. Furthermore, associations have been found between obesity and the development of prostate, liver, gallbladder, kidney, colon, endometrial, breast, and ovarian cancer. Bariatric and metabolic surgery is the most effective treatment for morbid obesity and its comorbidities. This surgery can reduce general mortality by 40% at ten years due to cardiovascular outcomes, diabetes, or cancer and improve metabolic diseases such as type 2 diabetes.
La obesidad es una epidemia global, según la Organización Mundial de la Salud (OMS) se define como una acumulación anormal o excesiva de grasa que puede ser perjudicial para la salud, su incidencia está aumentando de forma alarmante en los países en desarrollo. Asimismo, es un factor de riesgo importante para el desarrollo de enfermedades crónicas como la diabetes mellitus tipo 2, hipertensión arterial, enfermedad coronaria, enfermedad del hígado graso no alcohólico y trastornos musculoesqueléticos como la osteoartritis; además, se han encontrado asociaciones entre la obesidad y el desarrollo del cáncer de próstata, hígado, vesícula biliar, riñón, colon, endometrio, mama y ovarios. La cirugía bariátrica y metabólica es el tratamiento más eficaz para la obesidad mórbida y sus comorbilidades, esta cirugía puede reducir la mortalidad general en un 40% a los diez años por desenlaces cardiovasculares, diabetes o cáncer, como también mejorar enfermedades metabólicas como la diabetes tipo 2.
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In more than half a century of the development of bariatric metabolic surgery, a variety of classic surgical methods have been formulated. However, the improvement and innovation of bariatric metabolic surgery has never stopped. The replacement of new and old surgical methods in clinical application and development reflects the vitality and progress in the field of bariatric metabolic surgery, and also promotes the development of bariatric metabolic surgery to the best balance between benefits and risks. In the early stages, studies in metabolic surgery are more inclined to confirm the efficacy, safety and mechanism of classical procedures. In recent years, metabolic surgeons around the world have become more inclined to focus on the exploration and innovation of new procedures. In addition, the improvement of biliopancreatic diversion with duodenal switch and the sleeve gastrectomy plus procedures have gradually become hot spots for surgical innovation. However, the new techniques are diverse, scattered and partially overlapping. The authors make a comment on this content, in order to provide assistance to clinical and scientific research.
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Introducción: La obesidad es la segunda causa de muerte susceptible de prevención. El tratamiento quirúrgico es el único tratamiento eficaz y demostrado para pacientes con obesidad grave (índice de masa corporal > 40 kg/m²). Las operaciones bariátricas prolongan la supervivencia y corrigen las enfermedades asociadas con la obesidad grave. Objetivos: Caracterizar los resultados de la cirugía bariátrica en pacientes obesos internados en el Hospital Nacional de Itauguá de marzo a diciembre del año 2019. Materiales y métodos: Estudio observacional, descriptivo de corte transversal, retrospectivo con muestreo no probabilístico a conveniencia. Se incluyeron pacientes de ambos sexos, mayores a 16 años con obesidad sometidos a cirugía bariátrica en el Servicio de Cirugía General del Hospital Nacional de Itauguá. Resultados: Se incluyeron a 24 pacientes, cuyo promedio de peso fue de 117,5 kg y un promedio del IMC de 43,5. El 67% presentó obesidad grado III y el 70% un ASA III. La técnica quirúrgica empleada con mayor frecuencia fue gastrectomía vertical en manga laparoscópica. El promedio de pérdida de exceso de peso post quirúrgico a los 12 meses fue de 56,4 kg. La estancia hospitalaria post quirúrgico en promedio fue de 48 horas. En el 96% de los casos no se presentaron complicaciones. Conclusión: El resultado de nuestro estudio sugiere que la cirugía bariátrica ha demostrado ser una alternativa con excelentes resultados para el tratamiento de la obesidad, mejorando así no solo patologías clínicas crónicas sino también la calidad de vida del paciente.
Introduction: Obesity is the second cause of death susceptible to prevention. Surgical treatment is the only effective and proven treatment for severely obese patients (body mass index > 40 kg/m²). Bariatric operations prolong survival and correct diseases associated with severe obesity. Objectives: To determine the short-term and long-term results of bariatric surgery in obese patients admitted to the National Hospital of Itauguá from March to December 2019. Materials and methods: Observational, descriptive cross-sectional, retrospective study with non-probabilistic sampling at convenience. We included patients of both sexes, over 16 years of age with obesity who underwent bariatric surgery and were admitted to the General Surgery Service of the Hospital Nacional de Itauguá in 2019. Results: Twenty-four patients were followed up in the study, with an average weight of 117.5 kg and a mean BMI of 43.5. 67% presented with grade III obesity and 70% with ASA III. The most frequently used surgical technique was vertical gastrectomy in the laparoscopic sleeve. The average postoperative weight loss at 12 months was 56.4 kg. The average postoperative hospital stay was 48 hours. There were no complications in 96% of cases. Conclusion: The result of our study suggests that bariatric surgery has proven to be an alternative with excellent results for the treatment of morbid obesity, , thus improving not only chronic clinical pathologies but also the quality of life of the patient with increased life expectancy.
