Estudio del bypass gástrico en Y de Roux y de la gastrectomía tubular sobre el metabolismo de la glucosa y la secreción de hormonas intestinales. Estudio prospectivo y randomizado

Introducció: El bypass gàstric en Y de Roux laparoscòpic (BGYRL) és la tècnica quirúrgica d'elecció per al tractament de l'obesitat mòrbida. La gastrectomia tubular laparoscòpica (GTL) és una tècnica bariàtrica restrictiva amb resultats molt prometedors en relació a la pèrdua de pes, però se'n desconeixen els efectes metabòlics i endocrins. L'objectiu d'aquest estudi és l'avaluació de les diferències en la resposta del metabolisme de la glucosa i la secreció d'hormones intestinals entre ambdós procediments. Material i mètodes: Es va dissenyar un estudi prospectiu i aleatoritzat per la realització del BGYRL i la GTL, ambdós realitzats via laparoscòpica. Totes les pacients es varen avaluar abans, i als 3 i 12 mesos de la intervenció. Se'ls va prendre una mostra de sang venosa després d'un dejuni de 12 hores i als 10 i 60 minuts després de la ingesta d'Ensure® 420 kcal per realitzar les determinacions dels nivells plasmàtics de glucosa, insulina, grelina, leptina, pèptid relacionat amb glucagó (GLP-1), pèptid YY (PYY) i polipèptid pancreàtic (PP). Resultats: Es varen incloure 15 pacients (totes de gènere femení, edat mitja de 48±9 anys, IMC de 44±2.7 kg/m2 amlitat preoperatòria) dels quals 7 van ser aleatoritzats a BGYRL i 8 a GTL. No hi van haver diferències entre ambdós grups en edat, IMC preoperatori, classificació ASA i determinacions hormonals preoperatòries. Després de la cirurgia, s'observa un descens de la glicèmia i insulinèmia, amb una reducció de l'índex HOMA-IR en ambdós grups. Postoperatòriament, es detecta una disminución de les concentracions de la leptina en dejú i després de la ingesta, significativament menor en el grup de BGYRL. Mentre que els nivells de grelina en dejú només descendeixen de forma significativa en el grup de la GTL. Després de la ingesta es produeix una augment dels nivells de GLP-1, significativament major en el grup de BGYRL. Conclusions: Tan el BGYRL como la GTL s'associen a una significativa pèrdua de pes, encara que aquesta fou significativament superior en el BGYRL. Ambdós procediments han millorat notablement l'homeostasi de la glucosa. Només la GTL va rehuir els nivells de grelina tan en dejú com després de la ingesta, mentre que els nivells de GLP-1 i PYY s'elevaren després de la cirurgia, sense diferències estadísticament significatives entre ambdues tècniques.Introducción: El bypass gástrico en Y de Roux laparoscópico (BGYRL) es la técnica quirúrgica de elección para el tratamiento de la obesidad mórbida. La gastrectomía tubular laparoscópica (GTL) es una técnica bariátrica restrictiva con resultados muy prometedores con relación a la pérdida de peso, pero se desconocen, sin embargo, sus efectos metabólicos y endocrinos. El objetivo de nuestro estudio es evaluar las diferencias en la respuesta del metabolismo de la glucosa y la secreción de hormonas intestinales entre ambos procedimientos. Material y métodos: Se diseñó un estudio prospectivo y aleatorizado tras la realización del BGYRL y la GTL, ambos realizados por vía laparoscópica. Todas las pacientes se evaluaron antes y a los 3 y 12 meses de la intervención. Se les tomó una muestra de sangre venosa tras un ayuno de 12 horas y a los 10 y 60 minutos tras la ingesta de Ensure® 420 kcal para realizar las determinaciones de los niveles plasmáticos de glucosa, insulina, grelina, leptina, péptido relacionado con glucagón (GLP-1), péptido YY (PYY) y polipéptido pancreático (PP).Resultados: Se incluyeron 15 pacientes (todas del género femenino, edad media de 48±9 años, IMC de 44±2.7 kg/m2 con comorbilidad preoperatoria) de los cuales 7 fueron aleatorizados a BGYRL y 8 a GTL. No hubo diferencias entre ambos grupos en la edad, IMC preoperatorio, clasificación de ASA y determinaciones hormonales preoperatorias. Después de la cirugía, se observa un descenso de la glicemia e insulinemia, con una reducción del índice HOMA-IR en ambos grupos. Postoperatoriamente, se detecta una disminución de las concentraciones de leptina en ayunas y tras la ingesta, significativamente menor en el grupo de BGYRL. Mientras que los niveles de grelina en ayunas sólo descienden de forma significativa en el grupo de la GTL. Tras la ingesta se produjo un aumento de los niveles de GLP-1, significativamente mayor en el grupo de BGYRL. Conclusiones: Tanto el BGYRL como la GTL se asociaron a una significativa pérdida de peso, aunque ésta fue significativamente superior en el BGYRL. Ambos procedimientos han mejorado notablemente la homeostasis de la glucosa. Sólo la GTL redujo los niveles de grelina tanto en ayunas como tras la ingesta. Mientras que los niveles de GLP-1 y PYY se elevaron tras la cirugía, sin diferencias estadísticamente significativas entre ambas técnicas

