scholarly journals Sleeve Gastrectomy Is Associated with a Greater Reduction in Plasma Liver Enzymes Than Bypass Surgeries—A Registry-Based Two-Year Follow-Up Analysis

2021 ◽  
Vol 10 (5) ◽  
pp. 1144
Author(s):  
Shira Azulai ◽  
Ronit Grinbaum ◽  
Nahum Beglaibter ◽  
Shai Meron Eldar ◽  
Moshe Rubin ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Fatty Liver Disease ◽  
Laboratory Tests ◽  
Liver Enzymes ◽  
Liver Pathology ◽  
Hepatic Enzyme ◽  
Demographic Information ◽  
Post Surgery

Bariatric surgeries may lead to an improvement in metabolic fatty liver disease, and a reduction in the levels of the hepatic enzyme Alanine Aminotransferase (ALT). We compared the effects of Sleeve Gastrectomy (SG), Roux en Y Gastric Bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) on the levels of ALT by analysis of two-year follow-up data from 4980 patients in the Israeli Bariatric Registry that included laboratory tests and demographic information. Pre-operative characteristics of patients, and particularly levels of liver enzymes, were similar across surgery types. Regression modeling and retrospective matching showed that SG was superior to RYGB and OAGB in reducing ALT levels, and in reducing the fraction of patients with abnormally high ALT levels. Two-year post-surgery, an increase in ALT levels from normal to abnormal levels was observed in 5% of SG patients, and in 18% and 23% of RYGB and OAGB patients. In conclusion, SG leads to a greater reduction in ALT levels compared with bypass surgeries and a lower incidence of post-surgical elevation of ALT levels. Further studies are required to identify the cause for the rise in liver enzymes, and to determine whether ALT levels correlate with liver pathology especially following bariatric surgery.

scholarly journals Long-term effects of laparoscopic sleeve gastrectomy and Roux-Y-gastric bypass on body composition and bone mass density

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
S Rast ◽  
J Bühler ◽  
C Beglinger ◽  
R Peterli ◽  
T Peters ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Body Composition ◽  
Sleeve Gastrectomy ◽  
Bone Mass ◽  
Vitamin D3 ◽  
Mass Density ◽  
Bone Mass Density ◽  
Post Surgery

Abstract Objective Currently, the two most common bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB). Long-term data comparing the two interventions in terms of their effect on body composition and bone mass density (BMD) is scarce. The aim of this study was to assess body composition and BMD at least five years after sleeve gastrectomy (LSG) and gastric bypass (LRYGB). Methods Bariatric patients at least five years post-surgery (LSG or LRYGB) were recruited and body composition and BMD was measured by means of DEXA. Data from body composition before surgery was included in the analysis. Blood samples were taken for determination of plasma calcium, parathyroid hormone (PTH), Vitamin D3, alkaline phosphatase and C-terminal telopeptide (CTX), and individual risk for osteoporotic fracture assessed by The Fracture Risk Assessment Tool (FRAX) score was calculated. After surgery, all patients received multivitamins, vitamin D3, and zinc. In addition, LRYGB-patients were prescribed calcium. Results A total of 142 patients were included, 72 LSG and 70 LRYGB, before surgery: median BMI 43.1 kg/m2, median age 45.5 years, 62.7% females. Follow-up after a median of 6.7 years. For LRYGB, percentage total weight loss (%TWL) at follow up was 26.3%, and for LSG 24.1%, (p = 0.243). LRYGB lead to a slightly lower fat percentage in body composition. At follow-up, 45% of both groups had a T-score at the femoral neck below -1, indicating osteopenia. No clinically relevant difference between the groups in BMD was found. Conclusion At 6.7 years post-surgery, no difference in body composition and BMD between LRYGB and LSG was found. Deficiencies and bone loss remain an issue after both interventions and should be monitored.

Effects of sleeve gastrectomy on liver enzymes, non-alcoholic fatty liver disease-related fibrosis and steatosis scores in morbidly obese patients: first year follow-up

2019 ◽  
Vol 43 (2) ◽  
pp. 115-122
Author(s):  
Evrim Kahramanoğlu Aksoy ◽  
Zeynep Göktaş ◽  
Özgür Albuz ◽  
Muhammet Yener Akpınar ◽  
Doğan Öztürk ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Liver Enzymes ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

