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Surgery Today
Published in: Surgery Today 8/2014

01-08-2014 | Original Article

Early and long-term clinical outcomes of bilio-intestinal diversion in morbidly obese patients

Authors: Alessandro De Cesare, Barbara Cangemi, Enrico Fiori, Marco Bononi, Roberto Cangemi, Luigi Basso

Published in: Surgery Today | Issue 8/2014

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Abstract

Purpose

To evaluate the early and long-term postoperative results of malabsorptive surgery in morbidly obese patients.

Methods

Between 2000 and 2007, 102 morbidly obese patients were referred to the Department of Surgery “Pietro Valdoni”, “Sapienza” University of Rome, Policlinico “Umberto I°”, Rome, Italy for malabsorptive surgery. All patients underwent derivative biliodigestive surgery after they had been reviewed by a team of surgeons, physicians, dieticians, and psychologists.

Results

There were no intra-operative complications, but two patients suffered postoperative pulmonary embolisms, which resolved with medical treatment. The mean postoperative hospital stay was 7 days, with no early or late mortality. Maximum weight loss was reached 12–24 months after surgery, while the mean percentage excess weight loss at 3–5 years ranged from 45 to 64 %. Specific postoperative complications in the first 2 years after surgery were abdominal abscess (n = 2), gastroduodenal reflux (n = 4), and incisional hernia (n = 6). Diabetes resolved in 98 % of the diabetic patients within a few weeks after surgery and blood pressure normalised in 86.4 % of those who had had hypertension preoperatively. Obstructive sleep apnoea and obesity hypoventilation syndrome also improved significantly in 92 % of the patients.