5-year collis-nissen gastroplasty outcomes for type III-IV hiatal hernia with short esophagus: a prospective observational study

Background: To assess the 5-year outcomes of patients undergoing Collis-Nissen gastroplasty for type III-IV hiatal hernia with short esophagus. Study design: From a prospective observational cohort of patients who underwent antireflux surgery for type III-IV hiatal hernia between 2009 and 2020, those with short esophagus (abdominal length <2.5 cm) in whom a Collis-Nissen procedure was performed and reached at least 5 years of follow-up were identified. Hernia recurrence, patients' symptoms, and quality of life were assessed annually by barium meal x-ray, upper endoscopy, and validated symptoms and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaires. Results: Of the 114 patients with Collis-Nissen gastroplasty, 80 patients who completed a 5-year follow-up were included (mean age 71 years). There were no postoperative leaks or deaths. Recurrent hiatal hernia (any size) was identified in 7 patients (8.8%). Heartburn, regurgitation, chest pain, and cough were significantly improved at each follow-up interval (p < 0.05). Preoperative dysphagia disappeared or improved in 26 of 30 patients, while new-onset dysphagia occurred in 6. Mean postoperative QOLRAD scores significantly improved at all dimensions (p < 0.05). Conclusions: Collis gastroplasty combined with Nissen fundoplication provides low hernia recurrence, good control of symptoms, and improved quality of life in patients with large hiatal hernia and short esophagus

Characterization of the pattern of food consumption in severely obese patients prior to bariatric surgery

Introduction: severe obesity is increasing rapidly in several countries, as well as the number of bariatric surgeries performed. However, the pattern of food consumption of the population is not well defined. Objectives: the aim of the present study was to describe the food consumption pattern (comparing men and women) of severely obese patient candidates to bariatric surgery and to determine the promoting and protecting factors. Methods: food consumption and nutrient intake were measured by a validated food frequency questionnaire (FFQ), including food and beverages. Multivariate principal component analysis (PCA) was done to analyze the component that best relates to the food pattern consumption dividing the different food groups in promotors and protectors. Results: significant differences in the food consumption pattern of men and women with severe obesity addressed for bariatric surgery were found. A positive correlation was found between the food groups that are protective factors for obesity such as the fiber (r = 0.84), vegetables (r = 0.767) and fruits (r = 0.83), whereas a negative correlation was found with those factors that are promotors of obesity such as fats (r = -0.341), saturated fats (r = -0.411), soft drinks (r = -0.386), and fast food (r = -0.17).Multivariate analysis of principal components revealed that calorie consumption is the component that correlates better with the pattern. Conclusions: there are significant differences in the food consumption pattern of men and women with severe obesity addressed for bariatric surgery and these differences should be taken into account when planning nutritional intervention. Therefore, a healthy lifestyle behaviour should be highly encouraged among the severe obese population