Abstract Background Non-alcoholic fatty liver disease (NAFLD) has a high prevalence among patients undergoing laparoscopic sleeve gastrectomy (LSG). Although liver biopsy is the gold standard for assessing histopathologic changes in the liver, it is an invasive procedure. The objective of this study was to evaluate the effect of sleeve gastrectomy on liver enzymes, fibrosis and steatosis scores; ultrasonographic findings; biochemical parameters; and anthropometric measurements in morbidly obese patients with NAFLD. Methods Ninety-seven obese patients who underwent LSG were included in this study. Sex, age, body mass index (BMI), comorbidities, liver enzymes, ultrasonographic findings and laboratory parameters to calculate fibrosis and steatosis scores were collected before surgery and after 1 year of follow-up. Results A total of 88.7% of patients had liver steatosis at the pre-surgical ultrasonographic evaluation and this ratio decreased to 46.4% 1 year after surgery. Alanine aminotransferase (ALT), homeostatic model assessment of insulin resistance index (HOMA-IR), aspartate aminotransferase-to-platelet ratio index (APRI) and liver fat score (LFS) were significantly higher in patients with steatosis grade III vs. others. There were improvements in high-density lipoprotein (HDL), triglycerides (TG), glycated hemoglobin (HbA1c), glucose, insulin, BMI, liver enzymes and all NAFLD-related fibrosis and steatosis scores. Conclusions HOMA-IR, ALT, LFS and APRI scores can be used for follow-up procedures in morbidly obese patients with NAFLD who underwent LSG.

scholarly journals Vitamin D Status After Gastric Bypass or Sleeve Gastrectomy over 4 Years of Follow-up

2019 ◽  
Vol 30 (4) ◽  
pp. 1473-1481 ◽  
Author(s):  
Alistair Fox ◽  
Chris Slater ◽  
Babur Ahmed ◽  
Basil J. Ammori ◽  
Siba Senapati ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Vitamin D ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Vitamin D Deficiency ◽  
Cohort Analysis ◽  
Vitamin Deficiencies ◽  
Post Surgery ◽  
Vitamin D Levels

Abstract Background Bariatric surgery for severe obesity can lead to micronutrient/vitamin deficiencies. Aims To study baseline and post-surgical prevalence of vitamin D deficiency in patients undergoing bariatric surgery. Participants and Setting Patients undergoing bariatric surgery in a university teaching hospital in North West England. Methods We performed an observational cohort analysis of longitudinal data on vitamin D and related parameters in patients who underwent bariatric surgery. Patients were routinely recommended daily combined calcium and vitamin D supplementation post-surgery. Results We studied 460 patients who had completed at least 12 months post-operatively; mean (standard deviation) age was 48.0 (10.5) years, weight 144.7 (27.3) kg and body mass index 50.0 (7.6) kg/m2; 292 (63.5%) underwent gastric bypass and 168 (36.5%) sleeve gastrectomy. Vitamin D level was 33.1 (23.9) nmol/L at baseline, rising to 57.1 (23.1) nmol/L at 12 months post-surgery. Whereas 43.2% had vitamin D deficiency and 34.7% insufficiency preoperatively, 8.9% and 26.7% had deficiency and insufficiency, respectively, at 12 months with similar trends up to 4 years of follow-up. There were no significant differences between procedures or sexes in vitamin D levels or sufficiency rates. Conclusion Vitamin D deficiency and insufficiency were prevalent pre-surgery and reduced significantly with routine supplementation post-surgery.

scholarly journals Utility of Fibroscan XL to assess the severity of non-alcoholic fatty liver disease in patients undergoing bariatric surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Andrew Yang ◽  
Melinda Nguyen ◽  
Irene Ju ◽  
Anthony Brancatisano ◽  
Brendan Ryan ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Liver Stiffness ◽  
Convincing Evidence ◽  
Alcoholic Fatty Liver ◽  
Post Surgery

AbstractSignificant weight loss can modify the progression of Nonalcoholic fatty liver disease (NAFLD) with the most convincing evidence coming from bariatric surgery cohorts. Effective ways to non-invasively characterise NAFLD in these patients has been lacking, with high Fibroscan failure rates reported. We prospectively evaluated the utility of Fibroscan using XL-probe over a two-year period. 190 consecutive patients undergoing bariatric surgery were followed as part of their routine care. All patients had Fibroscan performed on the day of surgery and at follow-up a mean of 13 months (± 6.3) later. The majority of patients were female (82%) with mean age of 42. Fibroscan was successful in 167 (88%) at baseline and 100% at follow up. Patients with a failed Fibroscan had higher body mass index (BMI) and alanine transaminase (ALT), but no difference in FIB-4/NAFLD score. Mean baseline Liver stiffness measurement was 5.1 kPa, with 87% of patients classified as no fibrosis and 4% as advanced fibrosis. Mean baseline controlled attenuation parameter was 291, with 78% having significant steatosis, 56% of which was moderate-severe. Significant fibrosis was associated with higher BMI and HbA1c. Significant steatosis was associated with higher BMI, ALT, triglycerides and insulin resistance. Mean follow up time was 12 months with weight loss of 25.7% and BMI reduction of 10.4 kg/m2. Seventy patients had repeat fibroscan with reductions in steatosis seen in 90% and fibrosis in 67%. Sixty-four percent had complete resolution of steatosis. Fibroscan can be performed reliably in bariatric cohorts and is useful at baseline and follow-up. Significant steatosis, but not fibrosis was seen in this cohort with substantial improvements post-surgery.

