Increased Belching After Sleeve Gastrectomy

Contains fulltext : 172797.pdf (publisher's version ) (Open Access)INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is considered to be an effective procedure for patients with morbid obesity. Belching is frequently reported after this procedure, but it has not been well studied in the bariatric population. This study aims to assess the changes in belching before and after sleeve gastrectomy, as measured with impedance monitoring. METHODS: In a prospective study, patients underwent 24-h pH-impedance monitoring before and 3 months after LSG. Using this technique, belches can be identified. Preoperative and postoperative upper gastrointestinal symptoms were assessed using the Reflux Disease Questionnaire (RDQ). RESULTS: Fifteen patients (1 M/14 F, mean age 42.2 +/- 11.0 years, mean weight 134.5 +/- 21.1 kg, mean BMI 46.4 +/- 6.0 kg/m(2)) participated in this study. Belching occurred significantly more often after LSG, with an increase in symptom score from 2.9 +/- 2.6 before to 5.3 +/- 3.5 3 months after LSG (p = 0.04). The total number of gastric belches increased from 29.7 +/- 11.7 before to 59.5 +/- 38.3/24 h 3 months after LSG (p = 0.03). The total number of supragastric belches did not change after LSG. The number of swallows decreased from 746.9 +/- 302.4 before to 555.7 +/- 172.5 3 months after the procedure (p = 0.03). The number of air swallows tended to decrease (p = 0.08). Esophageal acid exposure increased significantly, from 3.7 +/- 2.9 % before to 12.6 +/- 10.5 % after LSG (p = 0.01). CONCLUSION: Subjectively (as reported by patients) and objectively (as measured by impedance monitoring), an increase in gastric belches is seen after LSG, while the number of (air) swallows tends to decrease after the procedure and the incidence of supragastric belches remains constant. The altered anatomy as well as increased gastroesophageal reflux after LSG may play a role in the increase of belching

The Influence of Different Alimentary and Biliopancreatic Limb Lengths in Gastric Bypass Patients

Purpose The aim of this study was to compare the effect of two different limb lengths after RYGB on weight loss, postoperative gastro-intestinal complications, and vitamin deficiencies. Materials and Methods A retrospective analyses of 100 patients after RYGB with 2 different limb lengths were done. Group A (50 patients) had a biliopancreatic limb (BPL) of 75 cm and an alimentary limb (AL) of 150 cm. Group B (50 patients) had a BPL of 150 cm and an AL of 75 cm. The effect on weight loss, body mass index, excess weight loss (EWL), total weight loss (TWL), and postoperative complications was analyzed up to 2 years postoperatively. Results Patients with a longer BPL achieved significantly more %EWL compared to a shorter BPL 2 years postoperatively (82.8 +/- 31.2 versus 93.8 +/- 15.1;p = 0.038). A significant difference was also seen in %TWL after 1 year (30.3 +/- 10.1 versus 37.4 +/- 6.9;p< 0.01) and 2 years (31.6 +/- 7.5 versus 35.6 +/- 8.6;p = 0.022), both in favor of group B. However, patients with a longer BPL (group B) showed significant more diarrhea and steatorrhea compared to group A (p< 0.01). Conclusion BPL of 150 cm is associated with more %EWL and %TWL 2 years after RYGB. However, it is accompanied by an increase of diarrhea and steatorrhea to disadvantage off group B. Future studies need to focus on further tailoring BPL and AL lengths to achieve the best possible outcomes for patients with morbid obesity

Evaluation of laparoscopic sleeve gastrectomy on weight loss and co-morbidity

AbstractBackgroundThe sleeve gastrectomy is a surgical technique to treat morbid obesity by both restrictive and probably hormonal action. Originally developed as a first stage to gastric bypass, it is more and more performed as a sole procedure. Therefore it is important to report results on weight loss and reduction in co-morbidity.MethodsA consecutive series of 74 morbid obese patients were evaluated. Parameters were operative variables, complications, weight loss and the need for medication for co-morbidity at least six months postoperatively.ResultsSix procedures included the removal of a band and twice a vertical banded gastroplasty was performed previously. Median operating time diminished over time to 71 min. Three procedures were converted into open approach. Major complications were rhabdomyolysis (2), bleeding (2) and leakage (4). Four days was the mean hospital stay. The median follow-up was 12 months (range 6–33). The median percentage of excess weight loss was 49.6% (range 22–96%EWL). The median loss in BMI points was 23.1% (range 9–50%BMIL). Three quarters of the patients were able to diminish or stop their medication for diabetes, hypertension and hyperlipedemia.ConclusionThe laparoscopic gastric sleeve is effective in reduction of both weight and co-morbidity and has potential as a sole procedure. Patient’s selection is, however, recommendable for initial surgical experience and longer follow-up will be necessary