Changes in central 24-h ambulatory blood pressure and hemodynamics 12 months after bariatric surgery: the BARIHTA study

Background: Weight loss is associated to blood pressure (BP) reduction in obese patients. There is no information on central 24-h BP changes after bariatric surgery (BS). Methods and results: In this study, we analyzed changes in 24-h BP 12 months following BS, with intermediate evaluations at 1, 3, and 6 months, in severely obese adults. The primary endpoint was aortic (central) 24-h systolic BP changes. Circadian BP patterns and hypertension resolution were also assessed. As secondary endpoints, we analyze changes in central 24-h diastolic BP as well as in all office and ambulatory peripheral BP parameters. Obese adults scheduled for BS as routine clinical care were recruited. We included 62 patients (39% with hypertension, 77% women, body mass index, 42.6 ± 5.5 kg/m2). Reduction in body weight was mean (IQR) 30.5% (26.2-34.4) 1 year after BS. Mean (95% CI) change in central 24-h systolic BP was - 3.1 mmHg (- 5.5 to - 0.7), p = 0.01 after adjustment for age, sex, and baseline hypertensive status. BP parameter changes were different between normotensives and hypertensives. Mean (95% CI) change in central 24-h systolic BP was - 5.2 mmHg (- 7.7 to - 2.7), p < 0.001, in normotensives and - 0.5 mmHg (- 5.1 to 4.0), p = 0.818, in hypertensives. There was a remission of hypertension in 48% of patients. Most patients had a reduced dipping pattern, similarly at baseline and 12 months after BS. Conclusions: Among patients with severe obesity, there was a substantial central 24-h systolic BP decrease 12 months following BS. Importantly, this change was observed in those patients with normal BP at baseline

Postoperative complications do not impact on recurrence and survival after curative resection of gastric cancer.

BACKGROUND: We assessed the impact of complications on recurrence and survival after curative gastric cancer resection. METHODS: Patients undergoing R0 resections between 1990 and 2009 were identified in a prospectively maintained database and were categorized by presence of any complication Clavien-Dindo (CD) ≥ II, sepsis or intra-abdominal sepsis. Cox regression analyses to relate complications and clinico-pathological variables to time to recurrence (TTR) and overall survival (OS) were performed. RESULTS: A total of 271 patients were included with a median follow-up of 149.9 months (range 140.1-159.9). complications CD ≥ II occurred in 162 (59.8%) patients, sepsis in 66 (22.5%), and intra-abdominal sepsis in 37 (13.6%). Recurrence developed in 88 (32.4%) patients. Independent predictors of short TTR were pTNM stage (IIIB-IIIC vs. IA-IIA) (hazard ratio [HR] = 37.55, 95% confidence interval [CI] 17.57-80.24; p < 0.001), D1 lymphadenectomy (HR = 3.14, 95% CI 1.94-5.07; p < 0.001), and male gender (HR = 1.65, 95% CI 1.06-2.57; p = 0.026). pTNM stage (IIIB-IIIC vs. IA-IIA, HR = 10.28, 95% CI 6.51-16.23; p < 0.001), male gender (HR = 1.64, 95% CI 1.17-2.31; p = 0.005), age (HR = 1.03, 95% CI 1.02-1.05; p < 0.001), and adjuvant therapy (HR = 0.55, 95% CI 0.37-0.83; p = 0.004) were identified as independent predictors of OS../nCONCLUSIONS: Evidence provided by this study does not support a negative impact of postoperative complications CD ≥ II, sepsis, and intra-abdominal sepsis on the oncologic outcome after curative gastric cancer resection

