Early Improvement in Glycemic Metabolism after Laparoscopic Sleeve Gastrectomy in Obese Patients -A Prospective Study

Rezumat Ameliorarea rapidã a metabolismului glucidic dupã gastrectomia longitudinalã laparoscopicã la pacienåii cu obezitate -studiu prospectiv Introducere: Conform Organizaåiei Mondiale a Sãnãtãåii, existau în 2014 peste 600 de milioane de adulåi cu obezitate (mai mult decât dublu faåã de anul 1980) care prezintã un risc crescut de dezvoltare a sindromului metabolic, deci inclusiv pentru diabetul zaharat de tip 2. Datoritã controlului slab glicemic în urma tratamentului conservator al DZ tip 2, chirurgia metabolicã a fost capabilã sã câaetige un rol important în managementul pacientului cu DZ tip 2 aei obezitate, cu remisii sau îmbunãtãåiri semnificative raportate în literatura de specialitate. Obiectiv: studierea efectelor gastrectomiei longitudinale laparoscopice (LSG) asupra metabolismului glucidic la pacienåii cu obezitate, cu sau fãrã DZ tip 2. Metodã: 60 de pacienåi consecutivi, operaåi în spitalul Ponderas pentru obezitate prin gastrectomie longitudinalã laparoscopicã, au fost incluaei într-un studiu prospectiv, în perioada FebruarieMartie 2013. IMC-ul (indicele de masã corporalã), circumferinåã abdominalã aei parametrii glicemici au fost studiaåi pre-operator, la 10 zile aei 6 luni postoperator. Rezultate: controlul glicemic a fost semnificant îmbunãtãåit începând cu ziua 10 postoperatorie. Imbunãtãåiri semnificative statistic au fost notate la 6 luni postoperator în valorile IMCului (p<0.0001), circumferinåa abdominalã (p<0.0001), glicemie (p<0.0001), insulinemie (p<0.0001), peptid C (p<0.0001) aei HOMA. Concluzii: o îmbunãtãåire rapidã a metabolismului glucidic, atât la pacienåii cu obezitate aei DZ tip 2 cât aei la cei fãrã DZ tip 2, se regãseaete înaintea scãderii ponderale semnificative (10 zile postoperator). La 6 luni postoperator, când se asociazã aei o scãdere ponderalã semnificativã, atât pacienåii diabetici cât aei cei nediabetici prezintã o îmbunãtãåire suplimentarã a metabolismului glicemic, care poate susåine ideea ca gastrectomia longitudinalã laparoscopicã este o metodã eficientã pentru tratamentul pacienåilor cu obezitate aei sindrom metabolic. Aceste modificãri benefice pot explica atât remisia DZ tip 2 dar aei prevenåia acestuia la pacienåii cu obezitate supuaei tratamentului chirurgical metabolic. Cuvinte cheie: obezitate, metabolism glucidic, gastrectomie longitudinalã laparoscopicã, remisia aei prevenåia diabetului zaharat tip 2 Abstract Background: according to W.H.O. in 2014 more than 600 million adults were obese, (more than doubled since 1980), and face a major risk for the onset of metabolic syndrome, including T2DM. Due to the poor control of glycemic imbalance for the conservative treatment of T2DM, the metabolic surgery was able to gain an important role in modern management of T2DM, with significant reported improvements or remissions for these patients. Objective: to study the effects of laparoscopic sleeve gastrec- BMI, waist circumference and glycemic parameters were studied at the moment of entering the study, 10 days after surgery and at 6 months follow up. Results: the glycemic control was significantly improved starting with postoperative day 10. Statistically significant improvements were noticed after six months postoperatively in BMI values (p<0,0001), waist circumference (p<0,0001), glycemic levels (p<0,0001), insulin (p<0,0001), C-peptide (p<0,0001) and HOMA. Conclusions: a rapid induced improvement of glucose metabolism in both diabetic and non-diabetic patients occurs before a significant weight loss (POD 10). At 6 months, when associated with an important weight loss, both diabetic and non-diabetic patients present a furthermore improvement in glycemic metabolism, that enables us to consider that sleeve gastrectomy is an efficient method for a sustained improvement in the metabolic status of patients with obesity. These beneficial changes that can explain the remission of T2DM can also explain the prevention of T2DM after metabolic surgery

Ekspresja adiponektyny w otyłości trzewnej jest istotnym wyznacznikiem insulinooporności w otyłości olbrzymiej

