Single-incision or conventional laparoscopic adjustable gastric banding: A systematic review.

INTRODUCTION: Single-incision laparoscopic surgery (SILS) in gastric banding (SI-LAGB) has been reported to be a safe and technically feasible procedure among various operating methods. However, there is little evidence with regard to the question whether SI-LAGB has more advantages and should be recommended compared with conventional LAGB (CLAGB). Thus, this study was performed to assess the safety and efficacy of SI-LAGB. MATERIAL AND METHODS: A computerized search of the electronic databases PubMed and EMBASE was performed. Data regarding operative parameters, postoperative recovery parameters, follow-up time, percentage of excess weight loss, and postoperative complication were pooled and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS: Ten comparative studies including 2,073 patients (1,038 patients who received SI-LAGB and 1,035 patients who received CLAGB) were included and analyzed. Compared with CLAGB, a similar weight loss could be obtained using SI-LAGB. The postoperative complications of SI-LAGB were within the acceptable range, but one study reported one perioperative death. SI-LAGB required a longer operative time. Other outcome variables, such as blood loss, days of hospitalization, pain score, and hospitalization costs, were not significantly different between the two groups. CONCLUSIONS: SI-LAGB might be a safe and effective alternative to C-LAGB when performed by experienced surgeons, but available data do not allow to give a definitive answer and randomized controlled trials are needed.

Long-Term outcomes and experience of laparoscopic adjustable gastric banding: one center's results in China.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB), as one major bariatric surgery for treatment of obesity, results in ineffective long-term weight loss and a high reoperation rate. The objective of this study was to evaluate the long-term effects of LAGB on the weight loss outcomes and reoperation rates of obese patients with different body mass index (BMI) levels in China. METHODS: A retrospective study was performed to review the follow-up data of obese patients who underwent LAGB at Shanghai Changhai Hospital between November 2003 and May 2013. The main outcomes included weight loss, percentage excess weight loss (%EWL), reoperation rate, and reasons for reoperation. RESULTS: A total of 254 LAGB procedures were performed in our hospital. By the end of May 2013, 145 Chinese patients (57.8%) were followed up, 99 patients with BMI ≥ 35 kg/m(2) (high BMI group) and 46 patients with BMI < 35 kg/m(2) (low BMI group). In the high BMI group, the mean %EWL was > 25% within 5 years postoperatively, but it decreased to less than 25% after 5 years. However, in the low BMI group, the mean %EWL at each time point was over 50%. The reoperation rate was 33.1%; it was 17.4% in the low BMI group and 34.3% in the high BMI group. CONCLUSION: LAGB is more effective with a lower reoperation rate for obese patients with a BMI < 35 kg/m(2) compared to BMI ≥ 35 kg/m(2) in our population.

Therapeutic effects of hydrogen saturated saline on rat diabetic model and insulin resistant model via reduction of oxidative stress.

BACKGROUND: Molecular hydrogen, as a novel antioxidant, has been proven effective in treating many diseases. This study aimed to evaluate the therapeutic effects of hydrogen saturated saline in treatment of a rat model of diabetes mellitus and a rat model of insulin resistant. METHODS: A rat diabetes mellitus model was established by feeding a high fat/high carbohydrate diet followed by injection of a small dose of streptozotocin, and an insulin resistant model was induced with a high glucose and high fat diet. Hydrogen saturated saline was administered to rats with both models conditions on a daily basis for eight weeks. A pioglitazone-treated group and normal saline-treated group served as positive and negative controls. The general condition, body weight, blood glucose, blood lipids, and serum insulin levels of rats were examined at the 8th week after treatment. The oxidative stress indices, including serum superoxide dismutase (SOD), glutathione (GSH) and malondialdehyde (MDA) were also evaluated after eight weeks of treatment using the commercial kits. RESULTS: Hydrogen saturated saline showed great efficiency in improving the insulin sensitivity and lowering blood glucose and lipids. Meanwhile, the therapeutic effects of hydrogen saturated saline were superior to those of pioglitazone. Hydrogen saturated saline markedly attenuated the MDA level and elevated the levels of antioxidants SOD and GSH. CONCLUSION: Hydrogen saturated saline may improve the insulin resistance and alleviate the symptoms of diabetes mellitus by reducing the oxidative stress and enhancing the anti-oxidant system.

Intensive glycemic control and macrovascular events in type 2 diabetes mellitus: a meta-analysis of randomized controlled trials.

BACKGROUND: There is no agreement as to whether intensive glucose control in type 2 diabetes can reduce the incidence of macrovascular events in these patients. We performed a meta-analysis comparing intensive glucose control or conventional glucose control in randomized controlled trials. METHODS: Databases including MEDLINE, EMBASE, and Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were the incidence of major macrovascular events. RESULTS: Six trials involving 28 065 patients were included. Analysis suggested that there was an obviously decreased incidence of major macrovascular events in patients having intensive glucose treatment vs. controls (RR 0.92; 95%CI 0.87, 0.98; P = 0.005). However, intensive glycemia control strategies in type 2 diabetes showed no significant impact on the incidence of death from any cause compared with conventional glycemia control strategies, intensive 14.7%, controls 12.0% (RR 0.95; 95%CI 0.80, 1.12; P = 0.55), as well as on the incidence of cardiovascular death, intensive 3.7%, controls 3.6% (RR 1.10, 95%CI 0.79, 1.53; P = 0.57). CONCLUSIONS: Control of glycemia to normal (or near normal levels) in type 2 diabetes appears to be effective in reducing the incidence of major macrovascular events, but there were no significant differences of either the mortality from any cause or from cardiovascular death between the two glycemia-control strategies.

A systematic review on intrapyloric botulinum toxin injection for gastroparesis.

BACKGROUND: Though trials evaluating the effect of intrapyloric botulinum toxin injection on gastroparesis have been reported, there is no agreement whether botulinum toxin can effectively relieve the symptoms and improve the results of gastric emptying study in patients with gastroparesis. We performed a systematic literature review to address this issue. METHODS: Databases including PubMed, EMBASE, and the Cochrane Library and Science Citation Index were searched. Two reviewers independently identified relevant trials. Outcome measures were the improvement of subjective symptoms and objective measurement. RESULTS: 15 reports were included; only 2 randomized controlled trials were available. Almost all the non-randomized trials reported significant improvement in subjective symptoms and objective gastric emptying study after botulinum toxin injection. While the 2 randomized controlled trials did not confirm the efficacy of botulinum toxin injection, none of the individual trials showed that there was statistically significant subjective and objective improvement in the active patients when compared with patients receiving placebo. CONCLUSIONS: Available high-quality trials showed that intrapyloric botulinum toxin injection could not significantly relieve subjective symptoms and improve objective measurement in patients with gastroparesis, and there is no evidence to recommend botulinum toxin injection for the treatment of gastroparesis.