Doctor, how much weight will I lose? - a new individualized predictive model for weight loss

Bariatric surgery is an effective treatment for weight loss, but the patient’s ability to reach a sustained weight loss depends upon several technical and individual factors. Creating an easy model that adapts bariatric surgery’s weight loss goals for each patient is very important for pre-surgery and follow-up evaluations.info:eu-repo/semantics/publishedVersio

Pheochromocytomatosis associated with a novel TMEM127 mutation

Pheochromocytomatosis, a very rare form of pheochromocytoma recurrence, refers to new, multiple, and often small pheochromocytomas growing in and around the surgical resection bed of a previous adrenalectomy for a solitary pheochromocytoma. We here report a case of pheochromocytomatosis in a 70-year-old female. At age 64 years, she was diagnosed with a 6-cm right pheochromocytoma. She underwent laparoscopic right adrenalectomy, during which the tumor capsule was ruptured. At age 67 years, CT of abdomen did not detect recurrence. At age 69 years, she began experiencing episodes of headache and diaphoresis. At age 70 years, biochemical markers of pheochromocytoma became elevated with normal calcitonin level. CT revealed multiple nodules of various sizes in the right adrenal fossa, some of which were positive on metaiodobenzylguanidine (MIBG) scan. She underwent open resection of pheochromocytomatosis. Histological examination confirmed numerous pheochromocytomas ranging 0.1–1.2 cm in size. Next-generation sequencing of a panel of genes found a novel heterozygous germline c.570delC mutation in TMEM127, one of the genes that, if mutated, confers susceptibility to syndromic pheochromocytoma. Molecular analysis showed that the c.570delC mutation is likely pathogenic. Our case highlights the typical presentation of pheochromocytomatosis, a rare complication of adrenalectomy for pheochromocytoma. Previous cases and ours collectively demonstrate that tumor capsule rupture during adrenalectomy is a risk factor for pheochromocytomatosis. We also report a novel TMEM127 mutation in this case

Preliminary Outcomes 1 Year after Laparoscopic Sleeve Gastrectomy Based on Bariatric Analysis and Reporting Outcome System (BAROS)

# The Author(s) 2011. This article is published with open access at Springerlink.com Background The aim of this study was to assess outcomes of laparoscopic sleeve gastrectomy (LSG) as a stand-alone bariatric operation according to the Bariatric Analysis and Reporting Outcome System (BAROS). Methods Out of 112 patients included and operated on initially, 84 patients (F/M, 63:21) were followed up for 14– 56 months (mean 22±6.75). Patients lost to follow-up did not attend scheduled follow-up visits or they have withdrawn their consent. Mean age was 39 years (range 17–67; SD±12.09) with mean initial BMI 44.62 kg/m 2 (range 29.39–82.8; SD±8.17). Statistical significance was established at the p<0.05 level. Results Mean operative time was 61 min (30–140 min) with mean hospital stay of 1.37 days (0–4; SD±0.77). Excellent global BAROS outcome was achieved in 13 % of patients, very good in 30%, good in 34.5%, fair 9.5 % and failure in 13 % patients 12 months after surgery. Females achieved significantly better outcomes than males with the mean 46.5 % of excess weight loss (EWL) versus 35.3 % of EWL at 12 months (p=0.02). The mean percentage of excess weight loss (%EWL) was 43.6 % at 12 months and 46.6 % at 24 months. Major surgical complication rate was 7.1%; minor surgical complication rate 8.3%. There was one conversion (1.2%) due to the massive bleeding. Comorbidities improved or resolved in numerous patients

APOLO-Bari, an internet-based program for longitudinal support of bariatric surgery patients: study protocol for a randomized controlled trial

Background: Despite evidence of successful weight loss for bariatric surgery patients, some patients experience considerable weight regain over the long term. Given the strong association between post-surgery health behaviors and outcomes, aftercare intervention to address key behaviors appears to be a reasonable relapse-prevention strategy. As the burden of obesity rates increases in healthcare centers, an internet-based program appears to be a reasonable strategy for supporting bariatric surgery patients in the long term. The primary purpose of the current project is to develop and test the efficacy and perceived utility of APOLO-Bari.Methods/design: This study is a randomized control trial, which will be conducted in two hospital centers in the North of Portugal; it includes a control group receiving treatment as usual and an intervention group receiving the APOLO-Bari program for one year in addition to treatment as usual. A total of 180 male and female participants who underwent bariatric surgery (gastric sleeve or gastric bypass surgery) for 12 to 20 months will be recruited. Both groups will complete a similar set of questionnaires at baseline, every 4 months until the end of the intervention, and at 6 and 12 months follow-up. Assessment includes anthropometric variables and psychological self-report measures. The primary outcome measure will be weight regain measured at the end of treatment, and at 6 and 12 months follow-up. The secondary aims are to test the cost-effectiveness of the intervention and to investigate psychological predictors and trajectories of weight regain. APOLO-Bari was developed to address the weight regain problem in the bariatric population by offering additional guidance to bariatric patients during the postoperative period. The program includes: (a) a psychoeducational cognitive-behavioral-based self-help manual, (b) a weekly feedback messaging system that sends a feedback statement related to information reported by the participant, and (c) interactive chat sessions scheduled witThis research was partially supported by the Fundacao para a Ciencia e a Tecnologia through a European Union COMPETE program grant to Eva Conceicao (IF/01219/2014 and PTDC/MHC-PCL/4974/2012), a doctoral scholarship to Ana Pinto-Bastos (SFRH/BD/104159/2014), a doctoral scholarship to Sofia Ramalho (SFRH/BD/104182/2014), and a postdoctoral scholarship to Ana Rita Vaz (SFRH/BPD/94490/2013), co-financed by FEDER under the PT2020 Partnership Agreement (UID/PSI/01662/2013).info:eu-repo/semantics/publishedVersio

Weight loss during medical weight management does not predict weight loss after bariatric surgery: A retrospective cohort study

Background: Many bariatric surgical centers mandate achieving weight loss targets through medical weight management (MWM) programs before offering bariatric surgery, but the evidence for this is unclear.  Objectives: To examine the relationship between weight changes during (1) MWM, and (2) preoperative low-energy-diet (LED), and weight changes at 12 and 24 months after surgery.  Setting: Multicenter community- and acute-based MWM services referring to one regional bariatric center, United Kingdom. Methods: A retrospective cohort study of patients who attended MWM and then underwent a primary laparoscopic bariatric procedure (adjustable gastric banding [LAGB], or Roux-en-Y gastric bypass [RYGB]) in a single bariatric center in the United Kingdom between 2013 and 2015. Data were collected from patient electronic records.  Results: Two hundred eight patients were included (LAGB n = 128, RYGB n = 80). Anthropometric data were available for 94.7% and 88.0% of participants at 12 and 24 months, respectively. There was no relationship between weight loss during MWM and after surgery at either 12 or 24 months. Weight loss during the preoperative LED predicted greater weight loss after LAGB (β =. 251, P = .006) and less weight loss after RYGB (β = −.390, P = .003) at 24 months, after adjusting for age, sex, ethnicity, baseline weight, and LED duration.  Conclusions: Weight loss in MWM does not predict greater weight loss outcomes up to 24 months after LAGB or RYGB. Greater weight loss during the preoperative LED predicted greater weight loss after LAGB and less weight loss after RYGB. Our results suggest that patients should not be denied bariatric surgery because of not achieving weight loss in MWM. Weight loss responses to preoperative LEDs as a predictor of postsurgical weight loss requires further investigation