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II LIVE SURGERY WORKSHOP

UPDATE IN CHIRURGIA BARIATRICA LAPAROSCOPICA

ROMA, 13 MARZO 2017
AULA ANFITEATRO – POLICLINICO TOR VERGATA

Presidente: A. L. Gaspari
Coordinatore: P. Gentileschi
Segreteria Scientifica: D. Benavoli, A. Di Giorgio, S. D’Ugo, F. Perrone, V. Tognon
AGGIORNAMENTO MASTER IN CHIRURGIA DELL’OBESITÀ UNIVERSITÀ DEGLI STUDI DI ROMA TOR VERGATA
7.30
Registrazione Partecipanti
8.00
Saluto alle autorità
8.45
COLLEGAMENTO LIVE DALLE SALE OPERATORIE DEL PTV
Presidente:  D. Foschi (Milano) – Moderatori: R. Moroni (Cagliari), G. Silecchia (Roma)

• Sleeve gastrectomy: S. Olmi (Zingonia)
•Mini By-Pass gastrico: L.Piazza (Catania)
Invitati alla Discussione: M. Di Paola (Roma), P. Giustacchini (Roma), E. Manno (Napoli), M. Musella(Napoli), A. Paganini (Roma), G. Sarro (Magenta), G. Sica (Roma), M. Zoffoli (Roma)
Operatori: M. Anselmino (Pisa), V. Ceriani (Milano), N. Di Lorenzo (Roma), P. Gentileschi (Roma), F. Rubino (Londra)Invitati alla Discussione: F. Campanile (Civita Castellana), G. Casella (Roma), M. Di Paola (Roma), M. Raffaelli (Roma), F. Stipa (Roma), S. Vita (Roma), M. Zoffoli (Roma)

10.45

ERABS( Enhanced Recovery after BS)
11.00 II SESSIONE

Presidente: P. Marini (Roma) – Moderatori: N. Di Lorenzo (Roma), C. Giardiello (Napoli)

  • Sadis M. Raffaelli (Roma) – M. Raffaelli (Roma)
  • Re-do bypass Gastrico M. –  Anselmino (Pisa)
Invitati alla Discussione: P. Bernante (Pieve di Cadore), C. Callari (Palermo), F. Campanile (Civita Castellana), G. Casella (Roma), F. Greco (Brescia), F. Stipa (Roma), S. Vita (Roma)
13.00 III SESSIONE: HIGH-VOLUME CENTERS: Esperienze a confronto
Presidente: M. Zappa (Erba) – Moderatori: V. Ceriani (Milano), V. Pilone (Salerno)
  • Italia A. Giovannelli (Milano)
  • Olanda I. Janssen (Arnhem, Olanda)
13.45
14.30 IV SESSIONE: IL PAZIENTE DIFFICILE E IL TESSUTO SOCIALE
Presidente: P. Sbraccia (Roma) – Moderatori: L. Angrisani (Napoli), G. Semprini (Roma)
• Il paziente adolescente M. Biglia (Milano)
• Il paziente psichiatrico E. Bianciardi (Roma)
• Efficientamento, costi e risparmi della Chirurgia Bariatrica L. Mantovani (Milano)
• Il pazienteù

TAVOLA ROTONDA CON ESPERTI:

15.30 V SESSIONE
L’infermiere in chirurgia bariatrica P. Romanazzi (Roma)
15.45 V SESSIONE
Presidente: M. Lucchese (Firenze) – Moderatori: M. De Luca (Montebelluna), M. Foletto (Padova)
• Re-do dopo sleeve gastrectomy P. Gentileschi (Roma)
• Fallimento RYGB: trattamento endoscopico D. Benavoli (Roma)
Invitati alla Discussione: R. Bellini (Pisa), A. Formiga (Milano), A. Genco (Roma), G. Navarra (Messina), A. Scozzarro (Roma)
17.30 CLOSING REMARKS
FACULTY:
L. Angrisani
M. Anselmino
R. Bellini
D. Benavoli
P. Bernante
E. Bianciardi
M. Biglia
V. Bruni
C. Callari
F. Campanile
G. Casella
V. Ceriani
M. Dauri
M. De Luca
M. Di Paola
N. Di Lorenzo
M. Foletto
A. Formiga
D. Foschi
A. Genco
P. Gentileschi
C. Giardiello
A. Giovannelli
P. Giustacchini
F. Greco
I. Janssen
M. Lucchese
E. Manno
L. Mantovani
P. Marini
R. Moroni
M. Musella
G. Navarra
S. Olmi
A. Paganini
L. Piazza
V. Pilone
M. Raffaelli
P. Romanazzi
G. Sarro
P. Sbraccia
A. Scozzarro
G. Semprini
G. Sica
G. Silecchia
Stipa F.
Vita S.
Zoffoli M.
SEDE DEL WORKSHOP
Policlinico Tor Vergata – Viale Oxford, 81 – Roma
ISCRIZIONE
Policlinico Tor Vergata – Viale Oxford, 81 – Roma
La partecipazione al corso è gratuita e sarà riservata ai primi 100 medici chirurghi e infermieri che invieranno l’apposita scheda d’iscrizione alla Segreteria Organizzativa. Alla fine del workshop verrà rilasciato un attestato di partecipazione
CON IL PATROCINIO DI:
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SEGRETERIA ORGANIZZATIVA:

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Via Sergio Forti, 37 – 00144 Roma Tel. 06.60210638 – 06.65192185 – Fax 06.6551406 e-mail: info@cecongressi.it – www.cecongressi.it
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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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Una Relazione del Regno Unito mostra la sicurezza e l`efficacia di un intervento di chirurgia bariatrica

Il Secondo Rapporto Nazionale di Chirurgia Bariatrica 2014, pubblicato dalla Società BOMSS (British Obesity & Metabolic Surgery Society) ha dimostrato che la chirurgia bariatri-ca nel Regno Unito si può considerare un intervento SICURO, valutando la percentuale minima di mortalità, pari allo 0,07%, osservata nei pazienti ospedalizzati, dopo l’operazione di chirurgia primaria e la percentuale del 2,9% a seguito di complicanze post operatorie.

Il rapporto mette in luce anche l’efficacia dell’intervento chirurgico:  

–          due anni dopo l’intervento di chirurgia bariatrica il 65,1% dei pazienti con diabete di tipo 2  sono stati in grado di sospendere la terapia farmacologica;

–           tre anni dopo, i pazienti  hanno perso, mediamente,  il 59,6% del loro peso in eccesso.

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chirurgia-bariatrica-news

The Second National Bariatric Surgery Report published by the British Obesity & Metabolic Surgery Society (BOMSS) has shown that bariatric surgery in the UK is safe with an observed in-hospital mortality rate after primary surgery of 0.07% and an overall surgical complication rate for primary operations of 2.9%. The report also highlights the effectiveness of surgery; two years after surgery 65.1% of patients with type 2 diabetes returned to a state of no indication of diabetes and were able to stop their diabetic medications, and three years after surgery patients on average lost 59.6% of their excess weight

The report, published in conjunction with Dendrite Clinical Systems, is the second comprehensive, prospective, nationwide analysis of outcomes from bariatric surgery in the United Kingdom and Ireland, and a result of the data collected by the National Bariatric Surgery Registry (NBSR).

“For all comparisons, the data show that there is great benefit from bariatric surgery for all the diseases studied, in particular the effect on diabetes has important implications for the NHS,” the report states. “By implication, bariatric surgery greatly and cost-effectively improves the health of obese patients, much more so than other treatments.”

The publication has data from 161 surgeons from 137 hospitals who recorded 32,073 operations (18,283 in the three financial years ending 2011, 2012 and 2013). The vast majority (76.2%) of the procedure were funded by the National Health Service and the report includes information on 9,526 gastric bypass procedures, 4,705 gastric band operations and 3,797 sleeve gastrectomy operations.

The reports states that the average BMI was 48.8 and 53.9% of men and 41.4% of women had a high level of co-existing disease (four or more obesity-related diseases); 44.6% of men and 25.9% of women had type 2 diabetes.

“This increase in the burden of comorbid disease is present across all the BMI groups, which means this effect cannot be simply explained away by the assertion that surgeons are selectively treating more and more patients in the super-obese category,” the report continues. “On average, patients presenting for bariatric surgery are becoming sicker.”

The report illustrates the import role bariatric surgery can play in the resolution or alleviation of T2DM. Figure 1 shows that over a three-year post-operative period, patients requiring insulin before surgery were less likely to revert to a non-diabetic state than patients requiring oral hypoglycaemics (p<0.001); this cohort of patients in turn had lower resolution rates than patients treated by diet control alone (p=0.022). It is thought that this is the first data to demonstrate this on the scale of a national real-world registry in over 3,000 patients.