Subject(s)
Obesity , Patients , General Surgery , Bariatric SurgeryABSTRACT
Objective:To investigate the postoperative changes in levels of 25-hydroxy vitamin D (25-[OH]D], parathyroid hormone (PTH) and other relevant biomarkers in obese patients receiving metabolic surgery and analyze the dynamic changes in relevant biomarkers in the short term (after 3-6 months) and the long term (after 12-24 months).Methods:A total of 96 obese patients who underwent metabolic surgery and received follow-up examinations from January 2018 to January 2020 were included. Baseline and postoperative data were collected, including anthropometric data (height, weight, neck circumference, waistline and hipline) and laboratory test results (fasting glucose, glycated hemoglobin, 25-[OH)D, PTH, serum calcium and serum phosphorus). Body mass index (BMI) and waist-hip ratio were calculated. The anthropometric data were analyzed by repeated measures analysis of variance and laboratory data were compared between groups using t test and Kruskal-Wallis test. Results:96 patients (33 males and 63 females) were included, of whom 49 were complicated with diabetes. Prior to surgery, 79 (79.17%) of the patients had 25-(OH)D deficiency (< 20 μg/L), 16 (16.67%) had 25-(OH)D insufficiency (≥ 20 μg/L and < 30 μg/L) and 23 (23.96%) had high PTH levels (> 70 ng/L). After the surgery, 25-(OH)D level was transiently increased in the short term ( P = 0.01) but declined thereafter in the long term ( P < 0.01) to levels lower than baseline ( P = 0.023). Long-term PTH level was higher than baseline ( P = 0.012), with 11 patients showing PTH levels higher than normal (> 70 ng/L). Serum phosphorus level was increased in both the short term and the long term ( P < 0.01). Conclusions:Obese patients have 25-(OH)D deficiency/insufficiency before metabolic surgery and experience further decrease in the long term after surgery, despite a transient increase. Secondary increase in PTH level occurs in some of the patients after surgery. Long-term nutritional supplements and comprehensive nutritional management play important roles in postoperative management of obese patient.
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Objective:To explore the association of weight loss with diabetes remission after metabolic surgery in patients with type 2 diabetes mellitus(T2DM) for 10 years and more.Methods:Data of T2DM patients with obesity who underwent metabolic surgery in the General Surgery Department & Obesity and Metabolic Disease Center of China-Japan Friendship Hospital from November 2017 to June 2021 were retrospectively collected and analyzed. Remission of diabetes was defined as glycated hemoglobin (HbA1c) < 6.5% or fasting blood glucose < 7.0 mmol/L after discontinuing anti-diabetic medication for more than 3 months. The patients were followed up and divided into two groups according to whether the percentage total weight loss (%TWL) was ≥ 20% or not. The age, sex, body mass index (BMI), fasting C-peptide, and HBA1c were compared between the two groups.Results:Among 65 (28 males and 37 females) patients with T2DM for ≥ 10 years , 50 (76.9%) achieved diabetes remission after a median of 12-month follow-up. 6.2%, 41.5% , 38.5% and 13.8% of the patients achieved %TWL < 10%, 10~20%, 20~30% and ≥ 30% , respectively. The diabetes remission rates were 50%, 63.0%, 92.0% and 88.9%, respectively. Compared with the %TWL < 20% group, the preoperative weight [(95.5±18.8) kg vs (85.5±11.0) kg, P = 0.012] and BMI [(34.4±6.0) vs (30.9±3.3) , P = 0.006] were significantly higher in the %TWL ≥ 20% group, and diabetes remission rates was aslo significantly higher in the %TWL ≥ 20% group (91.2% vs 61.3%, P = 0.010) . After adjusting for age, preoperative BMI, fasting C-peptide and duration of T2DM, Cox multivariate regression analysis showed that %TWL ≥ 20% was independently associated with diabetic remission after metabolic surgery in patients with T2DM for ≥ 10 years (HR = 1.99, 95% CI: 1.03 to 3.83, P = 0.04). Conclusions:More than 70% of patients with T2DM for ≥ 10 years could achieve diabetes remission after metabolic surgery. %TWL ≥ 20% may be one independent factor of diabetes remission in patients with long-duration T2DM.
