ABSTRACT
PURPOSE: The laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the standard procedures in metabolic surgery. Different limb lengths have been proposed in the past to maximize weight loss (WL) and reduce metabolic complications. Distal gastric bypass surgery with a very short common channel (CC) (up to 100 cm) has been often criticized due to frequent side effects such as malnutrition, bone weakening and short-bowel syndrome. We introduced a modified version of a distal LRYGB with a 50-70 cm long biliopancreatic limb (BPL) and an intermediate short CC (120-150 cm). Our primary goal was to compare the long-term WL between distal and proximal LRYGB in two cohorts of patients. Secondary outcomes were weight regain (WR), insufficient weight loss (IWL), postoperative complications and metabolic changes 5 years after surgery. METHODS: In this retrospective study we collected data from 160 patients operated between 2014 and 2015, with a BMI of 37-44 Kg/m2. 101 patients underwent a distal and 59 patients a proximal LRYGB in two bariatric centers. WL was calculated as percent of excess of BMI loss (%EBMIL), loss of body mass index (Delta-BMI), percent of excess weight loss (%EWL) and percent of total weight loss (%TWL). Data were collected 3, 6, 9, 12, 24, 48 and 60 months after surgery. RESULTS: The distal LRYGB resulted in significantly better 5-year-WL compared to the proximal bypass in terms of %EBMIL (median at 5 years: 83% vs. 65%, p = 0.001), %TWL (median at 5 years: 32% vs. 26%, p = 0.017) and %EWL (median at 5 years: 65% vs. 51%, p = 0.029), with equal major complications and metabolic alterations. In addition, WR was significantly lower in patients with distal bypass (18% vs. 35%, p = 0.032). CONCLUSIONS: Distal LYRGB with a 120-150 long CC results in better WL and WL-maintenance compared to proximal LRYGB without major side effects after five years.
Subject(s)
Body Mass Index , Gastric Bypass , Laparoscopy , Obesity, Morbid , Weight Loss , Humans , Gastric Bypass/adverse effects , Gastric Bypass/methods , Female , Male , Middle Aged , Adult , Retrospective Studies , Obesity, Morbid/surgery , Obesity, Morbid/complications , Treatment Outcome , Laparoscopy/adverse effects , Laparoscopy/methods , Postoperative Complications/etiology , Postoperative Complications/epidemiologyABSTRACT
The authors aimed to analyze the relation of psychological predictors with medical and psychological therapy success indicators in continuous subcutaneous insulin infusion (CSII). Besides blood glucose control as a medical indicator of therapy success (by means of HbA(1c) levels), the authors assessed treatment satisfaction, depressive symptoms, and quality of life among 51 adult patients on CSII. The authors examined the following psychological factors that were assumed to be associated with outcome variables: coping style, locus of control, and self-efficacy. Self-efficacy correlated positively with all psychological outcome variables. A high external locus of control was related to negative glycaemic outcome and more depressive symptoms. Multiple linear regression analyses revealed that when considering all psychological factors simultaneously, locus of control was the strongest predictor of HbA(1c). For the psychological outcomes, self-efficacy was the most powerful predictor. The authors demonstrated that medical and psychological diabetes-related outcomes were strongly related to psychological factors in adult CSII patients. Patients who felt responsible for the process of CSII therapy showed more positive outcomes; therefore, psychological care can be seen as an important part of diabetes education in CSII therapy.
