One Anastomosis/Mini-Gastric Bypass (OAGB/MGB) as Revisional Surgery Following Primary Restrictive Bariatric Procedures: a Systematic Review and Meta-Analysis

One anastomosis gastric bypass (OAGB/MGB) has gained popularity in the past decade. International databases were searched for articles published by September 10, 2020, on OAGB/MGB as a revisional procedure after restrictive procedures. Twenty-six studies examining a total of 1771 patients were included. The mean initial BMI was 45.70 kg/m2, which decreased to 31.52, 31.40, and 30.54 kg/m2 at 1, 3, and 5-year follow-ups, respectively. Remission of type-2 diabetes mellitus (T2DM) following OAGB/MGB at 1-, 3-, and 5-year follow-up was 65.16 ± 24.43, 65.37 ± 36.07, and 78.10 ± 14.19%, respectively. Remission/improvement rate from gastroesophageal reflux disease (GERD). Also, 7.4% of the patients developed de novo GERD following OAGB/MGB. Leakage was the most common major complication. OAGB/MGB appears to be feasible and effective as a revisional procedure after failed restrictive bariatric procedures

One Anastomosis/Mini-Gastric Bypass (OAGB/MGB) as Revisional Surgery Following Primary Restrictive Bariatric Procedures: a Systematic Review and Meta-Analysis

One anastomosis gastric bypass (OAGB/MGB) has gained popularity in the past decade. International databases were searched for articles published by September 10, 2020, on OAGB/MGB as a revisional procedure after restrictive procedures. Twenty-six studies examining a total of 1771 patients were included. The mean initial BMI was 45.70 kg/m2, which decreased to 31.52, 31.40, and 30.54 kg/m2 at 1, 3, and 5-year follow-ups, respectively. Remission of type-2 diabetes mellitus (T2DM) following OAGB/MGB at 1-, 3-, and 5-year follow-up was 65.16 ± 24.43, 65.37 ± 36.07, and 78.10 ± 14.19, respectively. Remission/improvement rate from gastroesophageal reflux disease (GERD). Also, 7.4 of the patients developed de novo GERD following OAGB/MGB. Leakage was the most common major complication. OAGB/MGB appears to be feasible and effective as a revisional procedure after failed restrictive bariatric procedures. © 2020, The Author(s)

The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

Background: Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods: An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results: 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion: This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building

Finite element analysis of implant-assisted removable partial denture attachment with different matrix designs during bilateral loading

Purpose: The aim of this study was to investigate the effect of different matrix designs on resilient attachment on an implant-assisted removable partial denture (IARPD) using finite element analysis (FEA). Materials and Methods: A laser scanner was used to extract the geometrical data of a human partially edentulous mandible. A 12-mm-long and 4.8-mm-diameter-wide implant was modeled, and two types of intradental attachment of snap fastener principle (elliptical) and resilient attachment (titanium) matrices were modeled along with tooth roots and periodontal ligaments. The modeling was performed with a combination of reverse engineering and solid modeling. The model incorporated a removable partial denture and was loaded with realistic bilateral forces. The FEA was used to analyze the stress and strain distributions in the IARPD and in the metal framework. Results: Stresses and deformations in the metal framework and resin denture base surfaces were analyzed for the elliptical and titanium matrix designs. The maximum von Mises stresses were 605.85 and 614.96 MPa in the metal framework surface and 10.35 and 10.63 MPa in the resin denture base surface, respectively, for the elliptical and titanium matrix designs. The maximum deformations (displacements) were 418.5 and 428.3 μm in the metal framework surface for the elliptical and titanium matrix designs, respectively. The corresponding values of displacements for the resin denture base surface were 325.52 and 249.22 μm for the elliptical and titanium matrix designs, respectively. The maximum displacements in the matrixes were, however, nearly the same (229.51 and 229.47 μm) for both the elliptical and titanium matrixes. Conclusion: The titanium matrix design was a more favorable design compared with the elliptical design, because it had lower lateral deformation as indicated by the maximum displacement

Finite element analysis of implant-assisted removable partial dentures: Framework design considerations

