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obstructive-sleep-apnea

La Chirurgia Bariatrica riduce l`Apnea Ostruttiva durante il sonno (OSA) in pazienti gravemente obesi

 

Uno studio clinico randomizzato, pubblicato sulla rivista multidisciplinare Medicina Respiratoria, intitolato “Apnea Ostruttiva del Sonno e la funzione polmonare in pazienti con grave obesità, prima e dopo la Chirurgia Bariatrica” ha evidenziato una riduzione significativa dei sintomi di apnea ostruttiva del sonno (OSA)

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Bariatric surgery results in a reduction in the symptoms of obstructive sleep apnoea (OSA), according to the results of a randomised clinical trial and subequent paper entitled, ‘Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial’, published in the journal Multidisciplinary Respiratory Medicine.

The researchers from Brazil and Italy wanted to assess the daytime sleepiness, sleep architecture and pulmonary function in patients with severe obesity before and after bariatric surgery. They hypothesised that in severely obese patients significant weight loss (from bariatric surgery) would provide an effective improvement in pulmonary function and sleep quality.

The patients were divided into a control group and a bariatric surgery group and polysomnography (PSG) performed before and after bariatric surgery (gastric banding) in the bariatric surgery group with a 90-day interval between evaluations.

Eighty patients were recruited for the study; eighteen subjects refused to participate and ten were excluded for not meeting the eligibility criteria. The final 52 patients were randomised and 16 patients (13 women) who were in the bariatric surgery group were evaluated before and after surgical intervention.

The patients who had bariatric surgery had a significant reduction in BMI (p=0.004) and waist circumference of 23.34% and 15.33% (p<0.001), respectively, at three months following bariatric surgery. A significant reduction of 13.45% (p<0.001) in neck circumference was found and it was positively correlated with reductions of body weight (p=0.015) and BMI (p=0.049).

“The findings of this study demonstrate that weight loss following bariatric surgery led to a reduction of apnoea–hypopnea index and enhanced sleep architecture…Moreover, significant increases were found in the percentage of REM sleep and percentage of the deepest sleep stage N3,” the authors write. “The findings demonstrate that bariatric surgery for patients with severe obesity effectively reduces neck and waist circumference, improves pulmonary function, improves sleep arc hitecture and reduces respiratory sleep disorders, especially OSA.”

Giovedi, August 14, 2014 – 15:45
Owen Haskins – Editor in chief, bariatrica Notizie

http://www.bariatricnews.net/?q=news/111611/surgery-reduces-osa-severely-obese-patients

Articolo completo:

http://www.mrmjournal.com/content/pdf/2049-6958-9-43.pdf%20%20

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Nel Regno Unito nuove linee guida propongono l`intervento chirurgico bariatrico anche per i pazienti diabetici con Indice di Massa Corporea (BMI) superiore a 30

 

In Inghilterra il progetto proposto dal National Institute of Health and Cura Excellence (Nice),  vorrebbe far considerare l’ipotesi di intervento chirurgico anche per i pazienti che riportano un BMI superiore a 30 che soffrano di diabete,  diagnosticato negli ultimi dieci anni. 

Currently, surgery is given to patients on the NHS to those who are morbidly obese with a BMI 40 or to those with a BMI over 35 if they have another condition, such as type 2 diabetes.

“Obesity rates have nearly doubled over the last ten years and continue to rise, making obesity and overweight a major issue for the health service in the UK,” said Professor Mark Baker, director of the Centre for Clinical Practice at NICE. “Updated evidence suggests people who are obese and have been recently diagnosed with type 2 diabetes may benefit from weight loss surgery. More than half of people who undergo surgery have more control over their diabetes following surgery and are less likely to have diabetes related illness; in some cases surgery can even reverse the diagnosis.”

As well as meaning diabetics with a BMI of at least 30 could be eligible, the recommendations state those from an Asian background should be considered even if they are not obese, because of evidence that body fat carries higher risks of diabetes in such populations.

“The first line of attack will be diet and exercise and we would expect clinicians to consider the risks and benefits of surgery for patients,” added Baker.

He said some would not be operated on because of age, concluding: “It would be between 5,000 and 20,000 operations a year, but we haven’t done the modelling.”

The draft guidance states that there is evidence to suggest that around 60 per cent of morbidly obese diabetics (those with a BMI of 40 and over) could put the condition in remission by having bariatric surgery.

