Introduction: Vertical banded gastroplasty (VBG) is associated with high weight regain; Roux-en-Y gastric bypass (RYGB) is used as a revision procedure in patients with VBG experiencing weight... Show moreIntroduction: Vertical banded gastroplasty (VBG) is associated with high weight regain; Roux-en-Y gastric bypass (RYGB) is used as a revision procedure in patients with VBG experiencing weight regain. This study compared the 5-year follow-up outcomes of primary (PRYGB) and revision RYGB after VBG (RRYGB). Methods: Patients who underwent PRYGB or RRYGB after VBG from 2008 to 2016 were enrolled. Data on weight regain, weight loss (WL), food tolerance (FT), early and late complications, and resolution or improvement in associated medical conditions were analyzed.Results: PRYGB and RRYGB groups had 558 and 156 patients, respectively, after exclusion of the lost to follow-up patients. PRYGB group showed significantly lower mean body mass index (over the entire follow-up period), early complications, reintervention rates for late complications, and overall reintervention rates than that of the RRYGB group. On the other hand, FT scores, odds of late complications, and improvements (in the fifth year) in associated medical conditions were comparable between the two groups. Conclusion: RRYGB in patients with VBG who regained weight showed comparable safety and resolution of associated diseases to that of PRYGB over the 5-year follow-up period. The WL in the RRYGB group was acceptable despite being less than that of the PRYGB group. FT was better after RRYGB than that of PRYGB in the first year; however, both were comparable at the fifth year follow-up. Patients with VBG undergoing RYGB should receive attentive treatment and evaluation of associated factors. Show less
Hart, J.W.H. 't; Leeman, M.; Mourik, B.C.; Pouw, N.; Biter, L.U.; Apers, J.A.; ... ; Dunkelgruen, M. 2021
Background: In metabolic-bariatric fast-track surgery, patients are scheduled for discharge on postoperative day 1. The neutrophil-to-lymphocyte ratio (NLR) could be an inexpensive and rapid way to... Show moreBackground: In metabolic-bariatric fast-track surgery, patients are scheduled for discharge on postoperative day 1. The neutrophil-to-lymphocyte ratio (NLR) could be an inexpensive and rapid way to identify patients at risk of early complications. This study aimed to determine the predictive value of the NLR on early complications.Methods: Prospective data were collected of all patients undergoing primary metabolic surgery in a single center, between April 2018 and April 2019. The association between NLR, leukocyte count, hemoglobin, and C-reactive protein (CRP) was compared with early complications.Results: In total, 829 patients underwent primary metabolic surgery: 336 (40.5%) Roux-en-Y gastric bypass, 410 (49.5%) sleeve gastrectomy, and 83 (10.0%) one anastomosis gastric bypass. Major complications occurred in 34 (4.1%) patients, who had significantly higher levels of postoperative NLR (p < 0.001), delta-NLR (p < 0.001), leukocyte count (p < 0.001), and CRP (p = 0.008). The ideal cutoff points to predict complications after metabolic surgery were 6.73 for postoperative NLR (sensitivity 74% and specificity 70%) and 4.68 for delta-NLR (sensitivity 77% and specificity 75%).Conclusion: Postoperative NLR and delta-NLR were independently associated with early major complications after metabolic surgery. These markers may be useful to help identify patients who are at risk for complications, and can aid in the decision making for safe postoperative discharge on day 1 or early intervention. Show less
Akpinar, E.O.; Liem, R.S.L.; Nienhuijs, S.W.; Greve, J.W.M.; Marang-van de Mheen, P.J.; Dutch Audit Treatment Obesity Res 2021
Background: Bariatric surgery among patients with obesity and type 2 diabetes (T2D) can induce complete remission. However, it remains unclear whether sleeve gastrectomy (SG) or Roux-en-Y gastric... Show moreBackground: Bariatric surgery among patients with obesity and type 2 diabetes (T2D) can induce complete remission. However, it remains unclear whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) has better T2D remission within a population-based daily practice.Objectives: To compare patients undergoing RYGB and SG on the extent of T2D remission at the 1-year follow-up.Setting: Nationwide, population-based study including all 18 hospitals in the Netherlands providing metabolic and bariatric surgery.Methods: Patients undergoing RYGB and SG between October 2015 and October 2018 with 1 year of complete follow-up data were selected from the mandatory nationwide Dutch Audit for Treatment of Obesity (DATO). The primary outcome is T2D remission within 1 year. Secondary outcomes include >= 20% total weight loss (TWL), obesity-related co-morbidity reduction, and postoperative complications with a Clavien-Dindo (CD) grade >= III within 30 days. We compared T2D remission between RYGB and SG groups using propensity score matching to adjust for confounding by indication.Results: A total of 5015 patients were identified from the DATO, and 4132 (82.4%) had completed a 1-year follow-up visit. There were 3350 (66.8%) patients with a valid T2D status who were included in the analysis (RYGB = 2623; SG = 727). RYGB patients had a lower body mass index than SG patients, but were more often female, with higher gastroesophageal reflux disease and dyslipidemia rates. After adjusting for these confounders, RYGB patients had increased odds of achieving T2D remission (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.14-2.1; P<.01). Groups were balanced after matching 695 patients in each group. After matching, RYGB patients still had better odds of T2D remission (OR, 1.91; 95% CI, 1.27-2.88; P<.01). Also, significantly more RYGB patients had >= 20%TWL (OR, 2.71; 95% CI, 1.96-3.75; P<.01) and RYGB patients had higher dyslipidemia remission rates (OR, 1.96; 95% CI, 1.39-2.76; P<.01). There were no significant differences in CD >= III complications.Conclusion: Using population-based data from the Netherlands, this study shows that RYGB leads to better T2D remission rates at the 1-year follow-up and better metabolic outcomes for patients with obesity and T2D undergoing bariatric surgery in daily practice. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. Show less
Background Current studies mainly focus on total weight loss and comorbidity reduction. Only a few studies compare Quality of Life (QoL) after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass ... Show moreBackground Current studies mainly focus on total weight loss and comorbidity reduction. Only a few studies compare Quality of Life (QoL) after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). This study was conducted to examine the extent of improvement in QoL on different domains after primary bariatric surgery and compare these results to Dutch reference values. Methods The study included prospectively collected data from patients who underwent primary bariatric surgery in five Dutch hospitals. The RAND-36 questionnaire was used to measure the patient's QoL; preoperatively and twelve months postoperatively. Postoperative scores were compared to Dutch reference values, standardized for age, using t-test. A difference of more than 5% was considered a minimal important difference. A multivariate linear regression analysis was used to compare SG and RYGB on the extent of improvement, adjusted for case-mix factors. Results In total, 4864 patients completed both the pre- and postoperative questionnaire. Compared with Dutch reference values, patients postoperatively reported clinically relevant better physical functioning (RYGB + 6.8%), physical role limitations (SG + 5.6%; RYGB + 6.2%) and health change (SG + 77.1%; RYGB + 80.0%), but worse general health perception (SG - 22.8%; RYGB - 17.0%). Improvement in QoL was similar between SG and RYGB, except for physical functioning (beta 2.758; p-value 0.008) and general health perception (beta 2.607; p-value < 0.001) for which RYGB patients improved more. Conclusions SG and RYGB patients achieved a better postoperative score in physical functioning, physical role limitations and health change compared to Dutch reference values, and a worse score in general health perception. Show less