Statement of problem Connecting an acrylic resin base to both a metal framework and a rigidly fixed implant may affect the rotational displacement of the prosthesis during loading. Purpose The purpose of this finite element analysis study was to analyze the effect of connecting a denture base metal framework to an implant with the aim of decreasing the rotational movement of an implant-assisted removable partial denture. Material and methods A mesial occlusal rest direct retainer and a distal occlusal rest direct retainer were modeled and adapted to incorporate a modified denture base metal framework in the connection area for each model. The stress and deformation patterns of the prosthesis structure were determined using finite element analysis and compared for both situations. Results A maximum von Mises stress of 923 MPa was observed on the metal framework of the prosthesis with a mesial occlusal rest, and the maximum value was 1478 MPa for the distal occlusal rest. A maximum von Mises stress of 17 MPa occurred on the acrylic resin denture base for the mesial occlusal rest, and a maximum von Mises stress of 29 MPa occurred for the distal occlusal rest. Conclusions The distal occlusal rest direct retainer is stiffer than the mesial design and undergoes approximately 66% less deformation. The modified denture base framework with an I-bar and distal occlusal rest design provides more effective support to the acrylic resin structure

Finite element analysis of an implant-assisted removable partial denture during bilateral loading: Occlusal rests position

Statement of problem When implants are incorporated into an existing partial removable dental prosthesis, the acrylic resin base can fracture. It is therefore essential to study the mechanical behavior of partial removable dental prostheses by using stress and deformation analysis Purpose The purpose of this study was to analyze the effect of the occlusal rest position on the implant-assisted partial removable dental prosthesis by finite element analysis. Material and methods A Faro Arm scan was used to extract the geometrical data of a human partially edentulous mandible. A standard plus regular neck (4.8×12 mm) implant and titanium matrix, tooth roots, and periodontal ligaments were modeled by using a combination of reverse engineering in Rapidform XOR2 and solid modeling with the Solid Works CAD program. The model incorporated a partial removable dental prosthesis and was loaded with standard bilateral forces. A uniform pressure was applied on the occlusal surface so as to generate an equivalent net force of 120 N for both the left and right prosthesis. The finite element analysis program ANSYS Workbench was used to analyze the stress and strain distributions in the implant-assisted partial removable dental prosthesis. Results Maximum stresses were significantly high for the metal framework compared to the acrylic resin surface, and these stresses were different for the mesial and distal arm designs. The maximum stress in the metal framework for the mesial arm design was 614.9 MPa, and it was 796.4 MPa for the distal arm design. The corresponding stresses in the acrylic resin surface were 10.6 and 8.6 MPa. Conclusions Within the limitation of this study, it was found that moving the position of the occlusal rest from the mesial to distal side of the abutment teeth improved the stress distribution in the metal framework and acrylic resin denture base structures

Strain distribution in a Kennedy class I implant assisted removable partial denture under various loading conditions

Purpose. This in vitro study investigates how unilateral and bilateral occlusal loads are transferred to an implant assisted removable partial denture (IARPD). Materials and Methods. A duplicate model of a Kennedy class I edentulous mandibular arch was made and then a conventional removable partial denture (RPD) fabricated. Two Straumann implants were placed in the second molar region, and the prosthesis was modified to accommodate implant retained ball attachments. Strain gages were incorporated into the fitting surface of both the framework and acrylic to measure microstrain (Strain). The IARPD was loaded to 120Ns unilaterally and bilaterally in three different loading positions. Statistical analysis was carried out using SPSS version 18.0 (SPSS, Inc., Chicago, IL, USA) with an alpha level of 0.05 to compare the maximum Strain values of the different loading conditions. Results. During unilateral and bilateral loading the maximum Strain was predominantly observed in a buccal direction. As the load was moved anteriorly the Strain increased in the mesial area. Unilateral loading resulted in a twisting of the structure and generated a strain mismatch between the metal and acrylic surfaces. Conclusions. Unilateral loading created lateral and vertical displacement of the IARPD. The curvature of the dental arch resulted in a twisting action which intensified as the unilateral load was moved anteriorly

Triglyceride Glucose Index and Related Parameters (Triglyceride Glucose-Body Mass Index and Triglyceride Glucose-Waist Circumference) Identify Nonalcoholic Fatty Liver and Liver Fibrosis in Individuals with Overweight/Obesity