Review article: Non-alcoholic fatty liver disease in morbidly obese patients and the effect of bariatric surgery

International audienceLa propriété intellectuelle est au coeur de l'économie du savoir ; matière en pleine évolution, elle trouve ses fondements dans la période révolutionnaire tout en étant aujourd'hui confrontée à Internet et à la mondialisation. Matière spéciale du droit des biens, elle porte sur les questions contemporaines liées à l'immatérialité et à l'internationalisation des échanges. Le droit de la propriété intellectuelle trouve ses sources dans le droit de l'Union européenne comme dans des accords internationaux majeurs dont l'OMC. La présente édition intègre notamment les apports du paquet marque de décembre 2015 et de la loi Liberté de création de juillet 2016. Cet ouvrage propose une analyse unitaire de la propriété intellectuelle. Sans écarter les différences entre le droit d'auteur, le droit des brevets ou le droit des marques, il expose des points d'unité facilitant la compréhension de la logique de la propriété intellectuelle et donnant des perspectives nouvelles dans l'étude et l'utilisation de celle-ci. La première partie est consacrée aux éléments spécifiques de chacun des régimes de propriété intellectuelle, intégrant de façon synthétique les sources nationales, européennes et internationales. La seconde partie, reprenant la même approche synthétique, expose les éléments communs des régimes de propriété intellectuelle, dont le droit des contrats et l'influence de la réforme du droit des obligations, le droit de la concurrence ou le droit de la contrefaçon. Ce Manuel est destiné aussi bien aux étudiants en droit qu'à ceux des écoles de commerce ou d'ingénieurs, aux scientifiques ou aux gestionnaires de titres de propriété intellectuelle, en entreprise comme en cabinet de conseil

Review article: Non-alcoholic fatty liver disease in morbidly obese patients and the effect of bariatric surgery

BACKGROUND: Morbid obesity is strongly associated with non-alcoholic fatty liver disease. The effects of bariatric surgery on liver tests an histological abnormalities after weight loss are controversial. AIM: To review the literature on the prevalence of non-alcoholic fatty liver disease in patients with morbid obesity with respect to laboratory and histopathological parameters and the effect of weight loss on these parameters after bariatric surgery. RESULTS: Standard liver tests do not seem to be a sensitive tool for the assessment and follow-up of non-alcoholic fatty liver disease in obesity. In nearly all patients with morbid obesity, histological abnormalities reflecting non-alcoholic fatty liver disease are present. Bariatric surgery in these patients will decrease the grade of steatosis. However, there are some concerns about the effect of bariatric surgery on hepatic inflammation and fibrosis. In particular, older follow-up studies reported negative results as opposed to more recent studies, which also showed improvement in hepatic inflammation and fibrosis. Unfortunately, most studies had limitations because of the selection of patients. CONCLUSION: Despite limitations in many studies, bariatric surgery seems to be a promising treatment in patients with obesity presenting with non-alcoholic fatty liver disease

Factors Affecting Patient Adherence to Multivitamin Intake After Bariatric Surgery : a Multicentre Survey Study from the Patient’s Perspective

Purpose: Lifelong multivitamin supplementation is recommended to prevent nutritional deficiencies. Despite this advice, deficiencies are common which may be due to poor adherence to MVS intake. The aim of this study was to identify which factors affect patient adherence to Multivitamin Supplement (MVS) intake after bariatric surgery. Materials and Methods: A 42-item questionnaire was sent to 15,424 patients from four Dutch bariatric center. In total, 4975 patients wanted to participate of which 361 patients were excluded. A total of 4614 patients were included, and MVS users (n=4274, 92.6%) were compared to non-users (n=340, 7.4%). Most patients underwent Roux-en-Y gastric bypass (64.3%) or sleeve gastrectomy (32.3%). Results: Seven hundred and ten patients (15.4%) reported inconsistent MVS use and 340 patients (7.4%) did not use any MVS at all. For inconsistent MVS users, most reported reasons included forgetting daily intake (68.3%), gastro-intestinal side effects (25.6%) and unpleasant taste or smell (22.7%), whereas for non-users gastro-intestinal side effects (58.5%), high costs (13.5%) and the absence of vitamin deficiencies (20.9%) were most frequently reported. Overall, 28.5% were dissatisfied about instructions on MVS use, attention paid to MVS use during medical consultation and the extent to which personal preferences were taken into account. Conclusion: The attitude of bariatric patients towards MVS use is predominantly negative. It is important to provide accurate information on different options for MVS intake and collect information about patient’s personal preferences when prescribing supplements. Improving adherence to MVS intake is challenging and requires implementation of a shared decision-making process, further optimization of MVS formulas and exploring options for reimbursement. Graphical abstract: [Figure not available: see fulltext.