Research indicates that the costs of obesity-associated health issues means the typical cost of an operation is repaid in savings to the NHS within three years, resulting in saved costs of around £4,000 a year per patient in the long-term.

It is estimated diabetes costs the NHS £14billion a year, much of which spent treating debilitating complications such as blindness, strokes, kidney failure and amputations. NICE says evidence shows bariatric surgery helps patients control their diabetes and in some cases effectively resolves the condition.

Diabetes UK estimates that the new criteria mean between 850,000 and 900,000 extra people could qualify to be considered for surgery. Currently, there are only around 9,000-10,000 weight loss procedures funded by local NHS organisations annually.

“Expecting the UK to have the provision to operate on nearly a million people is an unrealistic proposition. The majority of people, their degree of obesity will be corrected by exercise alone,” James Halstead, a bariatric surgeon at Leeds hospital told Radio 4’s Today programme. “The idea that the NHS could deal with 900,000 extra patients with this alone is nonsensical.”

The surgery can cost between £3,000 and £15,000 and the move by NICE has raised concerns that the NHS will not be able to afford the treatment, even if there are savings in the longer term.

“We’ve got a mismatch between what Nice recommended and what the country can afford,” said Tam Fry from the National Obesity Forum. “Clearly there are going to be thousands of people who will look at this and say, I fit that criteria, I want the surgery. We could end up with a situation where clinical commissioning groups say we can’t get the extra midwives we need for the local hospital, we can’t pay for life-saving drugs for people with cancer – because other people have been given the right to have expensive bariatric surgery.”

Current guidelines state that patients must have tried and failed to achieve clinically beneficial weight loss by all other appropriate non-surgical methods and be fit for surgery. This recommendation has not changed.

The updated draft guidelines include additional recommendations on bariatric surgery for people with recent-onset type 2 diabetes. These recommendations include:

  • Offering an assessment for bariatric surgery to people who have recent-onset type 2 diabetes and are also obese (BMI of 35 and over).
  • Considering an assessment for bariatric surgery for people who have recent-onset type 2 diabetes and have a BMI between 30 and 34.9. People of Asian origin will be considered for surgery if they have a lower BMI than this, as the point at which the level of body fat becomes a health risk varies between ethnic groups. Asian people are known to be particularly vulnerable to the complications of diabetes.

The draft guideline also makes recommendations regarding very low-calorie diets (800kcal per day or less). These include:

  • Not routinely using very low-calorie diets to manage obesity.
  • Only considering very low-calorie diets for a maximum of 12 weeks (continuously or intermittently) as part of a multicomponent weight management strategy with ongoing support. This would be for people who are obese and have a clinically assessed need to rapidly lose weight – for example, people who require joint replacement surgery or who are seeking fertility services.
  • Giving counselling and assessing people for eating disorders or other mental health conditions before starting them on a very low-calorie diet. This is to ensure the diet is appropriate for them.

“This raises really important issues, such as the morality [and cost] of giving a surgical procedure for what is essentially a behavioural disease,” Dr Simon Heller from the academic unit of diabetes, endocrinology, and metabolism at the University of Sheffield, United Kingdom, told Medscape Medical News. “This is something that we as a society have really got to think about, and that’s true for every country in the world.”

“This is an extremely difficult situation with all kinds of vested interests,” he said. “The pharmaceutical industry, for example, presumably doesn’t want to see surgery adopted too widely, because these extremely expensive [obesity and diabetes] drugs they have developed are undoubtedly more expensive than bariatric surgery.”

The charity Diabetes UK is currently funding the largest study in the UK into this approach, the  Diabetes Remission Clinical Trial (DIRECT) to compare the long-term health effects of current type 2 diabetes treatments with those of a very low-calorie diet, followed by a long-term approach to weight management.

“For most people, losing weight can be very difficult. For some, as well as a healthy diet and physical activity, additional treatments include medication and surgery,” said Simon O’Neill from the charity Diabetes UK. “Although studies have shown that bariatric surgery can help with weight loss and have a positive effect on blood glucose levels, it must be remembered that any surgery carries serious risks. Bariatric surgery should only be considered as a last resort if serious attempts to lose weight have been unsuccessful and if the person is obese.”