Background: The triglyceride glucose (TyG) index has been proposed as a reliable surrogate marker for nonalcoholic fatty liver disease (NAFLD). Furthermore, NAFLD is strongly related with obesity. This study aimed to compare TyG index and its related parameters (TyG-waist circumference WC and TyG-body mass index BMI), comprising TyG and obesity markers, in predicting NAFLD and liver fibrosis in overweight/obese individuals without diabetes. Methods: This was a cross-sectional study consisting of 184 overweight/obese people (96 with and 88 without NAFLD), 30-65 years of age. TyG, TyG-BMI, and TyG-WC were computed using the established formula. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were determined by transient elastography (FibroScan). Results: In correlation analyses, CAP and LSM were significantly associated with WC, BMI, TyG, TyG-BMI, and TyG-WC. Regression analyses highlighted TyG-WC as a significant predictor of NAFLD, with the highest standardized odds ratio (2.25, P < 0.001); while liver fibrosis was associated more strongly with TyG-BMI. In receiver operating characteristic (ROC) analysis, TyG-WC showed the largest area under the ROC curve (AUC) for detection of NAFLD (0.693, 95% confidence interval CI: 0.617-0.769). However, TyG-BMI was a better discriminator of liver fibrosis (AUC: 0.635, 95% CI: 0.554-0.714). TyG-WC value of 876 (sensitivity: 81.3%, specificity: 52.3%) and TyG-BMI value of 259 (sensitivity: 78.3%, specificity: 51.3%) were the optimal cutoff points to predict NAFLD and liver fibrosis, respectively. Conclusions: The results highlight the significant associations of TyG and its related indices with NAFLD, with TyG-WC being a better indicator. TyG-BMI and TyG-WC could reliably predict liver fibrosis in this population. These indices appear to be simple, practical, and affordable tools for screening NAFLD and liver fibrosis in clinical settings. © Copyright 2021, Mary Ann Liebert, Inc., publishers

Revision procedures after initial Roux-en-Y gastric bypass, treatment of weight regain: a systematic review and meta-analysis

Morbid obesity is a global chronic disease, and bariatric procedures have been approved as the best method to control obesity. Roux-en-Y gastric bypass is one of the most common bariatric surgeries in the world and has become the gold standard procedure for many years. However, some patients experience weight regain or weight loss failure after the initial bypass surgery and require revisional or conversional interventions. International databases including PubMed, International Scientific Indexing (ISI), and Scopus were considered for a systematic search of articles that were published by 5th of May 2020. Forty-one published studies, which reported revision procedure on 1403 patients, were selected and analyzed for this review. The selected studies were categorized into six groups of revision procedures, including laparoscopic pouch resizing and/or revision of gastro-jejunal anastomosis (GJA), adjustable or non-adjustable gastric band over pouch ± pouch/GJA resizing, endoscopic revision of gastric GJA ± pouch, distal Roux-en-Y gastric bypass (DRGB), biliopancreatic diversion with duodenal switch (BPD-DS) or single anastomosis duodeno-ileal bypass with gastric sleeve (SADI-S), DRGB + Band or pouch/GJA resizing. Revision procedures result in more weight loss after the initial weight loss procedures. In the one-year follow-up, DRGB by itself with standardized mean difference (SMD) of � 1.24 presented a greater decrease in body mass index (BMI). DRGB plus band or pouch/GJA resizing, BPD-DS or SADI, adjustable or non-adjustable gastric banding over pouch ± pouch/GJA resizing, endoscopic pouch and/or GJA revision and laparoscopic pouch or/and GJA resizing revealed a lower decrease in BMI in order, respectively. In the three-year follow-up, BPD-DS or SADI-S method with SMD of � 1.40 presented the highest decrease in BMI. In follow, DRGB alone, adjustable or non-adjustable gastric banding over gastric pouch ± pouch / GJA resizing, DRGB + Band or gastric pouch/GJA resizing, laparoscopic pouch and/or GJA resizing and endoscopic revision of pouch and/or GJA revealed less reduction in BMI, respectively. In the five-year follow-up, DRGB alone procedures with SMD of � 2.17 presented the greatest reduction in BMI. Subsequently, BPD-DS or SADI-S, laparoscopic pouch and/or GJA size revision, and endoscopic revision of GJA/pouch revealed less overall decrease in BMI in order. All methods of revision procedures after the initial RYGB have been effective in the resolution of weight regain. However, based on the findings in this systematic review, it seems DRGB or BPD-DS/SADI-S is the most effective procedure in the long-term follow-up outcome. More studies with a higher number of patients and even longer follow-ups will be required to obtain more accurate data and outcome. © 2021, Italian Society of Surgery (SIC)