Figure 1: Primary surgery for patients with an indication of diabetes prior to surgery: Changes in rates of recorded diabetes per type of diabetes group; financial years 2011-2013

“The aim of bariatric surgery is to improve the overall health of patients by ameliorating, curing or preventing the development of the many diseases associated with obesity,” the reports notes. “In this regard weight loss is not a primary aim of surgery. However, weight loss is a convenient and important proxy measure of the effectiveness of surgery.”

Interestingly, the publication notes that for each type of operation on average men lost less of their excess weight than women. For all three common operations, patients with a BMI of less than 50 lose more excess weight than those with BMIs greater than 50. This might be seen as evidence in support of a policy of operating on patients at an earlier stage in their disease process, states the report.

“Perhaps most importantly, this second report demonstrates the commitment of British surgeons to share their data in the interests of understanding and improving the quality of care they offer,” writes Professor Sir Bruce Keogh, Medical Director of the National Health Service in England, in the Foreword of the report. “The pooling of so much data will help define the place of surgery for people debilitated by obesity and will, in time, help to refine surgical strategies and even unravel the mystery of why this surgery has such an instantaneous, profound and beneficial effect on diabetes, another scourge of our society. In short, this report is a tribute to the professionalism of the British Obesity & Metabolic Surgery Society.”

Owen Haskins – Editor in chief, Bariatric News

Friday, October 31, 2014

http://www.bariatricnews.net/?q=news/111708/uk-report-shows-safety-and-effectiveness-surgery

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Gli interventi chirurgici di Bypass gastrico assicurano ai pazienti migliori risultati, rispetto alla procedura di bendaggio gastrico

Secondo gli studi pubblicati dalla rivista medica JAMA e condotti dall’ Università del Texas, nota anche come UT Southwestern, uno dei più importanti Centri medici accademici al Mondo, hanno evidenziato che i pazienti che si sono sottoposti ad intervento chirurgico di bypass gastrico hanno perso circa il 66% del loro peso in eccesso, rispetto al 45% di quelli sottoposti alla procedura di bendaggio gastrico, ottenendo così una maggiore perdita di peso a lungo termine, un maggiore controllo del diabete di tipo 2 e della pressione alta nonché un significativo abbassamento dei livelli di colesterolo nel sangue.

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Gastric bypass surgery has better outcomes than gastric banding for long-term weight loss, controlling type 2 diabetes and high blood pressure, and lowering cholesterol levels, according to a review by UT Southwestern Medical Center surgeons of nearly 30 long-term studies comparing the two types of bariatric procedures.

The review, published in JAMA, found that those undergoing gastric bypass operations lost more weight – an average of 66 percent of their excess weight – compared to 45 percent average excess weight loss for those undergoing gastric banding procedures.

“We know gastric bypass brings more weight loss success and relief of commonly associated illness versus gastric band at one year after surgery,” said Dr Nancy Puzziferri, Assistant Professor of Surgery and part of the bariatric surgery team at UT Southwestern. “We now have the best evidence available telling us this outcome continues to be true even up to five years after surgery. We also know these procedures maintain their safety profile long-term.”

The researchers also reported dramatic differences between the two procedures in controlling diabetes; more than two-thirds of gastric bypass patients with T2DM saw remission of the disease, compared to less than a third of gastric band patients.

Gastric bypass surgery also lowered hypertension better than gastric banding. Nearly half of patients (48 percent) with hypertension reported remission after two years with gastric bypass, compared to less than a fifth (17 percent) for those undergoing gastric band procedures.

Gastric bypass also improved hyperlipidemia, with approximately 60 percent of gastric bypass patients reported remission in the studies, compared to about 23 percent of gastric band patients.

“The review underscores the importance of thinking about durable treatments, as obesity, type 2 diabetes, hypertension, and elevated cholesterol are chronic illnesses, rather than focusing on short-term results,” said Puzziferri.

Long-term complication rates for the two procedures also favoured gastric bypass, through both were relatively low, less than 3 percent for bypass surgery and less than 5 percent for banding procedures.

They also concluded there were not a sufficient number of studies meeting these criteria to accurately assess gastric sleeve procedures.

“It is also very important to understand sleeve gastrectomy, which with the evidence we have so far, appears to perform as well as gastric bypass for weight loss. We just don’t have as much evidence, in quantity or quality, as we have for the other procedures. The evidence will come in time,” she added. “We have not been doing sleeve gastrectomies for as many years as we have been performing gastric bypass or gastric band surgeries.”