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Objective:By comparing the changes of metabolic parameters before and after laparoscopic sleeve gastectomy (LSG) in patients with type 2 diabetes mellitus (T2DM) and obesity, the insulin resistance index (HOMA-IR) and atherogenic index of plasma (AIP) were calculated to evaluate the effect of metabolic surgery on insulin resistance and atherosclerosis in patients with type 2 diabetes mellitus (T2DM) and obesity.Methods:LSG treatment were retrospectively analyzed in 54 patients with type 2 diabetes mellitus and obesity, detection of preoperative and postoperative 1 month, 6 month of fasting plasma glucose (FPG), fasting insulin (FINS), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), measuring blood pressure, body weight, calculating body mass index, and according to the steady state evaluation model and the formula for calculating HOMA-IR and AIP. Before and after surgery, paired t test was used, and Pearson correlation analysis and multiple stepwise regression analysis.Results:FPG, FINS, TG, HOMA-IR and AIP were (6.38±2.03) mmol/L and (5.36±1.33) mmol/L, (20.42±25.77) uU/mLand (11.22±3.62) uU/mL, (1.94±2.81) mmol/Land (1.70±2.33) mmol/L, (5.60±7.52) and (2.58±0.80), (0.15±0.27) and (0.08±0.25) ,which were significantly lower than those before surgery ( P<0.05) ,HDL-C was (1.04±0.20) mmol/L and (1.10±0.18) mmol/L at 1 and 6 months after operation, respectively, which was higher than that before operation ( P<0.05) .Preoperative correlation analysis showed that AIP was positively correlated with FPG, TG and HOMA-IR ( P<0.05), and negatively correlated with HDL-C ( P<0.05) .The results of multiple stepwise regression analysis showed that FPG, TG and HDL-C were independent influencing factors of AIP ( P<0.05) . Conclusion:LSG surgery can effectively reduce the blood glucose and lipid levels in patients with type 2 diabetes complicated with obesity, improve insulin resistance and reduce the plasma atherosclerosis index.
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Objective:To investigate the application value of right minimal invasive three-port technique of laparoscopic sleeve gastrectomy (RMIT-LSG) for the treatment of obesity.Methods:The retrospective and descriptive study was conducted. The clinical data of 66 obesity patients who underwent RMIT-LSG in the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from January to October 2021 were collected. There were 15 males and 51 females, aged 28.5(range, 16.0?54.0)years. The body mass index (BMI) of the 66 patients was (36.9±4.3)kg/m 2. There were 20 of the 66 patients combined with type 2 diabetes. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination or the WeChat to detect postoperative recovery of patients including body mass changing, BMI and complications 6 months after operation. The follow-up was up to December 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. All the 66 patients underwent RMIT-LSG successfully, without conversion to laparotomy or changing surgical method. The operation time and the volume of intraoperative blood loss of the 66 patients were (132±22)minutes and (14±8)mL, respectively. (2) Postoperative situations. The time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative initial water intake, time to postoperative initial liquid food intake and duration of postoperative hospital stay of the 66 patients were (15±6)hours, (1.80±0.60)days, (1.00±0.20)days, (2.00±0.20)days and (3.40±0.60)days, respectively. Of the 66 patients, one case underwent post-operative abdominal hemorrhage at postoperative day 1 and received a second surgery for hemostasis. The patient with postoperative abdominal hemorrhage and other 65 patients recovered well without gastroparesis, gastric fistula, abdominal infection and other complication. (3) Follow-up. All the 66 patients were followed up for 6(range, 1?11)months. All the 66 patients completed the postoperative scar photography at postoperative 1 month, and results of scar photography showed concealed scar with good cosmetic effects. Twenty-seven of the 66 patients were followed up for 6 months after operation, with the weight loss, percentage of weight loss and decrease of BMI were (42±7)kg, 34.8%±2.9%, (14.2±1.9)kg/m 2, respectively. None of the 66 patient had innutrition during the follow-up. Conclusion:The RMIT-LSG is safe and feasible for the treatment of obesity, with a good cosmetic effect of the wound.
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At present, the aging trend of China′s population is intensifying and the number of overweight and obese elderly people is on the rise. The elderly obese is facing the treatment of related metabolic diseases, including cardiovascular disease, hypertension, type 2 diabetes, etc. In addition to life intervention and drug control, bariatric surgery is also one of the effective methods. Bariatric surgery can permanently reduce body mass, improve or alleviate the condition of patients, and prolong life. The authors analyze the indications and contraindications, perioperative manage-ment, surgical methods, surgical safety and effectiveness, and current problems of bariatric surgery for elderly obese patients.
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Bariatric surgery is effective on obesity, which can significantly improve the metabolic diseases of obesity patients, especially the type 2 diabetes. However, the surgical proce-dures of bariatric and metabolic surgery are still evolving and in progress. One anastomosis gastric bypass (OAGB) is the latest bariatric surgery recognized by the international bariatric and metabolic surgery community. The authors review the relevant literatures at home and abroad, and introduce the development history, surgical skills, clinical efficacy, status quo and adaptability of OAGB.
