Obesity surgery
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Bariatric surgery was developed with the aim of weight reduction. Success was defined only by excess weight loss. Other indices of resolution of metabolic comorbidities were reported, but were mostly secondary. ⋯ Medical treatment is evolving, but is expensive and not risk-free. Surgery aimed mainly at diseases such as diabetes and not weight loss are referred to as "metabolic surgery." Metabolic surgery has been proven to be safe and effective, and although more data are needed, it is unquestionable that a new discipline has been founded. Metabolic surgery can effectively treat T2DM in individuals with any BMI, including that below 35 kg/m(2).
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Review
Metabolic surgery for type 2 diabetes with BMI <35 kg/m(2) : an endocrinologist's perspective.
Is bariatric surgery as primary therapy for type 2 diabetes mellitus (T2DM) with body mass index (BMI) <35 kg/m(2) justified? Open-label studies have shown that bariatric surgery causes remission of diabetes in some patients with BMI <35 kg/m(2). All such patients treated had substantial weight loss. ⋯ Deficiencies of data are lack of randomized long-term studies comparing risk/benefit of bariatric surgery to contemporary intensive medical therapy. Current data do not justify bariatric surgery as primary therapy for T2DM with BMI <35 kg/m(2).
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There is a strong relationship between obesity and the development of obstructive sleep apnea (OSA). Respectively, bariatric surgery is often touted as the most effective option for treating obesity and its comorbidities, including OSA. Nevertheless, there remains paucity of data in the literature of the comparison of all the specific types of bariatric surgery themselves. ⋯ All the procedures achieved profound effects on OSA, as over 75 % of patients saw at least an improvement in their sleep apnea. BPD was the most successful procedure in improving or resolving OSA, with laparoscopic adjustable gastric banding being the least. In conclusion, bariatric surgery is a definitive treatment for obstructive sleep apnea, regardless of the specific type.
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Review Comparative Study
Maternal and neonatal outcome after laparoscopic adjustable gastric banding: a systematic review.
The number of women of reproductive age undergoing bariatric surgery, including laparoscopic adjustable gastric banding (LAGB), has increased in recent years. The objective of this study was to list both maternal and neonatal outcomes in pregnancies in obese women (BMI ≥ 30 kg/m(2)) after LAGB and compare them with pregnancies in obese or normal weight women without LAGB. Studies showed a lower incidence of gestational diabetes, pregnancy-induced hypertension (PIH), pre-eclampsia, caesarean section (CS), macrosomia, and low birth weight babies in post-LAGB pregnancies compared to pregnancies in obese women without LAGB. ⋯ However, the incidence of PIH, pre-eclampsia, CS, preterm birth, large for gestational age, spontaneous abortion, and NICU admission was higher in post-LAGB pregnancies than in normal weight pregnancies. In conclusion, LAGB seems to improve pregnancy outcomes in obese women, even when obesity is still present at the onset of pregnancy. However, further research is needed and pregnant women with a gastric band should always be closely monitored by a multidisciplinary team.
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Review Meta Analysis
Bariatric surgery is effective and safe in patients over 55: a systematic review and meta-analysis.
Effective weight loss and reduction in comorbidities has been convincingly demonstrated with bariatric surgery. Concerns regarding increased perioperative complications and poor results have led to a reluctance to offer such surgery to older patients. We performed a systematic review and meta-analysis of the published evidence for those in the ≥55-year age group. ⋯ Meta-analysis of old versus young patients revealed better comorbidity and mortality outcomes for younger patients. Bariatric surgery for patients ≥55 years achieves weight loss and reduction in comorbidities and mortality comparable to the general bariatric surgery population. Based on the above findings, patients should not be denied bariatric surgery on the basis of age alone.