 Owen Haskins – Editor in chief, Bariatric News

http://www.bariatricnews.net/?q=news/111563/uk-proposes-surgery-bmi-30-diabetes

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Cambiamenti a breve e medio termine della densità ossea dopo la Sleeve Gastrectomy laparoscopica

 

 

E’ stato dimostrato un aumento progressivo del-la densità minerale ossea (BMD) durante il primo e il secondo anno succes-sivi all’intervento chirurgi-co di gastrectomia verti-cale, tipo Sleeve. Tali variazioni non sono asso-ciate alla perdita di peso ma hanno mostrato una correlazione diretta con la vitamina D e una correlazione inversa con i livelli di PTH (paratormo-ne)

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LA CHIRURGIA BARIATRICA AIUTA A RIDURRE IL RISCHIO DI CANCRO NEI SOGGETTI OBESI

 

Quattro studi controllati, condotti dalla dott.ssa  Daniela Casagrande della Universidade Federal do Rio Grande do Sul in Brasile e dai suoi colleghi, hanno dimostrato che la chirurgia bariatrica riduce il rischio di cancro nei soggetti obesi, per cause ancora sconosciute ma presumibilmente legate ai cambiamenti metabolici associati alla perdita di peso.

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Bariatric surgery induced weight loss can help reduce the risk of cancer to rates almost similar to those of people of normal weight, according to the findings of the first comprehensive review published in Obesity Surgery. The review, which takes into into account relevant studies about obesity, cancer rates and bariatric surgery, concluded that the reasons for the findings were unknown but likely assocaited with weight loss or better awareness/diagnosis post surgery.

Some previous studies suggested a relationship between bariatric surgery and reduced cancer risk among obese people, as a result Dr Daniela Casagrande of the Universidade Federal do Rio Grande do Sul in Brazil. and her colleagues contrasted and combined results from 13 relevant studies that focus on the incidence of cancer in patients following bariatric surgery.  These include both controlled and uncontrolled studies, and the relevant information of 54,257 participants.

They found that the cancer incidence density rate was 1.06 cases per 1,000 person-years within the surgery groups up to 23 years after the surgery was performed. This is markedly better than the rate for the global population of obese people. Importantly, the effect of bariatric surgery was found within both controlled and uncontrolled studies. Four controlled studies showed that bariatric surgery was associated with a reduction in the risk of cancer.

In the meta-regression, there was an inverse relationship between the pre-surgical BMI and cancer incidence after surgery (beta coefficient −0.2, p<0.05).

It is still unknown whether the lower cancer rates following bariatric surgery are related to the metabolic changes associated with weight loss, or if lower BMIs following surgery result in earlier diagnosis and improved cancer treatment outcomes among patients.

Casagrande said that it is difficult to separate the effects of the surgery from the multiple associated changes it yields in patients. She believes that undergoing a surgical procedure of the magnitude of bariatric surgery raises awareness and possible earlier diagnosis of cancer among such patients.

Although bariatric surgery is associated with reduced cancer risk in morbidly obese people, Casagrande notes that conclusions should be drawn with care because there was high heterogeneity among the studies.

In addition, there were some limitations about the data available among the studies and variables associated with cancer should still be measured in prospective bariatric surgery trials.

Owen Haskins – Editor in chief, Bariatric News

http://www.bariatricnews.net/?q=news/111500/surgery-reduces-cancer-rates-reasons-unknown

 

 

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L`INGROSSAMENTO DEL CUORE (CARDIOMEGALIA) RISULTA FORTEMENTE ASSOCIATO ALL`OBESITÀ

Una ricerca retrospettiva condotta su circa 500 casi di morte improvvisa ed inaspettata (fonte: Federal University of Sao Paulo, Sao Paulo, Brazil), dimostra che l’ingrossamento del cuore (cardiomegalia) è la principale causa di morte per grave aritmia (50 % circa dei casi studiati) in uomini e donne adulti ed è associata all’obesità.

La Cardiomegalia rappresenta un frequente substrato aritmogeno nelle morti cardiache improvvise in età adulta ed è associata con l`obesità.

Pubblicato in Pathology – The Journal of the Royal College of Pathologists of Australasia
2012 Apr; 44(3):187-91 – Autori: Tavora F, Zhang Y, Zhang M, Li L, Ripple M, Fowler D, Burke A – Fonte: Federal University of Sao Paulo, Sao Paulo, Brazil

BACKGROUND:

Both coronary artery disease (CAD) and cardiomyopathy may present with sudden cardiac death (SCD). It is generally accepted that CAD is the most common cause of SCD in adults, but the frequency of cardiomegaly as a primary or contributing cause is less known.

