Bariatric Surgery - Science topic

how to transform my results in the EuroQOL EQ-5D + EQ VAS to get an overall score that can be presented as “good, moderate, poor“ quality of life?

we will use it pre and post bariatric surgery research and it is not the main topic so we would like a short and easy to use questionnaire that is easy to calculate and easy to present

Bariatric surgery are groups of procedures that include gastrointestinal modifications to weight loss

We have a group of patients who underwent bariatric surgery, their BMI and creatinine clearance were measured before surgery and monthly for the following three months, in total we have 4 pairs of observations for both variables per individual with 4 repetitions in time.

What we want to do is to verify if both variables are correlated, however we cannot figure out how to do it in this particular scenario. Any suggestion?

Dear Bariatric Surgeons,

The importance of obesity management in patients with BMIs over 50 has not been completely addressed and it should be considered separately from patients with morbid obesity.

Despite standardized guidelines for reporting the outcomes of bariatric/metabolic surgery for patients with severe obesity, new insight into for specific situations such as in patients with BMIs over 50 is needed. In recent decades, there has been an increase in the number of patients with BMI>50 kg/m2 who present unique challenges for bariatric surgeons. Therefore, there is an unmet need to better define their weight loss outcomes. In addition, there is also a need to consider standardizing the surgical management of patients with BMIs over 50.

This survey, if filled out by a large number of bariatric surgeons, would provide important insight into the bariatric surgical procedures performed on patients with BMI>50 and also give insight into their perioperative care.

To the best of our knowledge this would be the first study on this important topic.

In this light we created this survey entitled "The First Survey Addressing Patients with BMIs over 50." We urge all IFSO members to please complete the survey. The information extracted from this survey may positively impact our care for patients with BMIs over 50.

The survey has 50 questions divided in 4 parts which is submitted via Survey Monkey at the link https://www.surveymonkey.com/r/7W9K9FK

The survey has been designed by 15 bariatric surgeons from around the world: Luciano Antozzi, Miguel Carbajo, Sonja Chiappetta, Amirhossein Davarpanah Jazi, Radwan Kassir, Mohammad Kermansaravi, Panagiotis Lainas, Kamal Mahawar, Mario Musella, Chetan Parmar, Shahab Shahabi, Scott Shikora, Ramon Villalonga, Antonio Vitiello, Lorea Zubiaga.

We thank you in advance for your positive action!

Mohammad Kermansaravi

Mario Musella

Scott Shikora

The purpose of this study is to understand the factors that make surgery technically difficult for bariatric surgeons. 

It is entirely a subjective study where the respondents are asked to give their opinion about a number of factors that may be important in making bariatric surgery technically more (or less as the case may be) demanding. 

If you think there is something else we could add, please use the comment box at the end of the survey. If you are a bariatric surgeon, you can make a significant contribution to this project by filling out a short survey designed to reflect your current practices. The survey shouldn’t take more than 15 minutes of your time.

As you all know, the wider the participation, the greater will be the accuracy of the information.

The link to the survey is:  https://www.surveymonkey.com/r/ZMDJMTL

Bariatric surgery may be restrictive procedure or malabsortive procedure

Regarding VTE prophylaxis post bariatric surgery, what is your protocol, and I would like to know based on your last year data, what is the incidence of postoperative VTE or post-discharge VTE?

We evaluated patients from public and privative health care before and after bariatric surgery (pdf paper below). The presence or absence of advanced hepatic fibrosis was evaluated by NAFLD Fibrosis Score, a non-invasive method that uses age, BMI, AST/ALT ratio, albumin, platelet count and the presence or absence of hyperglycemia or diabetes. The characteristics of the two groups were compared.

Were analyzed 40 patients with a mean age of 34.6±9.5 years for private network and 40.6± 10.2 years for public. The study sample, 35% were treated at private health system and 65% in the public ones, 38% male and 62% female. Preoperatively in the private network one (7.1%) patient had advanced liver fibrosis and developed to the absence of liver fibrosis after surgery. In the public eight (30.8%) patients had advanced liver fibrosis preoperatively, and at one year after the proportion fell to six (23%).

The non-alcoholic fatty liver disease in its advanced form is more prevalent in obese patients treated in the public network than in the treated at the private network and bariatric surgery may be important therapeutic option in both populations.

There are so many of us performing the mini-gastric bypass, including of course Dr. Rutledge who has done more than 3000 since 1997. As of 2019, about 30,000 procedures have been performed world wide. Also, there is a ton of data on this subject. But health insurance providers are not covering this procedure.

What are your opinions? 

Laparoscopic gastrectomy is commonly performed but as in bariatric surgery, many different anasotmotic techniques are employed, each with advanatges and disadvanatges

How significant is OSA in your practice and how aggressively do you manage it?