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Analysis of the layout and proportion of classic and innovative surgical procedures of bariatric and metabolic surgery throughout the world, the sleeve gastrectomy is beco-ming the most accepted and respected surgical procedure with its increasingly prominent advan-tages, and its operation number has even exceeded the "gold standard" surgery of the roux-en-Y gastric bypass. This trend is even more pronounced in China. With a small number of physicians lacking experience in gastrointestinal surgery and more and more young physicians joining in the field of bariatric and metabolic surgery, operation related complications and the consequences of insufficient perioperative management experience have occurred successively in clinical practice, such as gastrointestinal leakage, bleeding, lumen and anastomotic stenosis, internal hernia and obstruction, venous thromboembolism, etc. Bariatric and metabolic surgery is a branch of gastro-intestinal surgery, and physicians in the field should have the ability to prevent, predict and manage short- and long-term complications after surgery. The authors believe that through the comprehen-sive evaluation of laboratory indexes, patient signs and related examinations, physicians should have the basic qualities of decisively choosing the surgical timing, choosing the right decision-making, and taking effective measures.
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Objective:To investigate the safety and efficacy of metabolic surgery in obese and type 2 diabetes patients with viral hepatitis cirrhosis.Methods:The data of 8 patients with viral hepatitis cirrhosis undergoing metabolic surgery at Department of General Surgery ,Beijing Tiantan Hospital, Capital Medical University from Aug 2012 to Dec 2021 were retrospectively analyzed.Results:Among the 8 patients, 2 underwent laparoscopic Roux-en-Y gastric bypass and 6 underwent laparoscopic sleeve gastrectomy. The Child-Pugh classification of all patients before operation was classified as Grade A. The operation process was successful with no complications such as ascites, bleeding , digestive tract and gastric leakage or obstruction during the perioperative period. There was no abnormal liver function and decompensation during the median 2.5 year's (3 month to 8 years) follow-up period. The weight loss after the operation was obvious, when 1 year after operation, percentage of excess weight loss (EWL%)>54.78% and the surgery was also conducive to the control of blood glucose in diabetes patients.Conclusion:Metabolic surgery is safe and feasible for obese and type 2 diabetes patients with viral hepatitis cirrhosis.
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La prevalencia de obesidad y diabetes mellitus se asocia al desarrollo de enfermedad renal crónica y estadios terminales de la misma. En individuos con obesidad se produce un mecanismo de hiperfiltración, probablemente compensatorio para satisfacer la alta demanda metabólica asociada al aumento del peso corporal, con la presencia de proteinuria en individuos sin enfermedad renal. La histopatología muestra una glomeruloesclerosis focal y segmentaria relacionada con la obesidad en un marco de glomerulomegalia. La cirugía metabólica es el medio más efectivo para obtener una pérdida de peso sustancial y persistente. Se ha demostrado la superioridad de la cirugía sobre el tratamiento médico no solo para lograr un mejor control glucémico, sino también para la reducción de los factores de riesgo cardiovascular. Los mecanismos parecen extenderse más allá de la magnitud de la pérdida de peso e incluyen mejoras tanto en los perfiles de incretinas como en la secreción y la sensibilidad a la insulina. El Comité de Nefropatía de la Sociedad Argentina de Diabetes realizó esta revisión sobre los mecanismos involucrados en la obesidad como causa de enfermedad renal o empeoramiento de la misma por diabetes, y los mecanismos a través de los cuales la cirugía bariátrica beneficiaría a los pacientes con diabetes y enfermedad renal crónica en todos los estadios de la misma, así como los controles pre y posquirúrgicos en este tipo de cirugías.
The prevalence of obesity and diabetes mellitus are associated with the development of chronic kidney disease and its terminal stages. In individuals affected by obesity, a probably compensatory hyperfiltration mechanism occurs to satisfy the high metabolic demand associated with increased body weight; it is also associated with the presence and development of proteinuria in individuals without kidney disease. Histopathology shows obesity-related focal and segmental glomerulosclerosis in a setting of glomerulomegaly. Metabolic surgery is the most effective means of obtaining substantial and lasting weight loss. The superiority of surgery over medical treatment has been demonstrated only to achieve better glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms appear to extend beyond the magnitude of weight loss and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. The Nephropathy Committee of the Argentine Diabetes Society carried out this review on mechanisms involved in obesity as a cause of kidney disease or worsening of kidney disease due to diabetes, the mechanisms by which bariatric surgery would benefit patients with diabetes and kidney disease chronic and its terminal stages, the pre and post-surgical controls that should be performed by patients undergoing this type of surgery
Subject(s)
Bariatric Surgery , Diabetes Mellitus , Kidney Diseases , ObesityABSTRACT
Resumen La obesidad es reconocida como "la gran epidemia" del siglo XXI. Los primeros tratamientos fueron enfocados en el manejo médico, sin lograr los resultados esperados, por lo cual surge la cirugía bariátrica (CB) como la mejor alternativa. Inicialmente la obesidad se concibe como una figura de poder en el imperio egipcio, luego como enfermedad por Galeno e Hipócrates, reapareciendo más tarde como símbolo de fecundidad en Europa. Las primeras técnicas fueron el bypass yeyuno-colónico por Payne y De Wind modificado luego por Scopinaro, consolidándose más tarde como el bypass actual por Mason, Wittgrove e Higa. Por su parte, la gastrectomía en manga fue concebida por Gagner como puente de la derivación biliopancreática, pero dado sus excelentes resultados se consolida como técnica por sí sola. A su vez, la CB evidencia efectos metabólicos inesperados, posicionándose en la actualidad como el mejor tratamiento tanto para la obesidad como para el síndrome metabólico. En Chile la CB se inicia en 1986 con González del Hospital Van Buren con la experiencia en bypass yeyuno-ileal, continuando con Awad y Loehnert del Hospital San Juan de Dios. Luego se consolida con el desarrollo de la CB moderna tanto en la Universidad Católica como en la Universidad de Chile, llegando en la actualidad a ser un procedimiento ampliamente difundido en todo el país. El objetivo principal de la siguiente revisión es analizar el concepto de obesidad en la historia y la evolución de la CB en Chile y el mundo, rememorando sus inicios y destacando su constante desarrollo.