METHODS:

We retrospectively studied the cardiac findings of all cases of adult SCD attributed to cardiomegaly, severe atherosclerosis, or both, in the absence of specific cardiomyopathy. Association between findings and risk factors was studied.

RESULTS:

There were 484 sudden cardiac deaths, of which 402 met study criteria. Mean age was 49 ± 13 years, with 289 men and 159 African Americans (AAs). Cardiomegaly with presumed hypertensive, multifactorial or unknown cause, was the sole arrhythmogenic substrate in 38% of men and 49% of women (p = 0.003); CAD was the sole cause of SCD in 19% of men and 26% of women, and mixed CAD + cardiomegaly the cause of death in 43% of men and 25% of women. Cardiomegaly was associated by univariate analysis with younger age (46 ± 12 years versus 53 ± 14 for CAD, p < 0.0001), AA race (p = 0.004), and body mass index (p < 0.0001).

CONCLUSIONS:

Among adults with a mean age of about 50 years, cardiomegaly is a frequent cause of sudden cardiac death, and is highly associated with obesity. Cardiomegaly is also frequent in SCD with severe CAD. The causes and classification of cardiomegaly in patients without specific cardiomyopathy, and in patients with and without hypertension or coronary disease need to be better studied.

(C) 2012 Royal College of Pathologists of Australasia.

PMID:  22406485 [PubMed – indexed for MEDLINE]

Approfondimenti:
http://www.ncbi.nlm.nih.gov/pubmed/22406485
http://journals.lww.com/pathologyrcpa/pages/articleviewer.aspx?year=2012&issue=04000&article=00002&type=abstract

 

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La Chirurgia Bariatrica provoca la remissione della dipendenza dal cibo

In un recente studio, i ricercatori del Centro di Nutrizione Umana e Atkins (Centro di Eccellenza della Medicina dell’obesità) della Washington University School of Medicine, St Louis, MO, hanno valutato se la perdita di peso, indotta dall’intervento di Bypass gastrico o di Bendaggio gastrico o di Sleeve gastrectomy, provoca la remissione della dipendenza dal cibo e normalizza i comportamenti alimentari associati con questa condizione, nei pazienti ancora obesi.

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Bariatric surgery-induced weight loss induces remission of food addiction and improves several eating behaviours that are associated with the condition in extreme obesity, according to the study published in the journal Obesity.

Although, bariatric surgery is believed to be one most effective available weight loss therapy for obesity and impacts on patients desire to eat, it is not known whether it can affect food addiction in patients who meet diagnostic criteria for the condition before surgery.

Therefore, researchers from the Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St Louis, MO, assessed whether weight loss induced gastric bypass, gastric banding and sleeve gastrectomy induced remission of food addiction, as well as normalising eating behaviours associated with the condition.

They recruited 44 obese patients (39 women, mean BMI48 ± 8) before and after bariatric surgery (after they lost ∼20% of their body weight). Twenty five patients had gastric bypass, 11 gastric banding and eight sleeve gastrectomy).

Food addiction was identified in 14 of 44 subjects (32%) before surgery, with no significant differences in factors that could affect the condition such as age, race, level of formal education, and income level.

They reported that remission of food addiction in 13 of the 14 subjects (93%) and no new cases were identified after surgery. The prevalence of food addiction in this study population decreased from 32% to 2% (p< 0.00001) and reduced the median number of symptoms in all subjects (p< 0.0001).

Surgery was found to decrease food cravings in both groups, but the decrease was greater in patients addicted to food. Unsurprisingly, the addicted patients craved foods more frequently before, but not after surgery. Interestingly, surgery decreased cravings for all types of foods but cravings for starchy foods were still more frequent in in the food addicted group (p=0.009).

“Our findings demonstrate that weight loss can induce remission of food addiction, even though subjects are still obese,” the authors write. “These data suggest that obesity itself does not cause food addiction, but that food addiction is a contributing, but modifiable, risk factor for obesity. Additional studies are needed to determine the mechanism(s) responsible for food addiction remission, and to determine whether the presence of food addiction influences the weight loss efficacy of bariatric surgery.”