Estudio del bypass gástrico en Y de Roux y de la gastrectomía tubular sobre el metabolismo de la glucosa y la secreción de hormonas intestinales. Estudio prospectivo y randomizado

Introducció: El bypass gàstric en Y de Roux laparoscòpic (BGYRL) és la tècnica quirúrgica d'elecció per al tractament de l'obesitat mòrbida. La gastrectomia tubular laparoscòpica (GTL) és una tècnica bariàtrica restrictiva amb resultats molt prometedors en relació a la pèrdua de pes, però se'n desconeixen els efectes metabòlics i endocrins. L'objectiu d'aquest estudi és l'avaluació de les diferències en la resposta del metabolisme de la glucosa i la secreció d'hormones intestinals entre ambdós procediments. Material i mètodes: Es va dissenyar un estudi prospectiu i aleatoritzat per la realització del BGYRL i la GTL, ambdós realitzats via laparoscòpica. Totes les pacients es varen avaluar abans, i als 3 i 12 mesos de la intervenció. Se'ls va prendre una mostra de sang venosa després d'un dejuni de 12 hores i als 10 i 60 minuts després de la ingesta d'Ensure® 420 kcal per realitzar les determinacions dels nivells plasmàtics de glucosa, insulina, grelina, leptina, pèptid relacionat amb glucagó (GLP-1), pèptid YY (PYY) i polipèptid pancreàtic (PP). Resultats: Es varen incloure 15 pacients (totes de gènere femení, edat mitja de 48±9 anys, IMC de 44±2.7 kg/m2 amlitat preoperatòria) dels quals 7 van ser aleatoritzats a BGYRL i 8 a GTL. No hi van haver diferències entre ambdós grups en edat, IMC preoperatori, classificació ASA i determinacions hormonals preoperatòries. Després de la cirurgia, s'observa un descens de la glicèmia i insulinèmia, amb una reducció de l'índex HOMA-IR en ambdós grups. Postoperatòriament, es detecta una disminución de les concentracions de la leptina en dejú i després de la ingesta, significativament menor en el grup de BGYRL. Mentre que els nivells de grelina en dejú només descendeixen de forma significativa en el grup de la GTL. Després de la ingesta es produeix una augment dels nivells de GLP-1, significativament major en el grup de BGYRL. Conclusions: Tan el BGYRL como la GTL s'associen a una significativa pèrdua de pes, encara que aquesta fou significativament superior en el BGYRL. Ambdós procediments han millorat notablement l'homeostasi de la glucosa. Només la GTL va rehuir els nivells de grelina tan en dejú com després de la ingesta, mentre que els nivells de GLP-1 i PYY s'elevaren després de la cirurgia, sense diferències estadísticament significatives entre ambdues tècniques.Introducción: El bypass gástrico en Y de Roux laparoscópico (BGYRL) es la técnica quirúrgica de elección para el tratamiento de la obesidad mórbida. La gastrectomía tubular laparoscópica (GTL) es una técnica bariátrica restrictiva con resultados muy prometedores con relación a la pérdida de peso, pero se desconocen, sin embargo, sus efectos metabólicos y endocrinos. El objetivo de nuestro estudio es evaluar las diferencias en la respuesta del metabolismo de la glucosa y la secreción de hormonas intestinales entre ambos procedimientos. Material y métodos: Se diseñó un estudio prospectivo y aleatorizado tras la realización del BGYRL y la GTL, ambos realizados por vía laparoscópica. Todas las pacientes se evaluaron antes y a los 3 y 12 meses de la intervención. Se les tomó una muestra de sangre venosa tras un ayuno de 12 horas y a los 10 y 60 minutos tras la ingesta de Ensure® 420 kcal para realizar las determinaciones de los niveles plasmáticos de glucosa, insulina, grelina, leptina, péptido relacionado con glucagón (GLP-1), péptido YY (PYY) y polipéptido pancreático (PP).Resultados: Se incluyeron 15 pacientes (todas del género femenino, edad media de 48±9 años, IMC de 44±2.7 kg/m2 con comorbilidad preoperatoria) de los cuales 7 fueron aleatorizados a BGYRL y 8 a GTL. No hubo diferencias entre ambos grupos en la edad, IMC preoperatorio, clasificación de ASA y determinaciones hormonales preoperatorias. Después de la cirugía, se observa un descenso de la glicemia e insulinemia, con una reducción del índice HOMA-IR en ambos grupos. Postoperatoriamente, se detecta una disminución de las concentraciones de leptina en ayunas y tras la ingesta, significativamente menor en el grupo de BGYRL. Mientras que los niveles de grelina en ayunas sólo descienden de forma significativa en el grupo de la GTL. Tras la ingesta se produjo un aumento de los niveles de GLP-1, significativamente mayor en el grupo de BGYRL. Conclusiones: Tanto el BGYRL como la GTL se asociaron a una significativa pérdida de peso, aunque ésta fue significativamente superior en el BGYRL. Ambos procedimientos han mejorado notablemente la homeostasis de la glucosa. Sólo la GTL redujo los niveles de grelina tanto en ayunas como tras la ingesta. Mientras que los niveles de GLP-1 y PYY se elevaron tras la cirugía, sin diferencias estadísticamente significativas entre ambas técnicas