Introduction: Visceral adiposity is associated with decreased serum adiponectin levels, peripheral resistance to insulin and an increased risk of cardio-metabolic complications. However, the link between adiponectin expression in visceral adipose tissue (VAT), its serum levels and metabolic protection is controversial. The aim of this study was to investigate the relationship between the adiponectin gene expression in VAT and clinical and metabolic parameters in patients with severe obesity. Material and Methods: This is a cross-sectional study that included 51 severely obese patients (age 43.24±11.29 years, BMI 45.13±8.67 kg/m2), extensively evaluated clinically and biologically (metabolic tests, serum adiponectin measurements, HOMA-IR) before bariatric surgery. Omental adipose tissue was sampled during the intervention and the relative quantification of adiponectin gene expression was performed by real-time PCR, using beta-actin as reference gene. Results. Adiponectin mRNA in VAT was significantly higher in obese insulin-sensitive patients than in the rest of obese patients (p < 0.05) and negatively correlated with HOMA-IR (r =-0.354, p=0.016) and uric acid (r =-0.304, p=0.045). After adjustment for gender, TG/HDL ratio and uric acid, adiponectin expresion (β= -0.439, p=0.001), waist circumference (β=0.467, p=0.001) and serum adiponectin (β =-0.339, p=0.011) remained significantly associated with HOMA-IR, together explaining more than 50% of its variation. Conclusions. In severely obese patients, adiponectin gene expression in VAT is negatively correlated with serum levels of uric acid and is an independent determinant, together with anthropometric parameters of visceral obesity and serum adiponectin levels, of insulin resistance.Wstęp: Otyłość trzewna związana jest ze zmniejszonym stężeniem adiponektyny w surowicy krwi, obwodową opornością na działanie insuliny oraz ze zwiększonym ryzykiem powikłań sercowo-metabolicznych. Jednak związek między ekspresją adiponektyny w trzewnej tkance tłuszczowej, jej stężeniem w surowicy krwi a ochroną metaboliczną jest kwestią sporną. Celem niniejszej pracy było zbadanie związku między ekspresją genu adiponektyny w trzewnej tkance tłuszczowej a klinicznymi i metabolicznymi parametrami pacjentów ze znaczną otyłością. Materiał i metody: To przekrojowe badanie obejmowało 51 znacznie otyłych pacjentów (wiek 43,24 ± 11,29 roku, BMI 45,13 ± 8,67 kg/m2), szczegółowo ocenionych pod względem klinicznym i biologicznym (testy metaboliczne, pomiary stężenia adiponektyny w surowicy krwi, wskaźnik HOMA-IR) przed operacją bariatryczną. Podczas operacji pobrano tkankę tłuszczową sieci. Względna ocena ilościowa ekspresji genu adiponektyny była przeprowadzona metodą PCR w czasie rzeczywistym. Wyniki: Poziom mRNA adiponektyny w trzewnej tkance tłuszczowej był znacząco wyższy u otyłych pacjentów wrażliwych na insulinę niż u pozostałych otyłych pacjentów (p &lt; 0,05) oraz ujemnie skorelowany ze wskaźnikiem HOMA-IR (r = –0,354, p = 0,016) i kwasem moczowym (r = –0,304, p = 0.045). Po uwzględnieniu płci, wskaźnika TG/HDL i kwasu moczowego, ekspresja adiponektyny (β = –0,439, p = 0,001), obwód talii (β = 0,467, p = 0,001) i poziom adiponektyny w surowicy krwi (β = –0,339, p = 0,011) pozostały istotnie związane ze wskaźnikiem HOMA-IR, łącznie wyjaśniając ponad 50% jego wariancji. Wnioski: W przypadku znacznie otyłych pacjentów ekspresja genu adiponektyny w trzewnej tkance tłuszczowej jest ujemnie skorelowana ze stężeniem kwasu moczowego w surowicy krwi i razem z antropometrycznymi parametrami otyłości trzewnej oraz stężeniem adiponektyny w surowicy krwi jest niezależnym wyznacznikiem insulinooporności

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak

Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study

Background: It has been suggested that patients with a Body Mass Index (BMI) of &gt; 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI -Group I (BMI &lt; 50 kg/m2), Group II (BMI 50-60 kg/m2), and Group III (BMI &gt; 60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 &amp; PLUSMN; 24.4 Kgs and 43.03 &amp; PLUSMN; 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively.The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = &lt; 0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of &gt; 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI &gt; 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Background Age &gt;= 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients &gt;= 65-years-old (Group I) and patients &lt; 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 +/- 2.5 years, 119.5 +/- 24.5 kg, and 43 +/- 7 in Group I and 39.8 +/- 11.3 years, 117.7 +/- 20.4 kg, and 43.7 +/- 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = &lt; 0.001). The 30-day morbidity was significantly higher in Group I ( 11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those &gt;= 65 years of age compared to those &lt; 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n&nbsp;=&nbsp;122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7&nbsp;± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n&nbsp;=&nbsp;146; 85.9%), only 42.4% (n&nbsp;=&nbsp;72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n&nbsp;=&nbsp;9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients