Bariatric Surgery: Risks and Rewards

East Carolina University, Greenville, North Carolina 27834, USA.
Journal of Clinical Endocrinology &amp Metabolism (Impact Factor: 6.31). 11/2008; 93(11 Suppl 1):S89-96. DOI: 10.1210/jc.2008-1641
Source: PubMed

ABSTRACT Over 23 million Americans are afflicted with severe obesity, i.e. their body mass index (in kilograms per square meter) values exceed 35. Of even greater concern is the association of the adiposity with comorbidities such as diabetes, hypertension, cardiopulmonary failure, asthma, pseudotumor cerebri, infertility, and crippling arthritis.
Diets, exercise, behavioral modification, and drugs are not effective in these individuals. This article examines the effect of surgery on the control of the weight and the comorbidities, as well as the safety of these operations.
Although the article focuses on the outcomes of the three most commonly performed operations, i.e. adjustable gastric banding, the gastric bypass, and the biliopancreatic bypass with duodenal switch, it aims for perspective with the inclusion of abandoned and current investigational procedures, a review of the complications, and an emphasis on the appropriate selection of patients. POSITIONS: Ample evidence, including controlled randomized studies, now document that bariatric surgery produces durable weight loss exceeding 100 lb (46 kg), full and long-term remission of type 2 diabetes in over 80% with salutary effects on the other comorbidities as well with significant reductions in all-cause mortality. Although the severely obese present with serious surgical risks, bariatric surgery is performed safely with a 0.35% 90-d mortality in Centers of Excellence throughout the United States-similar to the complication rates after cholecystectomy.
Until better approaches become available, bariatric surgery is the therapy of choice for patients with severe obesity.