Laparoscopic sleeve gastrectomy: more than a restrictive bariatric surgery procedure?

Sleeve gastrectomy (SG) is a restrictive bariatric surgery technique that was first used as part of restrictive horizontal gastrectomy in the original Scopinaro type biliopancreatic diversion. Its good results as a single technique have led to a rise in its use, and it is currently the second most performed technique worldwide. SG achieves clearly better results than other restrictive techniques and is comparable in some aspects to the Roux-en-Y gastric bypass, the current gold standard in bariatric surgery. These benefits have been associated with different pathophysiologic mechanisms unrelated to weight loss such as increased gastric emptying and intestinal transit, and activation of hormonal mechanisms such as increased GLP-1 hormone and decreased ghrelin. The aim of this review was to highlight the salient aspects of SG regarding its historical evolution, pathophysiologic mechanisms, main results, clinical applications and perioperative complications

Changes in the lipid profile 5 years after bariatric surgery: laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy

BACKGROUND: Few studies have compared mid-term results of laparoscopic Roux-en-Y gastric bypass (LRYGB) versus laparoscopic sleeve gastrectomy (LSG), and none have focused on lipid profile. OBJECTIVES: To compare LRYGB versus LSG with respect to lipid disturbance evolution and remission at mid-term after bariatric surgery (BS) and to assess associated factors with the remission of lipid disturbances at 5 years. SETTING: Hospital del Mar, Barcelona, from January 2005 to January 2012. METHODS: A retrospective analysis of a nonrandomized, prospective cohort was conducted on patients undergoing BS at Hospital del Mar, Barcelona, from January 2005 to January 2012 with ≥5 years' follow-up. RESULTS: Of 259 patients, 151 (58.3%) completed the 5-year follow-up. The proportion of patients who achieved normal low-density lipoprotein cholesterol levels at 5 years post-LRYGB was greater than after LSG (30/49 [61.2%] versus 6/23 [26.1%]; P = .005), being male sex, absence of statins treatment, and type of BS technique (LRYGB) the associated factors with remission. Hypertriglyceridemia remission was also higher after LRYGB (23/25 [92.0%] versus 10/15 [66.7%]; P = .041), although type of surgery was not an associated factor. No differences were found in remission rates of low high-density lipoprotein cholesterol between groups. Absence of fibrates treatment and 5-year percentage of excess weight loss were independently associated with hypertriglyceridemia remission, and only the latter was independently associated with low high-density lipoprotein cholesterol remission 5 years after surgery. CONCLUSIONS: Five-year outcome data showed that, among patients with severe obesity undergoing BS, LRYGB was associated with a higher total and low-density lipoprotein cholesterol reduction and remission in comparison to LSG, with no differences in hypertriglyceridemia and high-density lipoprotein cholesterol normalization