Owen Haskins – Caporedattore, Bariatric News

http://www.bariatricnews.net/?q=news/111608/bariatric-surgery-causes-remission-food-addiction
http://onlinelibrary.wiley.com/doi/10.1002/oby.20797/full

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Il bypass gastrico per via laparoscopica Roux-en-Y con il posizionamento dell`impianto GABP RING mantiene la perdita di peso nel paziente a lungo termine

 

Un obiettivo importante alla base della chirurgia bariatrica è la perdita di peso e il suo mantenimento a lungo termine. L’efficacia del posizionamento dell’impianto GABP RING in aggiunta al by pass gastrico è stata valutata in un follow up di 4 anni, pubblicato in BMC Surgery.
Questo è il primo rapporto dei risultati milticentrici ottenuti dopo quattro anni.

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Banded gastric bypass maintains weight loss according to a study thought to be the first report of up to four years using the GaBP ring (Bariatec Corporation), published in BMC Surgery 

Although gastric bypass is the gold standard of bariatric surgery some patients show insufficient weight loss or weight regain. It is believed that dilation of the pouch or the pouch outlet may be the cause, but by banding the bypass surgeons overcome the dilation by placing an implant around the pouch or pouch outlet.

A total of 183 (118 women and 65 men) consecutive bariatric patients who agreed for GaBP implant were operated with banded gastric bypass between August 2007 and December 2010 at the Antwerp Medical Center, Belgium, the University of Schleswig-Holstein, the University of Freiburg, Germany, and the International Medical Centre, Jeddah, Kingdom of Saudi Arabia.

The mean BMI before the operation was 42.8 and mean excess weight was 60.9 kg. Patient weight and BMI were recorded prior to the operation, three and six months after the operation and at one, two, three and four years post-op.

All the cases were performed laparoscopically and a vertical tubular pouch 5–6cm was formed using linear staplers. The GaBP Ring was placed 4cm from the angle of and closed and fixed with two sutures. Rings with a circumference of 6.5cm (diameter of closed ring is 1.9cm) were used in all patients. The alimentary limb was created by dividing the jejunum 50cm below the ligament of Treitz. A gastroenterostomy was performed in an antecolic manner using a circular stapler or hand sewing anastomosis and the integrity of the anastomosis was tested with methylene blue.

In the perioperative and early postoperative period there were 8 (4.3%) complications, including:

  • One case of an intraoperative bleeding (0.5%) which made a splenectomy necessary
  • Two patients had postoperative intraabdominal bleedings and another two developed intraluminal bleedings which could be treated conservatively (2.1%)
  • In two cases (1%) an intestinal perforation was observed which resulted in revisionary surgery, but it was not necessary to remove the rings
  • One patient had a cardiac arrest (0.5%) in the early postoperative period with complete recovery

Outcomes

The results revealed that at six months follow up data was available for 147 patients: the mean EWL was 60% with a mean BMI 30.1. After one year mean EWL reached 75.3% with a mean BMI27 (n=110). After two and three years the EWL was 78.8% (n=49) and 79.9% (n=35). There was a mean EWL of 85% after four years. Thirteen patients finished a four year follow up period and mean BMI after 4 years was 25.2.

“We assume that ring implantation on the gastric pouch can indeed prevent pouch outlet and first jejunal limb dilation,” the authors write. “Since outlet dilation will probably not occur in the first year after gastric bypass, the effect of the banding is likely to be seen in a more than three year follow up.”

They note that banded bypass is not routinely used by most bariatric surgeons and state that it might be due to the fear of additional complications like infection, band or ring erosion, migration or stenosis. However, in this series they witnessed no ring-related complications besides one case where the ring was broken and had to be replaced.

Conclusion

“To our knowledge this is the first report of up to four years multicenter results using the GaBP ring for banded gastric bypass surgery. In the four year follow up we see a good weight loss in the first year and a further slight weight loss up to year four with no regain of weight,” the authors conclude. “However, one limitation of our study is that to date only 13 patients completed the four year follow. We assume that banding the pouch can prevent pouch outlet dilation and thus reduce the need for revisionary operations after gastric bypass surgery. We are looking forward to see the results of multicenter prospective comparison of banded and conventional gastric bypass.”

