August 2013 Issue
Volume and Outcome Relationship in Bariatric Surgery in the Laparoscopic Era
A new study published online in Surgical Endoscopy (August 13), found in-hospital mortality was higher at low volume centers (LVCs) (0.17%) than at high volume centers (HVCs) (0.07 %). Multivariate analysis showed that laparoscopic stapling procedures performed at LVCs had higher rates of mortality than those performed at HVCs, as well as higher rates of serious morbidity (OR 1.2; 95% CI 1.1–1.4; p\0.01). The in-hospital mortality rate at nonaccredited HVCs was 0.22% compared with 0.06% at accredited HVCs. Multivariate analysis showed that nonaccredited centers had higher rates of mortality than accredited centers (OR 3.6; 95% CI 1.5–8.3; p\0.01) but lower rates of serious morbidity (OR 0.8; 95% CI 0.7–0.9;p\0.01). The study concludes: “In this era of laparoscopy, hospitals managing more than 50 laparoscopic stapling cases per year have improved outcomes. However, nonaccredited HVCs have outcomes similar to those of LVCs. Therefore, the impact of accreditation on outcomes may be greater than that of volume.”
Reprogramming of Intestinal Glucose Metabolism and Glycemic Control in Rats After Gastric Bypass
A new study published in the July issue of Science, found a reprogramming of intestinal glucose metabolism in rats after Roux-en-Y gastric bypass (RYGB) to meet increased bioenergetic demands. Researchers show that reprogramming of intestinal glucose metabolism is triggered by the exposure of the Roux limb to undigested nutrients. The findings may explain why gastric bypass may sometimes result in early resolution of type 2 diabetes. The study was conducted by researchers from Boston Children’s Hospital.
DNA Methylation Analysis in Nonalcoholic Fatty Liver Disease Suggests Distinct Disease-Specific and Remodeling Signatures After Bariatric Surgery
A study, published in the August 6 edition of Cell Metabolism, found bariatric surgery may reverse the symptoms of non-alcoholic fatty liver disease (NAFLD) by altering DNA. Researchers analyzed liver samples from 27 obese individuals with different stages of NAFLD, 18 healthy obese individuals without liver disease, and 18 normal-weight individuals without liver disease. Methylation—a chemical modification on DNA that regulates gene expression—was altered on various genes in patients with NAFLD. Researchers found that when they compared patients' liver biopsies before and after weight loss surgery, the NAFLD-associated methylation changes were partially reversible. “These DNA modifications may point to the first steps in the evolution of the disease and may thus direct future research,” says senior author Dr. Hampe of University Hospital Dresden, Germany. “In the very long term, they may lead to new therapeutic options.”
Fracture Risk Following Bariatric Surgery: A Population-based Study
Bariatric surgery patients may have an increased risk of a fracture compared to the general population, according to a study published in the August 3 edition of Osteoporosis International. Gastric bypass surgery was performed in 94 percent of cases and median follow-up was 7.7 years. Relative risk for any fracture was increased over twofold and was elevated for a first fracture at the hip, spine, wrist, or humerus, as well as for a first fracture at any other site (SIR, 2.5; 95% CI, 2.0-3.2). Better preoperative activity status was associated with a lower age-adjusted risk, while prior fracture history was not associated with postoperative fracture risk. Johns Hopkins Hospital researchers concluded “while further studies of fracture risk are needed, bariatric surgery clinics need to discuss bone health with their patients.”
Laparoscopic Gastric Plication Versus Mini-Gastric Bypass Surgery in the Treatment of Morbid Obesity: A Randomized Clinical Trial
A randomized clinical trial out of a university hospital in Iran showed laparoscopic gastric plication (LGP) is “a simpler and less costly procedure compared to laparoscopic mini-gastric bypass (LMGB), with a lower risk of iron deficiency during a 1-year follow-up study.” The 40-patient study was published online in SOARD (July 26). Operative time and mean length of hospitalization were shorter in LGP group (71.0 versus 125.0 minutes; p< 0.001) and (1.6 versus 5.2 day; p< 0.001), respectively. The mean percent of excess weight loss (%EWL) at 12 months follow-up was 66.9% in LMGB group and 60.8% in LGP group (p= 0.34). Researchers noted LGP saved at least 2,500 dollars per case compared to LMGB.
Five-Year Results of Laparoscopic Sleeve Gastrectomy
According to a retrospective study published online in SOARD (July 12), laparoscopic sleeve gastrectomy (LSG) was “effective 5.9 years postoperatively with an excessive BMI loss of almost 60% and a considerable improvement or even remission of co-morbidities.”---------------------------------------------------------------------------------------------------------------------------------------------
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