Apart from CPAP therapy, should weight loss strategies be vigorously followed?- Bariatric surgery/ Liraglutide/other?

CPAP doesnt improve mortality

https://www.uptodate.com/contents/management-of-obstructive-sleep-apnea-in-adults UpToDate : available on open source, Google

See

It is very important to eliminate them in laparoscopic ventral hernia repair (LVHR) in order to prevent their many intra- and postoperative complications (organs iatrogenic lesions, intraoperative bleeding, hematomas, postoperative abdominal-wall chronic pain (1.4-30%), mesh breakdown, suture site infections, thin skin scars, etc.), and to reduce operation time.

single endoloop (in laparoscopy) application

double endoloop (in laparoscopy) application

purse-string suture

primary simple closure to bury the stump

silk; catgut; Vicryl

What is the ideal thing to do?

How can we upgrade the peptide yy in diet and control our obesity and get benefits from it for diabetes and other metabolic diseases. its best way that natural path be chosen for these types of diseases. in addition in bariatric surgery there is no removal or blockage of peptide yy pathway, is this true. herbal drugs if any effective for peptide yy to push or stimulate. Ghreline is another hormone which is also effective for diet control.

There is any change in serum fatty acid levels after bariatric surgery?

There is any relation between smoker and weight loss after bariatric surgery?

In adult obese patients with type II diabetes does bariatric surgery or dietary approaches alone cause greater likelihood of diabetic remission?

Gastric bypass surgery for morbid obesity is well know to cause a short and long term anemia, vitamin B12 and vitamin D deficiency because of bypassing the duodenum.

We receive more and more patients after sleeve gastrectomy complaining of severe anemia and vitamin deficiency similar to the bypass patient if not taker their supplements.

What you think

Despite hormonal changes and effect of these hormones on body metabolism and feed intake, it has been observed that in most of the preclinical studies female mice/rat are used. What justification could be given in this context?

MGB/OAGB has become a popular Bariatric and Metabolic procedure in various parts of the world.There are still lot of debatable issues exisits but it's adoption is growing all over the world but for North America.My interest is to know how did it come in to practice and it's adoption rate in the rest of the world.

Both Victoza and Saxenda have the same Liraglutide molecule but the former is indicated for weight loss alone and the latter can be used in obese, Diabetes patients. The dose for weight loss is 3mg daily but why do we need 2 different products?

Is there any reliable method other than mass spectrometry ?

Cholic Acid

Patients with no attacks under cholchicine treatment?

And also cholchicine resistant patients?

Hiatal hernias are common in the morbidly obese. It is quite common to repair these defects during Sleeve gastrectomy or RYGB. What is your algorithm for repair, and do you routinely repair anteriorly or posteriorly (as done at our institution). Also, do you routinely repair hiatal hernias in RYGB and LAGB patients?

Dear fellow researchers, 

I'm currently conducting a systematic review on the effects of bariatric surgery on Ghrelin levels. In order to stratify my groups for a meta-analysis I need to identify all possible influencing factors on Ghrelin levels. I don't have any laboratory skills, so I'm in the dark here because there seems to be a huge variation in laboratory techniques authors have used to quantify circulating Ghrelin. 

Does anybody know if RIA and ELISA differ in quantifying Ghrelin levels? And does it matter if Ghrelin is quantified from serum or plasma?

Thanks in advance!

I am interested to find out if there is a psychological element on having this type of surgery (and/or any one of he different types).  What interventions are recommended?

In the literature, there is a wide range of definitions employed to describe weight regain:

1. an increase of at least ten kilograms from nadir weight 

2. any weight regain 

3. greater than 25% EWL regain with respect to the minimal weight

4. regaining weight after successful loss to achieve a BMI > 35 kg/m2 

5. increase in BMI of 5kg/m2 or more above the weight loss nadir 

We are seeking to demonstrate small intestinal absorption of 3-O-methyl-D-glucose in one of our patient cohorts.

I am looking for:

1. A supplier of 3-OMG that is certified for oral administration in humans

2. A detailed protocol for measurement of 3-OMG levels in plasma/serum by high performance liquid chromatography (or any other methods!)

Any advice would be greatly appreciated!

Thanks, 

Jessie

Is there a good controlled trial with large number of patients?

The number of aspiration needed and timing to achieve complete resolution

Is it working for small as well as for large abscess?

There are many reports and small series about LECS for gastric tumors as well as for bariatric surgery. While lower GI ESD and ESR are increasingly being used, only a few case reports exist for lower GI LECS . Any personal experience or ideas into this matter?

I am wondering if we have reported occurrence rate of hypercalcinosis and oxalate nephropathy in patients after any bariatric surgery? The rates of kidney stones after bariatric surgery now have been well reported. But I would like to ask if anyone can provide me the estimated rates of oxalate nephropathy and hypercalcinosis after bariatric surgery.