Owen Haskins – Editor in chief, Bariatric News

Riferimento Pubmed: (http://www.ncbi.nlm.nih.gov/pubmed/25391401.

http://www.bariatricnews.net/?q=news%2F111715%2Fbanded-rygb-maintains-weightloss-four-years&utm_source=IFSO+Member&utm_campaign=2c16edc684-BN+IFSO+November+2014+highlights&utm_medium=email&utm_term=0_69274c1fb4-2c16edc684-%5BLIST_EMAIL_ID%5D&ct=t%28BN+IFSO+November+2014+highlights%29

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LA CHIRURGIA BARIATRICA PUO` MIGLIORARE LA FUNZIONE RENALE

LA CHIRURGIA BARIATRICA PUO` MIGLIORARE LA FUNZIONE RENALE

 

Secondo uno studio recente, presentato durante la Settimana del Rene (Kidney Week 2014), alla Società Americana di Nefrologia (ASN), presso il Pennsylvania Convention Center di Philadelphia, un gruppo di ricercatori ha esaminato e correttamente evidenziato l’associazione tra la perdita di peso ottenuta dal paziente obeso, dopo un intervento di chirurgia bariatrica e la velocità di filtrazione glomerulare (eGFR) , stimata attraverso l’equazione CKD-EPI.

 

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“Bariatric surgery serves as a good model to examine the effects of weight loss on kidney function. Our findings suggest a beneficial impact on kidney function in patients with and without baseline kidney disease,” said Alex Chang from the Geisinger Medical Center, Pennsylvania.

The association between weight loss and resolution of albuminuria was examined in the subset of patients with baseline albuminuria (albumin/creatinine ratio >=30mg/g) and subsequent ACR quantification. Mixed effects models were used, adjusted for time and baseline weight, allowing intercepts and slopes to vary for each individual.

A total of 3,134 patients were followed for a median of 2.4 years and the mean age was 47.2, 36.6% had diabetes, and 6.4% had eGFR

They noted that every 5kg of weight loss was associated with a 0.50 ml/ min/1.73m2 (95% CI: 0.42 to 0.57; p<0.001) increase in eGFR. The association between weight loss and increased eGFR was stronger in patients with eGFR <60ml/min/1.73m2: 0.89 ml/min/1.73m2 per 5kg decrease (95% CI: 0.63 to 1.15; p<0.001) compared to 0.46 (0.39 to 0.54; p<0.001) for those with eGFR >60 ml/min/1.73m2 (p

“More emphasis should be placed on promoting healthy lifestyles to avoid morbid obesity, and prevent chronic kidney disease,” concluded Chang. “Additional studies using other markers of kidney function are needed to confirm the study’s findings and to examine the effect of weight loss on long-term kidney outcomes.”

Owen Haskins – Caporedattore, Bariatric News

Novembre 2014

http://www.bariatricnews.net/?q=news/111716/bariatric-surgery-could-improve-kidney-function

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LA CHIRURGIA BARIATRICA APPORTA UN SIGNIFICATIVO MIGLIORAMENTO DELLA STEATOSI EPATICA NON ALCOLICA (NAFLD)

 

Secondo una nuova ricerca presentata alla Digestive Disease Week (DDW), i ricercatori della University of South Florida-Tampa (USF) hanno scoperto che la chirurgia Bariatrica risolve l’infiammazione del fegato e riducendo i depositi di grasso, provoca un miglioramento della fibrosi epatica in stadio precoce, dell’ispessimento e la cicatrizzazione del tessuto epatico.

“About 30 percent of the US population suffers from this disease, which is increasing, and more than half are also severely obese,” said Dr Michel Murr, lead researcher of the study, professor of surgery and director of Tampa General Hospital and USF Health Bariatric Center. “Our findings suggest that providers should consider bariatric surgery as the treatment of choice for NAFLD in severely obese patients.”

Murr and his colleagues suggest that bariatric surgery be considered for patients with a BMI>35 and obesity-related co-morbidities or BMI>40. They note that traditional interventions, such as medications, have a low success rate with these patients.

Researchers compared liver biopsies from 152 patients, one at the time of the bariatric procedure and a second an average of 29 months afterwards. Mean pre-op BMI was 52±10 and mean excess body weight loss was 62±22% at the time of the subsequent biopsy.

In examining pre-operative biopsies, researchers identified patients with cellular-level manifestations of NAFLD, specifically, fat deposits and inflammation of the liver. These types of liver damage can lead to liver fibrosis and cirrhosis.

