Gastric Cancer Following Bariatric Surgery: a Review

Background Bariatric procedures can induce a massive weight loss, that lasts more than 15 years after surgery; in addition they achieve important metabolic effects including diabetes resolution in the majority of morbidly obese patients. However some bariatric interventions may cause gastroesophageal reflux disease and other serious complications. The aim of our study is to evaluate the risk of cancer after bariatric surgery. Methods We performed a review of literature about the cases of gastric cancer arising after any bariatric procedure, including a case of adenocarcinoma incidentally discovered by the authors six months after Laparoscopic Adjustable Gastric Banding. Results Globally 17 case reports describing 18 patients were retrieved, including the case of the authors. The diagnosis of tumor was at mean of 8,6 years after bariatric surgery, respectively 9,3 after RYGB and 8,1 after restrictive procedures. The adenocarcinoma represented most cases (15 patients - 83%). In the patients with RYGB the adenocarcinoma was localized in the excluded stomach in 5 (83%) and in the pouch in 1 (17%). After a restrictive procedure the cancer was localized in the pouch in 5 patients (62,5%), in the pylorus in 2 patients (25%) and in lesser curvature only in 1 (12,5%). Conclusion Nowadays there is a lack of evidence about a connection between the late occurrence of gastric adenocarcinoma and the bariatric surgery. For this reason while the preoperative upper endoscopy is still mandatory, there is no need for a regular endoscopic evaluation of patients after surgery

Типологія синтаксичних конструкцій в німецькій та українській мовах

Німецька та українська мови є односистемними мовами: обидві належать до індоєвропейської мовної сім’ї. Спільні корені та тривалий період ізольованого розвитку, вказують на те, що вказані мови мають характеристики подібності та відмінності в своій внутрішній будові. Німецька та українська належать до синтетичного типу флективних мов. Це означає, що граматичне значення слів у них виражається, здебільшого, за допомогою системи флексій і реалізується в межах одного графічного слова. Але флективна система німецької мови бідніша, ніж у слов’янських мовах.Немецкий и украинский языки являются односистемными языками: оба принадлежат к индоевропейской языковой семье. Общие корни и длительный период изолированного развития, указывают на то, что указанные языки имеют характеристики сходства и различия в своем внутреннем строении. Немецкий и украинский принадлежат к синтетическому типу флективных языков. Это означает, что грамматическое значение слов в них выражается, в основном, с помощью системы флексий и реализуется в пределах одного графического слова. Но флективная система немецкого языка беднее, чем в славянских языках.German and Ukrainian are single-system languages: both belong to the Indo-European language family. Common roots and a long period of isolated development, indicate that these languages ​​have characteristics of similarity and differences in their internal structure. German and Ukrainian belong to the synthetic type of inflectional languages. This means that the grammatical meaning of words in them is expressed, mainly, with the help of a system of inflexions and is realized within a single graphic word. But the inflectional system of the German language is poorer than in the Slavic languages

miR-519d Overexpression Is Associated With Human Obesity

Obesity is a consequence of imbalance of food intake and energy expenditure that results in storage of energy as fat, primarily in adipose tissue. MicroRNAs are non-coding RNAs that regulate gene expression in metabolic pathways and they are also involved in fat-cell development. The aim of this study was to evaluate whether microRNA dysfunction contributes to obesity. We analyzed, by microarray, the expression profile of 1,458 microRNAs in subcutaneous adipose tissue (SAT) from nondiabetic severely obese (n = 20) and nonobese adults (n = 8). Among 42 differently expressed microRNAs, we confirmed by reverse-transcription PCR (RT-PCR) that miR-519d was overexpressed whereas the protein levels of peroxisome proliferator-activated receptor-α (PPARA) (a predicted miR 519d target) were lower, at western analysis, in severely obese vs. nonobese subjects. We also show that miR-519d specifically and dose-dependently suppressed translation of the PPARA protein, and increased lipid accumulation during preadipocyte differentiation. Because PPARA plays a central role in fatty acid homeostasis, and in the transcriptional regulation of genes that are necessary for maintenance of the redox balance during the oxidative catabolism of fatty acids, we suggest that PPARA loss and miR-519d overexpression could be associated with metabolic imbalance and subsequent adipocyte hypertrophy in SAT during obesity

Colorectal cancer after bariatric surgery (Cric-Abs 2020): Sicob (Italian society of obesity surgery) endorsed national survey

Background The published colorectal cancer (CRC) outcomes after bariatric surgery (BS) are conflicting, with some anecdotal studies reporting increased risks. The present nationwide survey CRIC-ABS 2020 (Colo-Rectal Cancer Incidence-After Bariatric Surgery-2020), endorsed by the Italian Society of Obesity Surgery (SICOB), aims to report its incidence in Italy after BS, comparing the two commonest laparoscopic procedures-Sleeve Gastrectomy (SG) and Roux-en-Y gastric bypass (GBP). Methods Two online questionnaires-first having 11 questions on SG/GBP frequency with a follow-up of 5-10 years, and the second containing 15 questions on CRC incidence and management, were administered to 53 referral bariatric, high volume centers. A standardized incidence ratio (SIR-a ratio of the observed number of cases to the expected number) with 95% confidence intervals (CI) was calculated along with CRC incidence risk computation for baseline characteristics. Results Data for 20,571 patients from 34 (63%) centers between 2010 and 2015 were collected, of which 14,431 had SG (70%) and 6140 GBP (30%). 22 patients (0.10%, mean age = 53 +/- 12 years, 13 males), SG: 12 and GBP: 10, developed CRC after 4.3 +/- 2.3 years. Overall incidence was higher among males for both groups (SG: 0.15% vs 0.05%; GBP: 0.35% vs 0.09%) and the GBP cohort having slightly older patients. The right colon was most affected (n = 13) and SIR categorized/sex had fewer values < 1, except for GBP males (SIR = 1.07). Conclusion Low CRC incidence after BS at 10 years (0.10%), and no difference between procedures was seen, suggesting that BS does not trigger the neoplasm development