They carried out the study to assess the quality of evidence and treatment effectiveness two years after bariatric procedures for weight loss, type 2 diabetes, hypertension, and hyperlipidemia in severely obese adults.

The review focused only on studies that followed patients for at least two years and in which more than 80 percent of patients were successfully tracked during that time; 29 studies total. Most (97 percent) of weight-loss surgery studies track only a small percent of patients and/or only for up to one year. The researchers suggested more studies are needed to look at long-term outcomes, at least two years past the initial surgery, while maintaining follow-up of at least 80 percent to be considered reliable.

“Very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results,” they concluded. “Gastric bypass has better outcomes than gastric band procedures for long-term weight loss, type 2 diabetes control and remission, hypertension, and hyperlipidemia. Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections.”

Owen Haskins – Editor in chief, Bariatric News

http://www.bariatricnews.net/?q=news/111668/bypass-betters-banding-controlling-chronic-conditions&utm_source=IFSO+Member&utm_campaign=1713ea3956-BN+IFSO+01%2F10%2F14&utm_medium=email&utm_term=0_69274c1fb4-1713ea3956-73102581

Long-term follow-up after bariatric surgery: a systematic review.

JAMA, 2014.JAMA. 2014 312(9):934-42.

Puzziferri NancyRoshek Thomas BMayo Helen GGallagher RyanBelle Steven HLivingston Edward H.

PubMed infoAbstract

Citation data from PubMed

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La chirurgia bariatrica produce effetti benefici sulla funzionalità epatica dei soggetti obesi

Secondo un recente studio Svedese, pubblicato on line in Plos One e condotto su diversi soggetti obesi (SOS), i risultati della Chirurgia bariatrica apportano  una riduzione significativa dei livelli delle transaminasi e un beneficio sulla funzionalità epatica dei pazienti.

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Bariatric surgery has beneficial effects on liver function according to the latest paper from the Swedish Obese Subjects (SOS) study. The paper, published on line in Plos One, found that surgery results in a sustained reduction in transaminase levels, and a long-term benefit in obese individuals.

“These data indicate that sustained weight loss has a beneficial long-term effect on chronic liver damage and that this effect is proportional to the weight loss reduction,” the authors write.

A transaminase is a type of enzyme whose activity is frequently measured, as part of a standard series of tests, to determine liver function. There are a number of different types of transaminases; the two commonly measured medically are alanine transaminase (ALT) and aspartate transaminase (AST). ALT is primarily localized to the liver and is considered a more specific test for liver damage.

Obesity is associated with elevated serum transaminase levels and non-alcoholic fatty liver disease and weight loss is a recommended therapeutic strategy.

As bariatric surgery is known to be effective in obtaining and maintaining weight loss, the aim of the study was to examine the long-term effects of bariatric surgery on serum transaminases in the prospective, controlled study, the SOS study.

SOS study

The SOS study is a non-randomised, matched, prospective, controlled, intervention trial that is comparing the long-term effects of bariatric surgery and usual care in obese subjects. The study includes 4,047 obese individuals of which 2,010 individuals had bariatric surgery and 2,037 individuals matched in a control group of enrolled based on 18 matching variables.

Individuals in the surgery group underwent either non-adjustable or adjustable banding (n=376), vertical banded gastroplasty (n=1,369) or gastric bypass (n=265). Subjects in the control group received the conventional treatment for obesity (advanced lifestyle modification, other or no treatment

Changes in serum transaminase levels and body weight were calculated as the difference between follow up (two or ten years) and baseline values. In addition, incidence of high transaminase during follow-up, as well as remission from high transaminase at baseline were analysed.

Specifically, the high transaminase group was defined by AST levels ≥33 U/L or 29 U/L and ALT levels ≥43 U/L or 30 U/L in men or women, respectively, as cut-offs. These transaminase cut-off levels have been shown to define NAFLD, indicated as liver fat content >5.6% by proton magnetic resonance spectroscopy in individuals with alcohol intake ≤20 (men) or ≤10 g/day (women).

Follow-up data were available for 3,102 (87%) persons after two years, and for 2,157 (60%) after ten years.

Results

A total of 3,570 individuals (control group, n=1,795; surgery group, n=1,775) from the overall SOS study population were included in the study.

Individuals in the surgery group were younger had higher body weight, BMI, blood pressure, glucose and liver transaminase levels compared to the control group. No differences in other parameters including alcohol consumption and use of lipid- and blood glucose-lowering medications were observed in the two treatment groups.