Thank you in advance,

Wisit

It has been shown that obese patients with diabetes benefit a lot from bariatric surgery, however less than 10% of the patient who qualify undergo the procedures. Given the severe adverse outcomes of uncontrolled diabetes, how patients, providers and insurers can be educated on favorable outcomes of surgery, so that more patients can benefit from it?

Bariatric surgery can help patients with ESRD with weight loss, then be able to undergo kidney transplantation. However, it also increases risk of enteric hyperoxaluria and oxalate nephropathy, There have been reported cases on oxalate nephropathy and allograft injury in kidney transplant patients. At the same time, bariatric surgery has demonstrated benefits of cardio-metabolic profiles and glycemic controls which might be good for kidney function. Therefore, my question is the overall effect of bariatric surgery on long term renal allograft, is it good or bad?

Thank you in advance!

Wisit

Could anyone please provide me the current updated indication for bariatric surgery? What organization published this? and suggested references?

Thank you very much in advance!

Wisit

Physicians report successful stories in weight loss combined with a more extensive recount of obvious failures. The perceived situation is that lifestyle interventions are unlikely to be sufficient to combat obesity on a population level. Even it is unlikely that these interventions may lead to actually important biological changes. We should admit that behavioral change result in moderate changes in weight and that most people regain lost weight. Randomized control trials indicate a mean average difference of -1.6 Kg in weight regain compared with controls at one year. However, all studies are clearly biased by the fact that the attrition rate is not computed (obviously) and this is apparently high. Then, should bariatric surgery the only reasonable tool to cope with obesity? I am not aware of sufficient data to confirm or refute this possibility but, in this surgery, we should assume that attendance to follow-up visits is important in the overall management. However, the attrition rates vary from 3% to 63% depending on the length of the follow-up. These numbers suggest some other questions: which are the attrition risk factors? Are there modifiable? And more importantly, is it possible to measure the effectiveness of bariatric surgery? Suggested source of data: Obes Surg. 2012, 10:1640-7; BMJ. 2014; 348: g2646

Patient may be male or female, 45 years old with no special alimentary habits. No previous operations, no GERD, no HP

The most common bariatric procedures are the Laparoscopic adjustable gastric banding, gastric bypass and sleeve gastrectomy, all with strong pros and cons. Other operations, such as biliopancreatic diversions are more rarely performed (for various reasons). Do you think that the "ordinary" operations would be efficient for such a patient?

I want to do a systematic review about this and I need a lot of articles. Can you help me? Thank you very much!

BMI = body mass index.

By the end of the 20th century , results from large series of patients who underwent bariatric surgery , have led to the following conclusions :

- Diabetic patients who benefited from bariatric surgeries , reached normoglycaemis level weeks after the surgery .

- The association of restrictive and malabsorptive procedures , has led to the best results .

This can be explained by the incretins effects theory . There are neuropeptides that are secreted normally by the stomach and proximal GI - these hormones have negative incretin effect , which means that they interfere negatively with glucose homeostasis and favors insulin resistance . once the greater curvature is removed by surgery , the secretion of ghrelin (which is considered as having a negative incretin effect) will be diminished , thus favoring normoglycaemia .

I'm trying to study the correlations between childhood obesity, providing lunches in primary schools on NZ and reducing ,in the long term, the soaring costs of health expenditure regarding  obesity, bariatric surgery.

Thanks.

Rapid weight loss has been shown to increase hepatic steatosis. On the other hand, rapid weight loss due to bariatric surgery seems to decrease hepatic steatosis. How is this contradiction explained?

Hydrolipoclasy is an alternative technique less invasive than liposuction. It uses normal saline or hypotonic solution and ultrasound waves to directly act on local adiposity. In theory the saline solution applied makes the fat cells easily eliminated.

It is being used for aesthetic reasons and/or after a bariatric surgery or after loosing a lot of weight.

Is the ultrasound effective to eliminate/break fat cells?

Is the hydrolipoclasy effective?

Bariatric surgery is a potential treatment option for overweight patients with type 2 diabetes, hypertension, and dyslipidemia.

Given requirements for follow up, complications and superior results with other procedures is this still a reasonable operation to treat obesity?

I attended a lecture for prof scopinaro in port saied claiming that BPD is not a weight loss surgery in those patients and it cures diabetes by unknown mechanism.

Does anyone know the first publication that used BMI to set the definition of morbid obesity (now called severe)? I am trying to track down the research behind deciding that a BMI of 40 is severely obese, and therefore requires more extreme intervention.

Looking for information related to Meleis's transition theory, obesity, bariatric surgery and weight regain.

any one has an experience in laparoscopic gastric plication?