Obesity is recognized as "the great epidemic" of the 21st century. The first treatments were focused on medical management, failing to achieve the expected results, which is why bariatric surgery (BC) emerges as the best alternative. Obesity was initially conceived as a power figure in the Egyptian empire, later as a disease by Galen and Hippocrates, later reappearing as a symbol of fertility in Europe. The first techniques were the jejuno-colonic bypass by Payne and De Wind, later modified by Scopinaro, to finally consolidate as the current bypass by Mason, Wittgrove and Higa. For its part, sleeve gastrectomy was conceived by Gagner as a bridge for biliopancreatic diversion, but given its excellent results, it is consolidated as a technique by itself. In turn, BC shows unexpected metabolic effects, currently positioning itself as the best treatment for both obesity and metabolic syndrome. In Chile, BC started in 1986 with González at the Van Buren Hospital with his experience in jejuno-ileal bypass, continuing with Awad and Loehnert at the San Juan de Dios Hospital. Later, it was consolidated with the development of modern BC both at the Catholic University and at the University of Chile, currently becoming a widely disseminated procedure throughout the country. The main objective of the following review is to analyze the concept of obesity in history and the evolution of BC in Chile and the world, recalling its beginnings and highlighting its continuous development.
Subject(s)
Humans , Bariatric Surgery/methods , Metabolism/physiology , Obesity, Morbid/surgery , Gastric Bypass/methods , Chile , Bariatric Surgery/history , Bariatric Medicine/historyABSTRACT
ABSTRACT BACKGROUND: Few reports have examined the effects of Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) on changes to serum albumin (Alb) and liver enzyme levels. OBJECTIVE: To compare short-term post-surgery changes in serum Alb, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALKP) levels. Body composition changes were also measured and compared among three groups. DESIGN AND SETTING: Retrospective cohort study conducted in Tehran, Iran. METHODS: 151 OAGB, RYGB and SG patients referred to the obesity clinic of Hazrat-e Rasool General Hospital, Tehran, Iran, were evaluated. Physical characteristics and biochemical parameters were measured pre-surgery and then after three and six months. RESULTS: Through repeated measurements to determine intragroup changes, significant changes in serum AST (P = 0.003) and ALT (P < 0.001) were observed in follow-ups. However, Alb levels did not change (P = 0.413). Body fat, fat-free mass and muscle mass decreased significantly in each group (P < 0.05). In a univariate general linear model for determining intergroup changes, SG showed greater decreases in ALT and AST at three and six months (P < 0.05) and in ALKP at six months (P = 0.037), compared with OAGB. There were no significant differences in Alb levels. Also, RYGB had a greater effect on reducing fat percentage (three months, P = 0.011; six months, P = 0.059) and fat mass (three months, P = 0.042) than OAGB. CONCLUSION: SG and RYGB may be superior to OAGB in reducing liver enzymes and body fat, respectively. However, Alb levels showed no significant differences.
Subject(s)
Humans , Obesity, Morbid/surgery , Gastric Bypass , Bariatric Surgery , Serum Albumin , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Gastrectomy , Iran , LiverABSTRACT
La prevalencia de obesidad y diabetes mellitus se asocia al desarrollo de enfermedad renal crónica y estadios terminales de la misma. En individuos con obesidad, se produce un mecanismo de hiperfiltración, probablemente compensatorio para satisfacer la alta demanda metabólica asociada al aumento del peso corporal, con la presencia de proteinuria, en individuos sin enfermedad renal. La histopatología muestra una glomeruloesclerosis focal y segmentaria relacionada con la obesidad en un marco de glomerulomegalia. La cirugía metabólica es el medio más efectivo para obtener una pérdida de peso sustancial y persistente. Se ha demostrado la superioridad de la cirugía sobre el tratamiento médico no solo para lograr un mejor control glucémico, sino también para la reducción de los factores de riesgo cardiovascular. Los mecanismos parecen extenderse más allá de la magnitud de la pérdida de peso e incluyen mejoras tanto en los perfiles de incretinas como en la secreción y la sensibilidad a la insulina. El Comité de Nefropatía de la Sociedad Argentina de Diabetes realizó esta revisión sobre los mecanismos involucrados en la obesidad como causa de enfermedad renal o empeoramiento de la misma por diabetes, y los mecanismos a través de los cuales la cirugía bariátrica beneficiaría a los pacientes con diabetes y enfermedad renal crónica en todos los estadios de la misma, así como los controles pre y posquirúrgicos en este tipo de cirugías.