Short-Term Results of Single-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Alaa Abbas Sabry ◽  
Karim Sabry Abd-Elsamee ◽  
Mohamed Ibrahim Mohamed ◽  
Mohammed Mohamed Ahmed Abd-Elsalam
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Weight Regain ◽  
Revisional Surgery ◽  
One Anastomosis Gastric Bypass ◽  
Short Term ◽  
Multicenter Studies ◽  
Metabolic Outcomes

Abstract Background It is already known that Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain is considered as a complication. Demand for secondary surgery is rising, partly for this reason, but through that study we try to discover the efficacy of conversion of failed sleeve gastrectomy to one anastomosis gastric bypass (OAGB) regarding weight loss and metabolic outcomes. Objective To asses the efficacy and safety of one anastomosis gastric bypass (OAGB) as a conversion surgery post Sleeve Gastrectomy failure as regard weight loss and metabolic outcomes. Patients and Methods This study is a retrospective cohort study which included 20 patients underwent one anastomosis gastric bypass at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric center, Cairo, Egypt From February 2019 to July 2019 with 6 months of postoperative follow up till January 2019. Results In this study, we reviewed and analyzed the outcomes from the revision of the SG due to either inadequate weight loss or weight regain to one anastomosis gastric bypass (OAGB) with %EBWL of 6.65% at 1 month, 13.61 % at 3 months and 20.86% at 6 months. Conclusion OAGB appears to be an effective and safe therapeutic technique as a revisional surgery for failed primary SG with good short-term results for treating morbid obesity and its associated comorbidities with a significantly low rate of complications. However the EBWL was less than what is reported after primary OAGB weight. Multicenter studies with larger series of patients and longer term follow up after SG revisions to OAGB are warranted.

scholarly journals Determinants of Adequate Response of Patient Undergoing Roux-en-y Gastric Bypass Surgery

2020 ◽  
Author(s):  
Thales Philipe Rodrigues Silva ◽  
Flávia Moraes Silva ◽  
Larissa Loures Mendes ◽  
Alexandra Dias Moreira D'assunção ◽  
Lauro Pinheiro Ferreira de Araujo ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Logistic Regression ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Inadequate Response ◽  
Post Surgery ◽  
Adequate Response ◽  
Follow Up Care

Abstract INTRODUCTION: Roux-en-Y gastric bypass surgery (RYGB) is known to induce, on average,60 to 75% excess body weight loss between 18 and 24 months post-surgery. However, several studies have shown weight regain after two years post-surgery, thus patients must have adequate follow-up in order to guarantee and/or maintain response to RYGB. AIM: To evaluate the determinants of adequate response in patients who underwent RYGB. METHODS: A longitudinal study with 193 adults who underwent RYGB between 2012 and 2014. Adequate response to RYGB was determined by Excess Weight Loss (%EWL). Logistic regression models were constructed to verify the degree of association between adequate response of patient after RYGB and determinants of variable risk based on estimate Odds Ratios (OR). RESULTS: RYGB improves Systemic arterial hypertension (SAH), Diabetes Mellitus (DM) and body mass index (BMI). From the multivariate logistic regression model, being female and not having SAH and DM reduce the chance of inadequate RYGB response. Regarding preoperative BMI, an increase in one unit of kg/m2 was associated with increased odds of inadequate response after RYGB. And patients who did not receive follow-up care with a psychologist or psychiatrist in the postoperative period presented higher odds of inadequate response to RYGB. CONCLUSION: The findings of this study contribute to the effective planning of interventions by multi-professional teams involved in RYGB, aimed at offering a better follow-up care focused mainly on post-surgery changes and adequate RYGB response.

scholarly journals Long-Term Effects of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Body Composition and Bone Mass Density

Obesity Facts ◽  
2020 ◽  
pp. 1-10
Author(s):  
Julian Bühler ◽  
Silvan Rast ◽  
Christoph Beglinger ◽  
Ralph Peterli ◽  
Thomas Peters ◽  
...  
Keyword(s):  
Vitamin D ◽  
Gastric Bypass ◽  
Body Composition ◽  
Sleeve Gastrectomy ◽  
Bone Mass ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Mass Density ◽  
Bone Mass Density