After reviewing post-operative biopsies, they found that bariatric surgery resulted in improvements for these patients. In the post-operative biopsies, researchers found that fat deposits on the liver resolved in 70 percent of patients. Inflammation was also improved, with lobular inflammation resolved in 74 percent of patients, chronic portal inflammation resolved in 32 percent, and steatohepatitis resolved in 88 percent.

In addition to these improvements, 62 percent of patients with stage two liver fibrosis had an improvement or resolution of the fibrosis. One of three patients with cirrhosis also showed improvement.

Murr noted that these findings on fibrosis reversal apply only to early-stage fibrosis, and not late-stage liver disease. 

“We are in the midst of an obesity epidemic that can lead to an epidemic of nonalcoholic fatty liver disease,” added Murr. “As a tool in fighting obesity, bariatric surgery could also help prevent the emergence of widespread liver disease.”

Tuesday, May 6, 2014 – 12:52

Owen Haskins – Editor in chief, Bariatric News

http://www.bariatricnews.net/?q=news%2F111450%2Fbariatric-surgery-can-reduce-liver-damage&utm_source=IFSO+Member&utm_campaign=270052366a-BN+Gen+06%2F05%2F14&utm_medium=email&utm_term=0_69274c1fb4-270052366a-%5BLIST_EMAIL_ID%5D&ct=t%28BN+Gen+06%2F05%2F14%29

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LA SLEEVE GASTRECTOMY LAPAROSCOPICA (LSG) HA I PIU`BASSI TASSI DI MORBILITA` LEGATI ALLA PROCEDURA

Secondo i risultati di un recente studio, condotto per sei anni e presentato al 29° Meeting Annuale ASMBS’ a San Diego, CA, l’intervento laparoscopico di Sleeve Gastrectomy (LSG) comporta una bassa morbilità e il più basso rischio di re-interventi, nel corso del tempo, se confrontato con altre procedure bariatriche: Roux-en-Y bypass gastrico (RYGB) e bendaggio gastrico regolabile laparoscopico (LAGB).

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“The aim of the study was to identify which of the bariatric procedures performed today is the safest in terms of procedure related morbidity,” said Dr Raul J Rosenthal from the Bariatric and Metabolic Institute and the Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida. “So we carried out a single institution retrospective review of our centre’s six year experience since LSG was introduced comparing the procedure with Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric band (LAGB).”

Rosenthal and colleagues retrospectively analysed a prospectively collected database in morbidly obese patients that underwent bariatric surgery between 2005 and 2011. They identified and compared complications, hospital stay, readmissions and re-operations in patients that underwent all three procedures.

A total of 2,433 bariatric procedures were performed during this period of time. There were no significant differences between the groups in terms of age, gender or BMI. Rosenthal explained that in his institution, banding is only applied to patients with a BMI 35-50, whereas LSG is applied to all patients including the high risk and RYGB is applied to all patients with a BMI of >35.

Outcomes

Of those procedures 1,492 were RYGB, 602 LSG and 339 LAGB. The number of readmissions was minimal in all three groups with RYGB 1.7 times, LSG 1.3 times and 1.5 times for LAGB. The percentage of procedures requiring reoperations due to complications or failures was 7.7% in the RYGB group, 1.5% in the LSG and 15.3% for the LAGB.

“LSG appears to have the lowest rate of re-operations when compared to banding and bypass, and surprisingly banding had the highest rate of re-intervention,” said Rosenthal. “The primary reason for removing bands was slippage, followed by failure and reflux.”

The outcomes also revealed that average postoperative length of stay was longer following RYGB (3.75 days) compared with LSG (3.4 days) and banding (1.47 days). The leakage rate was 0.4% for the RYGB and 0.3% for the LSG (leakage rates are not applicable for LAGB).

“One of the weaknesses of this study, as with all retrospective studies, is that patients were not randomised,” he explained. “Therefore, it could be that there is a patient population in one group or another that could trigger a difference in the outcomes.”

“However, I believe that this study adds to the body of evidence, which includes randomised studies and meta-analyses, that LSG is an outstanding treatment option for morbid obesity,” concluded Rosenthal. “I think the message from this relatively small study is that at this point LSG is the safest procedure when treating morbidly obese patients.”

The co-authors of the study were Drs Abraham Fridman, Karan Bath, Andre Teixeira and Samuel Szomstein.

Owen Haskins – Editor in chief, Bariatric News

http://www.bariatricnews.net/?q=news/11321/lsg-has-lowest-rates-procedure-related-morbidity

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