The prevalence of obesity and diabetes mellitus are associated with the development of chronic kidney disease and its terminal stages. In individuals affected by obesity, a probably compensatory hyperfiltration mechanism occurs to satisfy the high metabolic demand associated with increased body weight; it is also associated with the presence and development of proteinuria in individuals without kidney disease. Histopathology shows obesity-related focal and segmental glomerulosclerosis in a setting of glomerulomegaly. Metabolic surgery is the most effective means of obtaining substantial and lasting weight loss. The superiority of surgery over medical treatment has been demonstrated only to achieve better glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms appear to extend beyond the magnitude of weight loss and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. The Nephropathy Committee of the Argentine Diabetes Society carried out this review on mechanisms involved in obesity as a cause of kidney disease or worsening of kidney disease due to diabetes, the mechanisms by which bariatric surgery would benefit patients with diabetes and kidney disease chronic and its terminal stages, the pre and post-surgical controls that should be performed by patients undergoing this type of surgery.
Subject(s)
Bariatric Surgery , Diabetes Mellitus , Renal Insufficiency, Chronic , ObesityABSTRACT
Resumen: El término de síndrome metabólico (SM) se ha utilizado desde su definición en el año 2001 por el programa nacional del colesterol (NCEP: ATP III). El concepto ha sido discutido en la literatura científica por décadas. El síndrome X y otros términos como "el cuarteto de la muerte" y el síndrome de resistencia a la insulina, han sido utilizados para describir la asociación entre factores de riesgo metabólico y cardiovascular. En México, la prevalencia de SM en la Encuesta Nacional de Salud y Nutrición (ENSANUT) fue de un 34% para el año 2000; y para el 2012, del 41%. Las modificaciones del estilo de vida junto con aumento en la actividad física, dejar de fumar y limitar el consumo de alcohol son primordiales para el manejo y la prevención debido a que juegan un rol central en las anormalidades metabólicas. Sin embargo, a pesar del impresionante armamento de medicamentos disponible para la diabetes, se ha descrito que hasta el 50% de los pacientes no alcanzan las metas adecuadas de control, definidas por la Asociación Americana de Diabetes (hemoglobina glucosilada <7%). En contraste, la cirugía bariátrica (CB) ha confirmado claramente que contribuye a mejorar la función de las células beta en pacientes con índice de masa corporal (IMC) >35 kg/m2, así como el control de la dislipidemia y otras alteraciones metabólicas.
Abstract: The term Metabolic Syndrome (MS) has been used since its introduction in 2001 by the National Cholesterol Program (NCEP: ATP III). The concept has been discussed in the scientific literature for decades. The X Syndrome and other terms such as "death quartet" and insulin resistance syndrome have been used to describe the association between metabolic and cardiovascular risk factors. In Mexico, the prevalence of MS in the National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición, ENSANUT) was 34% in 2000 and 41% in 2012. Lifestyle modifications along with increased physical activity, quitting smoking, and limiting alcohol consumption are essential for management and prevention because they play a central role in metabolic abnormalities. However, despite the large amount of medications available for diabetes, up to 50% of patients have been reported to fail to achieve adequate control goals, as defined by the American Diabetes Association (glycosylated hemoglobin <7%). In contrast, bariatric surgery (BS) has clearly confirmed that it contributes to improved beta cell function in patients with BMI >35 kg / m2, as well as control of dyslipidemia and other metabolic disorders.