Feasibility, tolerability, and effects of exercise-based prehabilitation after neoadjuvant therapy in esophagogastric cancer patients undergoing surgery: an interventional pilot study

Patients requiring surgery for locally advanced esophagogastric cancer often require neoadjuvant therapy (NAT), which may have a detrimental impact on cardiorespiratory reserve. The aims of this study were to investigate the feasibility and tolerability of a 5-week preoperative high-intensity interval training program after NAT, and to assess the potential effects of the training protocol on exercise capacity, muscle function, and health-related quality of life (HRQL). We prospectively studied consecutive patients with resectable locally advanced esophageal and gastric cancer in whom NAT was planned (chemo- or chemoradiotherapy). Feasibility was assessed with the TELOS (Technological, Economics, Legal, Operational, and Scheduling) components, and data on exercise tolerability (attendance and occurrence of adverse or unexpected events). Exercise capacity was assessed with peak oxygen uptake (VO2peak) in a cardiopulmonary exercise test at baseline, post-NAT, and following completion of a high-intensity interval exercise training (25 sessions). Changes in muscle strength and HRQL were also assessed. Of 33 recruited subjects (mean age 65 years), 17 received chemoradiotherapy and 16 chemotherapy. All the TELOS components were addressed before starting the intervention; from a total of 17 questions considered as relevant for a successful implementation, seven required specific actions to prevent potential concerns. Patients attended a mean of 19.4 (6.4) exercise sessions. The predefined level of attendance (≥15 sessions of scheduled sessions) was achieved in 27 out of 33 (81.8%) patients. Workload progression was adequate in 24 patients (72.7%). No major adverse events occurred. VO2peak decreased significantly between baseline and post-NAT (19.3 vs. 15.5 mL/Kg/min, P < 0.05). Exercise led to a significant improvement of VO2peak (15.5 vs. 19.6 mL/kg/min, P < 0.05). Exercise training was associated with clinically relevant improvements in some domains of HRQL, with the social and role function increasing by 10.5 and 11.6 points, respectively, and appetite loss and fatigue declining by 16 and 10.5, respectively. We conclude that a structured exercise training intervention is feasible and safe following NAT in patients with esophagogastric cancer, and it has positive effects to restore exercise capacity to baseline levels within 5 weeks with some improvements in HRQL

Atherogenic Dyslipidemia Remission 1 Year After Bariatric Surgery

PURPOSE: Given the lack of evidence of the effect of bariatric surgery (BS) on atherogenic dyslipidemia (AD), which is a characteristic of obese subjects, this study aimed to describe the remission rate of AD 1 year after BS in severely obese patients. MATERIALS AND METHODS: A non-randomised, prospective cohort study was conducted in patients undergoing laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy with a 1-year follow-up. AD was defined as triglycerides ≥1.71 mmol/l or treatment with fibrates and low high-density lipoprotein (HDL) cholesterol (<1.03 mmol/l in men or <1.3 mmol/l in women). RESULTS: AD was present in 81 (22.8%) of the 356 patients; these were more frequently men and presented higher total cholesterol and non-HDL cholesterol concentrations. AD remission rate was 74.1% at 3 months, 90.1% at 6 months and 96.3% at 12 months, respectively, after BS. In this group of patients, HDL cholesterol levels rose progressively (1.0 ± 0.2 to 1.5 ± 0.3 mmol/l, p < 0.001) and triglycerides decreased (2.5 ± 0.9 to 1.2 ± 0.5 mmol/l, p < 0.001) during follow-up. Regarding previous lipid-lowering therapy, fibrates and ezetimibe were withdrawn in all patients and statins in 69.4% 1 year after surgery. CONCLUSION: BS has beneficial effects on lipid profile, achieving complete remission of AD at 1 year of follow-up in almost all patients