<b><i>Background:</i></b> Currently, the two most common bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Long-term data comparing the two interventions in terms of their effect on body composition and bone mass density (BMD) are scarce. <b><i>Objective:</i></b> The aim of this study was to assess body composition and BMD at least 5 years after LSG and LRYGB. <b><i>Setting:</i></b> Department of Endocrinology and Nutrition, St. Claraspital Basel and St. Clara Research Ltd., Basel, Switzerland. <b><i>Methods:</i></b>Bariatric patients at least 5 years after surgery (LSG or LRYGB) were recruited, and body composition and BMD were measured by means of dual-energy X-ray absorptiometry. Data from body composition before surgery were included in the analysis. Blood samples were taken for determination of plasma calcium, parathyroid hormone, vitamin D<sub>3</sub>, alkaline phosphatase, and C-terminal telopeptide, and the individual risk for osteoporotic fracture assessed by the Fracture Risk Assessment Tool score was calculated. After surgery, all patients received multivitamins, vitamin D<sub>3</sub>, and zinc. In addition, LRYGB patients were prescribed calcium. <b><i>Results:</i></b> A total of 142 patients were included, 72 LSG and 70 LRYGB, before surgery: median body mass index 43.1, median age 45.5 years, 62.7% females. Follow-up after a median of 6.7 years. For LRYGB, the percentage total weight loss at follow-up was 26.3% and for LSG 24.1% (<i>p</i> = 0.243). LRYGB led to a slightly lower fat percentage in body composition. At follow-up, 45% of both groups had a T score at the femoral neck below –1, indicating osteopenia. No clinically relevant difference in BMD was found between the groups. <b><i>Conclusions:</i></b>At 6.7 years after surgery, no difference in body composition and BMD between LRYGB and LSG was found. Deficiencies and bone loss remain an issue after both interventions and should be monitored.

scholarly journals Ist Diabetes heilbar durch bariatrische Chirurgie? – Mechanismen der Verbesserung der diabetischen Stoffwechsellage durch chirurgische Adipositastherapie –

2017 ◽  
Vol 12 (05) ◽  
pp. 372-385
Author(s):  
Matthias Weck
Keyword(s):  
Diabetes Mellitus ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Bariatrische Chirurgie ◽  
Diabetes Mellitus Typ 2 ◽  
Typ 2 Diabetes ◽  
Omega Loop ◽  
Bariatrische Operationen

In den letzten Jahren wurden die Ergebnisse randomisierter kontrollierter Studien publiziert, die im 5-Jahres-Verlauf die metabolischen Effekte der bariatrischen Chirurgie mit konventionellen Formen der Gewichtsreduktion vergleichen. Diese Studien zeigen unisono, dass die bariatrische Chirurgie hinsichtlich der Besserung der diabetischen Stoffwechsellage den konventionellen Behandlungsformen signifikant überlegen ist. Die Diabetesremissionsraten variieren abhängig von Ausgangsparametern, Operationsmethode und Follow-up-Dauer zwischen 95 und 23 %.Ist Diabetes heilbar durch bariatrische Chirurgie? Die klare Antwort muss lauten: Nein, aberInsofern ist die bariatrische Chirurgie in Form von Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG) und den neueren Verfahren wie Omega Loop Bypass („Mini-Bypass“) oder biliopankreatische Diversion (BPD) eine wirkungsvolle therapeutische Option in der Behandlung des Diabetes mellitus Typ 2 und verringert offenbar auch das Risiko des Auftretens von mikrovaskulären Diabetesfolgekomplikationen. Je früher im Krankheitsverlauf die bariatrische Chirurgie SSherangezogen wird, desto effektiver scheinen diese Verfahren zu sein.Welche der Operationen für Patienten mit Typ-2-Diabetes am besten geeignet ist, ist derzeit nicht definitiv entschieden. Der RYGB scheint etwas effektiver zu sein. Die Verfahren der bariatrischen Chirurgie gehören in das Spektrum der differenzialtherapeutischen Überlegungen insbesondere bei adipösen Patienten mit Typ-2-Diabetes mit einem BMI > 35 kg/m².Die Mechanismen der Verbesserung der diabetischen Stoffwechsellage durch bariatrische Operationen werden anhand der aktuellen Literatur detailliert beschrieben. Die Indikationen, Kontraindikationen, Komplikationen und Therapiealgorithmen der bariatrischen Chirurgie bei Typ-2-Diabetes sind in den entsprechenden Leitlinien ausführlich dargestellt und nicht Gegenstand dieser Publikation.

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