Conclusions

Morbidly obese patients can undergo biliodigestive surgery safely with good long-term weight loss and quality of life expectancy.
Literature
1.
2.
Ogden CL, Yanovski SZ, Carroll MD, Flegal KM. The epidemiology of obesity. Gastroenterology. 2007;132:2087–102.PubMedCrossRef
3.
4.
Meinders AE, Fogteloo J. Overweight and obesity; recommendations from the National Health Council (in Dutch). Ned Tijdschr Geneeskd. 2003;147:1847–51.PubMed
5.
Calza S, Decarli A, Ferraroni M. Obesity and prevalence of chronic diseases in the 1999–2000 Italian National Health Survey. BMC Public Health. 2008;8:140.PubMedCentralPubMedCrossRef
6.
Gallus S, Colombo P, Scarpino V, Zuccaro P, Negri E, Apolone G, et al. Overweight and obesity in Italian adults 2004, and an overview of trends since 1983. Eur J Clin Nutr. 2006;60:1174–9.PubMedCrossRef
7.
Li R, Lu W, Jia J, Zhang S, Shi L, Li Y, Yang Q, Kan H. Relationships between indices of obesity and its cardiovascular comorbidities in a Chinese population. Circ J. 2008;72:973–8.PubMedCrossRef
8.
Wolk R, Shamsuzzaman AS, Somers VK. Obesity, sleep apnea, and hypertension. Hypertension. 2003;42:1067–74.PubMedCrossRef
9.
Nobuoka D, Gotohda N, Kato Y, Takahashi S, Konishi M, Kinoshita T. Influence of excess body weight on the surgical outcomes of total gastrectomy. Surg Today. 2011;41:928–34.PubMedCrossRef
10.
11.
Waseem T, Mogensen KM, Lautz DB, Robinson MK. Pathophysiology of obesity: why surgery remains the most effective treatment. Obes Surg. 2007;17:1389–98.PubMedCrossRef
12.
Bult MJ, van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol. 2008;158:135–45.PubMedCrossRef
13.
Terranova L, Busetto L, Vestri A, Zappa MA. Bariatric surgery: cost-effectiveness and budget impact. Obes Surg. 2012;22:646–53.PubMedCrossRef
14.
Sebastian JL. Bariatric surgery and work-up of the massive weight loss patient. Clin Plast Surg. 2008;35:11–26.PubMedCrossRef
15.
Oria HE, Carrasquilla C, Cunningham P, Hess DS, Johnell P, Kligman MD, Moorehead MK, Papadia FS, Renquist KE, Rosenthal R, Stellato TA, American Society for Bariatric Surgery Standards Committee, 2004–2005. Guidelines for weight calculations and follow-up in bariatric surgery. Surg Obes Relat Dis. 2005;1:67–8.PubMedCrossRef
16.
Perry CD, Hutter MM, Smith DB, Newhouse JP, McNeil BJ. Survival and changes in comorbidities after bariatric surgery. Ann Surg. 2008;247:21–7.PubMedCrossRef
17.
18.
Gracia JA, Martínez M, Elia M, Aguilella V, Royo P, Jiménez A, et al. Obesity surgery results depending on technique performed: long-term outcome. Obes Surg. 2009;19:432–8.PubMedCrossRef
19.
Lee CW, Kelly JJ, Wassef WY. Complications of bariatric surgery. Curr Opin Gastroenterol. 2007;23:636–43.PubMed
20.
Palmer B, Hallberg D, Backman L. Skin reduction plasties following intestinal shunt operations for treatment of obesity. Scand J Plast Reconstr Surg. 1975;9:47–52.PubMedCrossRef
21.
Galati G, Izzo L, Binda B, De Cesare A, Fiori E, Bononi M, et al. Biliary-intestinal bypass in the treatment of severe obesity: personal experience with 23 patients (in Italian). Minerva Chir. 2001;56:345–9.PubMed
22.
Algahim MF, Sen S, Taegtmeyer H. Bariatric surgery to unload the stressed heart: a metabolic hypothesis. Am J Physiol Heart Circ Physiol. 2012;302:H1539–45.PubMedCentralPubMedCrossRef
23.
Fritscher LG, Mottin CC, Canani S, Chatkin JM. Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Obes Surg. 2007;17:95–9.PubMedCrossRef
24.
Kaul A, Sharma J. Impact of bariatric surgery on comorbidities. Surg Clin North Am. 2011;91:1295–312.PubMedCrossRef
25.
Pontiroli AE. Surgical treatment of obesity: impact on diabetes and other comorbidities. Nutr Metab Cardiovasc Dis. 2008;18:1–6.PubMedCrossRef
26.
Stroh C, Birk D, Flade-Kuthe R, et al. A nationwide survey on bariatric surgery in Germany—results 2005–2007. Obes Surg. 2009;19:105–12.PubMedCrossRef
27.
Livingston EH, Arterburn D, Schifftner TL, Henderson WG, DePalma RG. National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. J Am Coll Surg. 2006;203:625–33.PubMedCrossRef
28.
Livingston EH. Development of bariatric surgery-specific risk assessment tool. Surg Obes Relat Dis. 2007;3:14–20.PubMedCrossRef
29.
Catheline J-M, Bihan H, Quang T, Sadoun D, Charniot J-C, Onnen I, Fournier J-L, Bénichou J, Cohen R. Preoperative cardiac and pulmonary assessment in bariatric surgery. Obes Surg. 2008;18:271–7.PubMedCrossRef
30.
Fazylov RM, Savel RH, Horovitz JH, Pagala MK, Coppa GF, Nicastro J, et al. Association of super–super-obesity and male gender with elevated mortality in patients undergoing the duodenal switch procedure. Obes Surg. 2005;15:618–23.PubMedCrossRef
31.
Heinzer R. Obstructive sleep apnea: a risk for general anesthesia? (in French). Rev Med Suisse. 2007;3:2670–4.PubMed
32.
Melissas J. IFSO guidelines for safety, quality, and excellence in bariatric surgery. Obes Surg. 2008;18:497–500.PubMedCrossRef
33.
Dunkle-Blatter SE, St Jean MR, Whitehead C, 3rd Strodel W, Bennotti PN, Still C, et al. Outcomes among elderly bariatric patients at a high-volume center. Surg Obes Relat Dis. 2007;3:163–9.PubMedCrossRef
34.
Leykin Y, Pellis T, Del Mestro E, Fanti G, Marzano B. Perioperative management of 195 consecutive bariatric patients. Eur J Anaesthesiol. 2008;25:168–70.PubMedCrossRef
35.
Poirier P, Alpert MA, Fleisher LA, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the american heart association. Circulation. 2009;120:86–95.PubMedCrossRef
36.
Virji A, Murr MM. Caring for patients after bariatric surgery. Am Fam Physician. 2006;73:1403–8.PubMed
37.
Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach. Obesity (Silver Spring). 2006;14(Suppl 2):53S–62S.CrossRef
38.
Lee YH, Johan A, Wong KK, Edwards N, Sullivan C. Prevalence and risk factors for obstructive sleep apnoea in a multiethnic population of patients presenting for bariatric surgery in Singapore. Sleep Med. 2009;10:226–32.PubMedCrossRef
39.
McCloskey CA, Ramani GV, Mathier MA, Schauer PR, Eid GM, Mattar SG, et al. Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy. Surg Obes Relat Dis. 2007;3:503–7.PubMedCrossRef
40.
Requarth JA, Burchard KW, Colacchio TA, Stukel TA, Mott LA, Greenberg ER, et al. Long-term morbidity following jejunoileal bypass. The continuing potential need for surgical reversal. Arch Surg. 1995;130:318–25.PubMedCrossRef
41.
42.
Biertho L, Lebel S, Marceau S, Hould FS, Lescelleur O, Moustarah F, et al. Perioperative complications in a consecutive series of 1000 duodenal switches. Surg Obes Relat Dis. 2013;9:63–8.PubMedCrossRef
43.
Decker GA, Swain JM, Crowell MD, Scolapio JS. Gastrointestinal and nutritional complications after bariatric surgery. Am J Gastroenterol. 2007;102:2571–80.PubMedCrossRef
44.
Ellison SR, Ellison SD. Bariatric surgery: a review of the available procedures and complications for the emergency physician. J Emerg Med. 2008;34:21–32.PubMedCrossRef
45.
Livingston EH. Obesity, mortality, and bariatric surgery death rates (commentary). JAMA. 2007;298:2406–8.PubMedCrossRef
46.
Masoomi H, Buchberg B, Reavis KM, Mills SD, Stamos M, Nguyen NT. Factors predictive of venous thromboembolism in bariatric surgery. Am Surg. 2011;77:1403–6.PubMed
47.
Stephens DJ, Saunders JK, Belsley S, et al. Short-term outcomes for super–super obese (BMI > or = 60 kg/m2) patients undergoing weight loss surgery at a high-volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and open tubular gastric bypass. Surg Obes Relat Dis. 2008;4:408–15.PubMedCrossRef
48.
Mahony D. Psychological gender differences in bariatric surgery candidates. Obes Surg. 2008;18:607–10.PubMedCrossRef
49.
Kardys CM, Stoner MC, Manwaring ML, Barker M, Macdonald KG, Pender JR, et al. Safety and efficacy of intravascular ultrasound-guided inferior vena cava filter in super obese bariatric patients. Surg Obes Relat Dis. 2008;4:50–4.PubMedCrossRef
50.
Obeid FN, Bowling WM, Fike JS, Durant JA. Efficacy of prophylactic inferior vena cava filter placement in bariatric surgery. Surg Obes Relat Dis. 2007;3:606–8.PubMedCrossRef
51.
52.
Sarwer DB, Dilks RJ, West-Smith L. Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. Surg Obes Relat Dis. 2011;7:644–51.PubMedCrossRef
53.
Swanson CM, Roust LR, Miller K, Madura JA 2nd. What every hospitalist should know about the post-bariatric surgery patient. J Hosp Med. 2012;7:156–63.PubMedCrossRef
54.
Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;17:1150–8.PubMedCrossRef
55.
Gumbs AA, Pomp A, Gagner M. Revisional bariatric surgery for inadequate weight loss. Obes Surg. 2007;17:1137–45.PubMedCrossRef
56.
Lass A. Life after bariatric surgery. Adv Nurse Pract. 2008;16(47–8):50–1.
57.
Schweitzer DH. Mineral metabolism and bone disease after bariatric surgery and ways to optimize bone health. Obes Surg. 2007;17:1510–6.PubMedCrossRef
58.
Puzziferri N. Psychologic issues in bariatric surgery—the surgeon’s perspective. Surg Clin North Am. 2005;85:741–55.PubMedCrossRef
59.
Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Eng J Med. 2007;357:753–61.CrossRef
60.
Vogel JA, Franklin BA, Zalesin KC, Trivax JE, Krause KR, Chengelis DL, et al. Reduction in predicted coronary heart disease risk after substantial weight reduction after bariatric surgery. Am J Cardiol. 2007;99:222–6.PubMedCrossRef
61.
Zavorsky GS, do Kim J, Christou NV. Compensatory exercise hyperventilation is restored in the morbidly obese after bariatric surgery. Obes Surg. 2008;18:549–59.PubMedCrossRef
62.
Doucet E. Gastrointestinal peptides after bariatric surgery and appetite control: are they in tuning? Curr Opin Clin Nutr Metab Care. 2008;11:645–50.PubMedCrossRef
63.
Gagliardi L, Wittert G. Management of obesity in patients with type 2 diabetes mellitus. Curr Diabetes Rev. 2007;3:95–101.PubMedCrossRef
64.
Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care. 2008;31(Suppl 2):S290–6.PubMedCrossRef
65.
Gletsu-Miller N, Hansen JM, Jones DP, Go YM, Torres WE, Ziegler TR, et al. Loss of total and visceral adipose tissue mass predicts decreases in oxidative stress after weight-loss surgery. Obesity (Silver Spring). 2009;17:439–46.CrossRef
66.
Aricha-Tamir B, Weintraub AY, Levi I, Sheiner E. Downsizing pregnancy complications: a study of paired pregnancy outcomes before and after bariatric surgery. Surg Obes Relat Dis. 2012;8:434–9.PubMedCrossRef
67.
Karmon A, Sheiner E. Pregnancy after bariatric surgery: a comprehensive review. Arch Gynecol Obstet. 2008;277:381–8.PubMedCrossRef
68.
Sussenbach SP, Padoin AV, Silva EN, Benzano D, Pufal MA, Barhouch AS, et al. Economic benefits of bariatric surgery. Obes Surg. 2012;22:266–70.PubMedCrossRef
69.
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. New Eng J Med. 2007;357:741–52.PubMedCrossRef
Metadata
Title
Early and long-term clinical outcomes of bilio-intestinal diversion in morbidly obese patients
Authors
Alessandro De Cesare
Barbara Cangemi
Enrico Fiori
Marco Bononi
Roberto Cangemi
Luigi Basso
Publication date
01-08-2014
Publisher
Springer Japan
Published in
Surgery Today / Issue 8/2014
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-014-0856-x

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