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    • "The surgeries used for treating severe obesity include restrictive surgeries that limit food intake, such as vertical banded gastroplasty (VBG), adjustable gastric band (AGB), and sleeve gastrectomy (SG); and mixed surgeries that combine food intake restriction with nutrient malabsorption, such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) with duodenal switch (BPD-DS) (Pories, 2008). "
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    ABSTRACT: Obesity ultimately results from an unbalance between the intake and oxidation of the energy obtained from foods, and its treatments are based on correcting this unbalance by basicallyrestricting energy intake. Consequently, food intake is the center of attention when the subject is obesity, either as an etiological, protection, or even therapeutic factor. The inability of severely obese individuals to reduce or maintain their body weight using traditional methods makes them candidates to bariatric surgery, which is admittedly an effective method to reduce body weight significantly and obesity-associated morbidities. Bariatric surgery involves anatomic and physiological changes in the gastrointestinal tract that promote energy restriction, essential for weight loss, but also the restriction of many essential dietary nutrients. In addition to the anatomic aspects, bariatric surgery decreases appetite and increases postprandial satiety, possibly because of its effect on the secretion of hormones that regulate these systems (Kohli, Stefater e Inge, 2011). In addition to reducing body weight significantly, bariatric surgery also decreases some systemic inflammation markers (Chen et al., 2009; Miller et al., 2011), improves insulin sensitivity, promoting remission of type 2 diabetes (T2D), and lowers high blood pressure, among others. Although bariatric surgery is associated with better quality of life, nutritional deficiencies may occur after surgery because of the dramatically reduced food intake and/or micronutrient absorption. Unmonitored postoperative patients may develop severe malnutrition (Dodell et al., 2012). The literature has often reported deficiencies of vitamin B complex, iron, folic acid, vitamin D, and calcium (Saltzman e Karl, 2013). These deficiencies may cause neurological symptoms, osteopenia, and anemia. Hence, the nutritional approach of the bariatric patient, which began when the patient was in line for surgery and continued after surgery, is one of the most important themes of the interdisciplinary care of obese patients. The objective of this chapter is to review the theoretical bases for the nutritional approach of bariatric patients, the instruments for assessing food intake, and the nutritional recommendations, both preoperatively, when the patient is preparing for surgery, and postoperatively, during follow-up. The chapter also includes practical examples.
    Essentials and Controversies in Bariatric Surgery, Edited by Chih-Kun Huang, 10/2014: chapter 2: pages 33-57; InTech., ISBN: 978-953-51-1726-1
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    • "For example, it has been estimated that medical spending related to obesity in the United States in 2006 was approximately $119 billion [92]. Although effective surgical and pharmacological methods have been developed to treat symptoms related to metabolic syndrome, these treatments can be costly and are not without potential adverse effects [93] [94] [95] [96] . The development of dietary agents for the prevention or treatment of one or more of the symptoms of MetS, alone or in combination with lifestyle changes and pharmaceutical agents, could represent a cost-effective and safe approach to the problem. "
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    ABSTRACT: Green tea (Camellia sinensis, Theaceace) is the second most popular beverage in the world and has been extensively studied for its putative disease preventive effects. Green tea is characterized by the presence of a high concentrations of polyphenolic compounds known as catechins, with (-)-epigallocatechin-3-gallate (EGCG) being the most abundant and most well-studied. Metabolic syndrome (MetS) is a complex condition that is defined by the presence of elevated waist circumference, dysglycemia, elevated blood pressure, decrease serum high-density lipoprotein-associated cholesterol, and increased serum triglycerides. Studies in both in vitro and laboratory animal models have examined the preventive effects of green tea and EGCG against the symptoms of MetS. Overall, the results of these studies have been promising and demonstrate that green tea and EGCG have preventive effects in both genetic and dietary models of obesity, insulin resistance, hypertension, and hypercholesterolemia. Various mechanisms have been proposed based on these studies and include: modulation of dietary fat absorption and metabolism, increased glucose utilization, decreased de novo lipogenesis, enhanced vascular responsiveness, and antioxidative effects. In the present review, we discuss the current state of the science with regard to laboratory studies on green tea and MetS. We attempt to critically evaluate the available data and point out areas for future research. Although there is a considerable amount of data available, questions remain in terms of the primary mechanism(s) of action, the dose-response relationships involved, and the best way to translate the results to human intervention studies.
    Pharmacological Research 12/2010; 64(2):146-54. DOI:10.1016/j.phrs.2010.12.013 · 3.98 Impact Factor
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    ABSTRACT: bariatric surgery presented a dramatic increase due to the obesity epidemics and the laparoscopic approach. General surgeons might face acute or chronic complications of bariatric surgery, considering the increasing figures of obesity procedures performed every year in USA, as well as in Europe. to present the possible surgical emergencies after bariatric surgery. laparoscopic adjustable gastric banding is the most widely performed bariatric procedure in Europe. Acute anterior/posterior slippage of the gastric wall is the most frequent complication, and needs emergency treatment: band's deflation, laparoscopy for repositioning/removal. Intragastric band migration is diagnosed at the radiological or endoscopic controls and usually does not represent a surgical emergency. Anastomotic marginal ulcer may appear after gastric bypass GBP or biliopancreatic diversion BPD (with/without duodenal switch DS), and can be complicated by bleeding or rarely by perforation. Small bowel obstruction due to internal hernia after GBP or BPD represents major emergency that can be caused as well by trocar site hernia, intussusceptions, adhesions, strictures, kinking or blood clots. Correct diagnosis and immediate treatment are mandatory. Rapid weight loss after bariatric surgery can cause gallbladder diseases and choledocholitiasis that can be difficult to treat after gastric bypass procedures. General surgeon has to know the most diffuse bariatric procedures and their complications and to treat them as other gastrointestinal surgical procedures. Minimally-invasive approach should be considered in most of the cases, but the approach depends on the general surgeon's experience.
    Chirurgia (Bucharest, Romania: 1990) 01/2010; 105(4):455-64. · 0.78 Impact Factor
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