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Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrec-tomy (LSG) in the treatment of obesity associated nonalcoholic fatty liver disease (NAFLD).Methods:The retrospective and descriptive study was conducted. The clinical data of 40 patients with obesity associated NAFLD who were admitted to Xijing Hospital of Digestive Diseases of Air Force Medical University from January 2018 to June 2019 were collected. There were 19 males and 21 females, aged (27±8)years. Patients underwent LSG after preoperative examinations and evaluations. Observation indicators: (1) surgical and postoperative conditions; (2) follow-up. Follow-up was conducted by telephone interview, WeChat, and outpatient review to detect the liver function, glucose and lipid metabolism-related status as well as the relief of comorbidities of patients at 6 and 12 months after LSG. The follow-up was up to June 2020. Measurement data with normal distribu-tion were represented as Mean± SD. Repeated measurement data were analyzed by the repeated measures ANOVA. Count data were represented as absolute numbers, and chi-square test was used for comparison between groups. Results:(1) Surgical and postoperative conditions: 40 patients underwent LSG successfully, without intraoperative conversion to laparotomy or death. The operation time, volume of intraoperative blood loss, and duration of postoperative hospital stay were (83±12)minutes, (19±7)mL and (3.7±0.7)days. Among the 40 patients, 1 case had fat liquefac-tion after LSG and 2 had abdominal distension within a month, who were improved after symp-tomatic and supportive treatment. (2) Follow-up: 40 patients were followed up at postoperative 6 and 12 months. The body mass of 40 patients was (112±17)kg, (85±16)kg, (73±11)kg before operation, at postoperative 6 and 12 months, respectively. The body mass index was (39.7±4.2)kg/m 2, (30.0±4.5)kg/m 2, (25.9±2.9)kg/m 2 before operation, at postoperative 6 and 12 months, respectively. The alanine aminotransferase was (56.40±39.51)U/L, (30.15±17.93)U/L, (26.45±9.44)U/L before operation, at postoperative 6 and 12 months, respectively. The aspartate amino-transferase was (34.03±19.62)U/L, (28.20±10.27)U/L, (24.90±8.44)U/L before operation, at post-operative 6 and 12 months, respectively. The gamma-glutamyltransferase was (48.68±28.45)U/L, (43.30±18.56)U/L, (32.80±12.09)U/L before operation, at postoperative 6 and 12 months, respectively. The fasting blood-glucose was (6.51±2.38)mmol/L, (5.64±1.51)mmol/L, (4.98±0.91)mmol/L before operation, at postoperative 6 and 12 months, respectively. The triglyceride was (1.81±0.95)mmol/L, (1.48±0.57)mmol/L, (1.17±0.44)mmol/L before operation, at postoperative 6 and 12 months, respectively. The total cholesterol was (4.77±0.98)mmol/L, (4.58±0.75)mmol/L, (4.10±0.68)mmol/L before operation, at postoperative 6 and 12 months, respectively. The low density lipoprotein cholesterin was (2.99±0.81)mmol/L, (2.79±0.54)mmol/L, (2.48±0.40)mmol/L before operation, at postopera-tive 6 and 12 months, respectively. The high density lipoprotein cholesterin increased was (1.08±0.20)mmol/L, (1.15±0.18)mmol/L, (1.45±0.21)mmol/L before operation, at postoperative 6 and 12 months, respectively. Compared with preoperative indicators, there were significant differences in postoperative body mass, body mass index, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, fasting blood-glucose, triglyceride, total cholesterol and low density lipoprotein cholesterin ( F=472.439, 533.730, 26.791, 11.029, 25.545, 27.994, 27.534, 36.220, 18.596, P<0.05), showing a downward trend. There was a significant difference between preoperative and postoperative high density lipoprotein cholesterin ( F=68.974, P<0.05), showing a upward trend. The excess weight loss of 40 patients at 6 months and 12 months after LSG were 61%±18% and 85%±15%. The preoperative ultrasonography of 40 patients showed no, mild, moderate and severe fatty liver in 0, 2, 15 and 23 cases, respectively. The above indicators were 8, 9, 12, 11 cases at post-operative 6 months, and 23, 11, 6, 0 cases at postoperative 12 months, respectively. There was a significant difference of the grade of NAFLD between patients before and after surgery ( χ2=68.210, P<0.05). Conclusion:LSG has an accurate short-term clinical efficacy for obesity associated NAFLD, which can reduce body mass, improve liver function, alleviat the disorders of glucose and lipid metabolism and the severity of medium-severe fatty liver.
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Bariatric surgery has been proven to be an effective way to relieve obesity and related metabolic diseases. Complications after bariatric surgery mainly include postoperative bleeding, anastomotic leakage, gastroesophageal reflux, dumping syndrome and so on. Deep vein thrombosis is a rare complication, with low incidence in many literatures. However, deep vein thrombosis is an important cause of pulmonary embolism. Once pulmonary embolism occurs, the difficulty of treatment and mortality are both high. The authors summarize the related literature on venous thromboembolism after bariatric surgery, and briefly describe the strategies of prevention and treatment of venous thromboembolism.
