Reduction of sleeping metabolic rate after vertical banded gastroplasty.

Department of Surgery, University Hospital Maastricht, The Netherlands. OBJECTIVE: To investigate whether long-term weight loss after vertical banded gastroplasty (VBG) results in a sustained reduction of sleeping metabolic rate (SMR) as a persistent risk factor for weight regain. DESIGN: Longitudinal clinical intervention study of morbidly obese patients undergoing VBG. PATIENTS: Group I: Six patients in which body composition and SMR were measured before and at 3, 6 and 12 months after VBG. Group II (long-term effect): nine patients in which body mass (BM) was measured before VBG, and body composition and SMR were measured 98+/-30 months after VBG. MEASUREMENTS: Body composition was assessed by deuterium dilution and hydrostatic weighing. SMR was measured (SMRm) in a respiration chamber and predicted (SMRp) based on body composition. RESULTS: In group I, fat mass and fat free mass decreased significantly after VBG (P < 0.05). SMRm decreased from 11.1+/-1.8 (s.d.) MJ/d before VBG to 8.1+/-0.9 MJ/d (P < 0.05) at 12 months after VBG. In group II at a mean of 98 months after VBG, the SMRm (6.9+/-0.7 MJ/d) was lower than the preoperative value of group I (P < 0.05). SMRm was lower than SMRp at all intervals after VBG (P < 0.05). The ratio measured vs predicted SMR was in group I: 1.02+/-0.05 before VBG, 0.91+/-0.08 at 12 months after VBG (P<0.05), and in group 11: 0.94+/-0.08 at a mean of 98 months after VBG (P < 0.05). CONCLUSION: The reduction of SMR adjusted for body composition after VBG is sustained as long as weight loss is maintained. The sustained and disproportional reduction of SMR may reflect the persistent susceptibility of the postobese to weight regain

National bariatric surgery registries: an international comparison

Introduction Pooling population-based data from all national bariatric registries may provide international real-world evidence for outcomes that will help establish a universal standard of care, provided that the same variables and definitions are used. Therefore, this study aims to assess the concordance of variables across national registries to identify which outcomes can be used for international collaborations. Methods All 18 countries with a national bariatric registry who contributed to The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Global Registry report 2019 were requested to share their data dictionary by email. The primary outcome was the percentage of perfect agreement for variables by domain: patient, prior bariatric history, screening, operation, complication, and follow-up. Perfect agreement was defined as 100% concordance, meaning that the variable was registered with the same definition across all registries. Secondary outcomes were defined as variables having "substantial agreement" (75-99.9%) and "moderate agreement" (50-74.9%) across registries. Results Eleven registries responded and had a total of 2585 recorded variables that were grouped into 250 variables measuring the same concept. A total of 25 (10%) variables have a perfect agreement across all domains: 3 (18.75%) for the patient domain, 0 (0.0%) for prior bariatric history, 5 (8.2%) for screening, 6 (11.8%) for operation, 5 (8.8%) for complications, and 6 (11.8%) for follow-up. Furthermore, 28 (11.2%) variables have substantial agreement and 59 (23.6%) variables have moderate agreement across registries. Conclusion There is limited uniform agreement in variables across national bariatric registries. Further alignment and uniformity in collected variables are required to enable future international collaborations and comparison.Analysis and support of clinical decision makin

Alternative techniques for the treatment of colon carcinoma metastases in the liver: current status in The Netherlands

Alternative techniques for the treatment of colon carcinoma metastases in the liver: current status in The Netherlands. Greve JW. Dept. of Surgery, University Hospital Maastricht, The Netherlands. [email protected] BACKGROUND: Review of current treatment modalities for liver metastases resulting from colorectal cancer. METHODS: Literature review. RESULTS: An increasing number of techniques are available for the treatment of colorectal liver metastases. When it is not possible to use the current gold standard, radical surgical resection, many patients can be treated with alternative techniques. Chemotherapy in its present form must be considered as purely palliative, perhaps with the exclusion of isolated liver perfusion: however, this therapy should still be considered as experimental. Most other possible treatments focus on local destruction of the metastases. This can be achieved using either immuno-guided techniques (tumor antibodies which carry a local active agent), direct local application of a toxic agent (injection) or thermo therapy, which has been applied in patients on a large scale. Thermo therapy involves either localized heating, by means or laser photocoagulation or radiofrequency or microwave ablation, or localized freezing using cryo probes. CONCLUSIONS: Local destruction of liver metastases, especially by means of thermo therapy, is feasible and safe. Currently, cryotherapy is most frequently used in patients. New treatment modalities, such as radiofrequency ablation, arc very promising but their true clinical value should be determined in a randomized clinical tria

Should laparoscopic surgeons re-invent bariatric surgical procedures?

Should laparoscopic surgeons re-invent bariatric surgical procedures? Greve JW

Bariatric surgery for metabolic disorders.

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