For incidence and remission calculations, the SOS individuals were stratified in groups with low (LT) and high serum transaminase (HT) levels. At baseline, the prevalence of HT levels was 46% (n=818) in the surgery group and 36% (n=645) in the control group (p<0.001).

Bariatric surgery was associated with a significant and sustained decrease in body weight compared to the control group.

After two years, both ALT and AST were reduced in the surgery group, while there was no change in the control group. After ten years, this pattern remained for ALT, while there was an increase in AST, which was significantly smaller in the surgery group than in the control group.

In addition, serum transaminase level changes were positively correlated to body weight changes at both 2- (ALT: r=0.500, p<0.001; AST: r=0.289, p<0.001) and 1- year (ALT: r 0.357, p<0.001; AST: r=0.160, p<0.001) follow up when the surgery and control groups were pooled.

The investigators report that serum AST level were related to weight loss, however, there was no further reduction in AST levels beyond weight loss of more than 10kg at 2-year follow-up. At 10-year follow up, the AST levels were associated with weight change, but compared to baseline there was no reduction in the AST levels irrespective of the weight change categories. Weight gain was associated with increased serum transaminases at both 2- and 10-year follow-up.

The incidence of HT was lower in the surgery compared to the control group at both 2-year (6% and 21%, for surgery and control groups, respectively p<0.001) and at 10-year (18% and 27%, p<0.001) follow up. A reduced risk for HT onset was observed in the surgery group at 2 and 10 years (OR: 0.26 (95% confidence interval 0.18–0.36, p<0.001) and 0.61 (95% confidence interval 0.46–0.81, p<0.001, respectively).

In addition, remission from HT was more common in the surgery group compared to the control group (80% and 39%, for surgery and control groups, respectively after 2-years, p<0.001, and 63% and 47%, respectively after 10-years, p<0.001).

Conclusion

“These data suggest that bariatric surgery has a long-term protective effect against chronic liver damage,” the authors write. “The effects after 10 years were smaller than after 2 years and this is likely due to the weight regain observed 10 years after bariatric surgery.”

They also note that the relationship between changes in transaminase levels and changes in body weight showed that weight gain was associated with a significant increase of transaminase levels, with ALT showing a continuous linear reduction with increasing weight loss at the 2-year follow up which was maintained at the 10 year follow up.

When changes in AST levels were examined, a reduction related to weight loss was observed at the 2-year but not at the 10-year follow up. The reason for this unexpected finding is unknown but it may be due to factors that have changed over time (e.g., age, environmental factors, lifestyle habits, medications) and influenced transaminase differently [23]. Nonetheless, it is worth noting that despite the absence of reduction at 10-year follow up, the AST levels remained lower in the surgery when compared to the control group.

Furthermore, the long-term effect of bariatric surgery on HT incidence and remission was examined. The incidence of and the remission from HT at both 2- and 10-year follow up were significantly more favourable in the surgery group compared to the control group. Similarly, the prevalence of an ALT/AST ratio <1, an index of severe liver disease [20], was lower in the surgery group compared to the control group at both 2- and 10-year follow up.

Although the authors acknowledge that a limitation of the report is that the effect of bariatric surgery on transaminase levels was not a predefined endpoint of the SOS study, “taken as a whole, these data suggest that weight reduction has a positive effect on liver transaminases and chronic liver damage,” they note.

“It may be speculated that sustained weight loss obtained by bariatric surgery reduces liver damage and may possibly prevent hepatic long-term sequelae,” they write. “Further longitudinal studies, using more sensitive techniques to assess chronic liver disease, are warranted to confirm these data. In conclusion, this report shows that bariatric surgery is associated with long-term reduction of serum transaminases in obese individuals.”

Owen Haskins – Editor in chief, Bariatric News

 http://www.bariatricnews.net/?q=news/11938/bariatric-surgery-has-beneficial-effects-liver

Riferimento:

 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0060495

Long-Term Effect of Bariatric Surgery on Liver Enzymes in the Swedish Obese Subjects (SOS) Study

Maria Antonella Burza, Stefano Romeo, Anna Kotronen, Per-Arne Svensson, Kajsa Sjöholm, Jarl S. Torgerson, Anna-Karin Lindroos, Lars Sjöström, Lena M. S. Carlsson, Markku Peltonen.

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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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obesity_skeleton

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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IMG_2172

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.

==========================

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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cardiomegalia-cuore_ingrossato

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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