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Objective:To investigate the application value of 'N' shaped Trocar placement in Da Vinci robotic bariatric and metabolic surgery.Methods:The retrospective and descriptive study was conducted. The clinical data of 69 patients who underwent Da Vinci robotic bariatric and metabolic surgery in the China-Japan Union Hospital of Jilin University from March to October 2020 were collected. There were 18 males and 51 females, aged from 12 to 67 years, with a median age of 34 years. The surgery was performed with the 'N' shaped Trocar placement by the same team of surgeons. The Da Vinci robotic sleeve gastrectomy, Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy or Da Vinci robotic biliopancreatic diversion with duodenal switch was selected according to the patient's condition. Observation indicators: (1) surgical and post-operative conditions; (2) follow-up. Follow-up using the outpatient examination, telephone interview and WeChat to detect the body weight, body mass index, fasting blood glucose, glycosylated hemoglobin, total cholesterol, Trocar-related complications of patients at postoperative 3 months. The follow-up was up to November 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison of general data before and after surgery was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative conditions: of the 69 patients, 34 cases received Da Vinci robotic sleeve gastrectomy, 34 cases received Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy, and 1 case received Da Vinci robotic biliopancreatic diversion with duodenal switch. There was no conversion to open surgery or laparoscopic surgery. The operation time of 69 patients was (161±52)minutes, and the volume of intraoperative blood loss was 30 mL(range, 10-100 mL). Two of 69 patients had post-operative complications. One of them with postoperative abdominal hemorrhage was cured after symptomatic treatment and discharged on the 10th day after surgery. The other one patient with postoperative peritoneal effusion was cured and discharged from hospital after puncture drainage and symptomatic treatment. No Trocar-related complication such as Trocar foramen bleeding and Trocar foramen hernia occurred in the 69 patients. The duration of postoperative hospital stay of 69 patients was (6±3)days. (2) Follow-up: 47 of 69 patients were followed up for 3 months. The body mass, body mass index, fasting blood glucose, glycosylated hemoglobin, and total cholesterol were (86±19)kg, (30±5)kg/m 2, (5.2±0.7)mmol/L, 5.3%±0.6%, (4.3±1.3)mmol/L at postoperative 3 months, which had significant differences compared with the preoperative indicators ( t=6.101, 8.261, 2.973, 2.567, 2.098, P<0.05). All the 47 patients had no Trocar-related complications during the follow-up. Conclusion:The 'N' shaped Trocar placement method is safe and feasible in the Da Vinci robotic bariatric and metabolic surgery, with good efficacy.
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RESUMEN Objetivo: diseñar y evaluar la comprensión de una Herramienta Gráfica (HG) con recomendaciones de alimentación para personas con obesidad sometidas a Cirugía Bariátrica y Metabólica (CByM), con base en las guías propuestas por la American Society for Metabolic and Bariatric Surgery (ASMBS), American Association of Clinical Endocrinologists (AACE) y The Obesity Society (TOS), así como las recomendaciones del Colegio Mexicano de Cirugía para Obesidad y Enfermedades Metabólicas (CMCOEM) para el uso educativo de la persona profesional en nutriología-paciente. Metodología: se elaboró una HG nombrada "HG de alimentación pos-CByM" considerando las guías nutricionales propuestas por la ASMBS, AACE y TOS en conjunto con las recomendaciones de la CMCOEM. Además de realizar cuatro gráficos representando las fases que componen dicha HG, se incorporó una fase donde se aplicó un cuestionario de autollenado a tres grupos diferentes: 27 estudiantes de medicina, 8 pacientes posquirúrgicos y 16 pacientes prequirúrgicos. Se buscó identificar si el mensaje percibido era claro y conciso. Resultados: >70 % de la población intervenida entiende el mensaje de la HG diseñada, no existe significancia estadística entre los grupos entrevistados (p<0.05). Sin diferencia significativa (p<0.05) entre pacientes pre y posquirúrgicos, en ninguna de las respuestas. Conclusión: la educación en nutrición bariátrica es esencial para que las personas comprendan la transición de las fases posteriores a la intervención, los grupos, consistencia, tolerancia y porción de los alimentos. Esta HG puede ser de utilidad en la consulta nutricional exclusivamente para pacientes que se someterán a este tipo de cirugía o ya están en el proceso de recuperación.
ABSTRACT: Objectives: The purpose of this study is to Design and evaluate a graphic tool (GT) with feeding recommendations for people with obesity after bariatric surgery, based on the guidelines proposed by the American Society for Metabolic and Bariatric Surgery (ASMBS), American Association of Clinical Endocrinologists (AACE) y The Obesity Society (TOS) as well as the recommendations of the Mexican College of Surgery for Obesity and Metabolic Diseases (CMCOEM) for the educational use of the nutritionist-Bariatric patient. Methods: A GT named "Graphic tool for post bariatric surgery feeding" was elaborated based on the nutritional guidelines proposed by the ASMBS, AACE and TOS in conjunction with the recommendations of the CMCOEM. In addition to making four graphs representing each of the phases that conform the GT, a self-administered questionnaire was incorporate, it was carried out in three different groups: 27 medical students, 16 pre surgical patients and 8 postsurgical patients. We sought to identify if the perceived message was clear and brief. Results: More than 70% of the intervened population understood the message of the HG designed, there was no statistical significance among the groups interviewed (p <0.05) without significant difference (p <0.05) between pre and postsurgical patients, in none of the answers. Conclusion: Bariatric nutrition education is essential for the patient to understand the transition of the postsurgical phases, the food groups, the consistency, tolerance and portion of the food. This GT can be useful in the nutritional consultation exclusively for patients who will undergo this type of surgery or are already in the process of recovery.