La Diversione Biliopancreatica per la remissione della patologia diabetica nel paziente obeso

Numerosi studi clinici hanno dimostrato che la chirurgia bariatrica rappresenta la metodica più efficace per la terapia del diabete di tipo 2 (T2DM) nel paziente con obesità grave (1-4); in particolare dopo diversione biliopancreatica (BPD) la glicemia si normalizza e rimane a lungo termine entro l’intervallo di normalità in più del 95% dei casi, e contemporaneamente si verifica la sostanziale risoluzione del multiforme quadro della sindrome metabolica (5,6). Nei pazienti grandi obesi con T2DM dopo BPD, nel 75% dei casi la glicemia si normalizza entro il primo mese postoperatorio, quando il peso corporeo è ancora a livelli elevati, tutti gli studi clinici evidenziano una precoce normalizzazione dell’azione insulinica: la BPD ha, quindi, effetti metabolici specifici che sono indipendenti dalla variazione ponderale. I meccanismi invocati per spiegare le azioni specifiche della BPD sulle condizioni metaboliche sono numerosi (7,8,9). L’interruzione dell’asse entero-insulare potrebbe bloccare l’iperinsulinemia, riducendo indirettamente la resistenza insulinica indipendentemente da ogni riduzione di massa (8). La presenza di cibo indigerito in tratti intestinali distali potrebbe provocare l’increzione di enterochine e incretine, con effetti benefici sulla secrezione endocrina pancreatica e sulla stessa massa beta-cellulare (9,10). Accanto a ciò, l’estrema limitazione dell’assorbimento di grassi limita a sua volta grandemente la disponibilità dei grassi circolanti (11,12). La conseguente deplezione cellulare dei lipidi che le infiltravano obbliga le cellule a tornare all’utilizzazione del glucosio come fonte energetica preferenziale, e ciò risulta in ripristino della normale sensibilità insulinica. Inoltre la deplezione lipidica riduce la tossicità dei trigliceridi e degli acidi grassi liberi sulle cellule beta del pancreas, con miglioramento globale della secrezione insulinica. Se il soggetto operato ha un introito energetico maggiore di tale valore, potendo assorbire soltanto una quantità di energia pari alla soglia, perde peso sino a che il suo consumo energetico quotidiano è divenuto pari alla quantità di energia assorbita, e si stabilizza poi al peso corrispondente indipendentemente dall’effettivo introito energetico. Se viceversa l’introito è uguale alla soglia o inferiore o inferiore a essa, come può accadere in una persona con modesto sovrappeso, non vi semplicemente in sovrappeso, il peso corporeo non ha ragione di modificarsi, poiché in soggetto mangia tanto quanto è capace di assorbire, o addirittura meno di questo

Is the Sleeve Gastrectomy Always a Better Procedure? Five-Year Results from a Retrospective Matched Case-Control Study

Introduction: Bariatric surgery is considered the most effective treatment for obesity. A recent worldwide survey demonstrated that Laparoscopic Sleeve Gastrectomy (LSG) is the most commonly performed bariatric procedure, while Laparoscopic Adjustable Gastric Banding (LAGB) has been almost abandoned. Objectives: The aim of this retrospective study was to compare 5-year results of LSG and LAGB at our Institution. Materials and Methods: Prospective maintained database of our Institution was reviewed to find all patients who had undergone LSG between January 2009 and December 2011. Inclusion criteria were BMI of 40–50 kg/m2and age of 18–60 years old. Patients with Class I and II obesity, superobese subjects, and patients with previous history of bariatric surgery were excluded. Data on sex, age, pre-operative BMI, obesity-related diseases (diabetes, hypertension, dyslipidemia), and early and late complications were collected. Each subject who underwent LSG was matched one-to-one with a patient that had undergone LAGB. Outcomes were analyzed at 1, 3, and 5 years of follow-up. Results: A total number of 122 patients were included in this study, 61 in each group. Better %EWL was observed in the LSG group at 1, 3, and 5 years. Both procedures induced improvements of obesity-related diseases without significant difference. In the LAGB group, ten patients underwent uneventful band removal. In the LSG group, two patients had serious postoperative complications. Conclusion: LSG achieves better %EWL than LAGB within 5 years, but comorbidities improvement is not significantly different. Severity of complication is higher after LSG. LAGB is still a good option for selected patients

Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy—An Unusual but Effective Surgical Approach to Achieve Full Recovery

Sleeve gastrectomy is at present the most practiced bariatric intervention for patients suffering from severe obesity. Although rare, post-operative complications such as leakages and strictures may represent a challenging issue for bariatric surgeons and cause impaired quality of life for patients. Gastric twist is even more rare. This complication is a functional obstruction rather than a stricture of the gastric remnant most likely due to technical mistakes at index surgery. If endoscopy usually allows diagnosis and constitutes the first-line treatment for this condition, surgery is mandatory when endoscopy is not successful. The conversion of the sleeve to a Roux-en-Y gastric bypass is the usually chosen intervention but a wide range of reconstruction has been proposed. In this report, we discuss the surgical technique we employed to achieve a full resolution of a gastric twist