Laparoendoscopic Single-Site Bariatric Surgery: A Review of Single-Port Laparoscopic and Endoscopic Bariatric Treatments

강소현,박영석,안상훈,박도중,김형호 대한비만학회 2018 The Korean journal of obesity Vol.27 No.1

Bariatric surgery is an established and effective treatment, not only to combat morbid obesity, but also to address associated metabolic comorbidities. At this time, the cutoff for bariatric or metabolic surgery in terms of body mass index (BMI) is decreasing, making it more feasible for certain individuals to consider minimally invasive surgical options. Innovations in the technique have led to the application of laparoendoscopic single-site surgery (LESS) in the field of bariatrics, which uses a single or no incision in the performance of weight-reducing surgery. To date, there is no consensus regarding patient selection though most candidates for single-port bariatric surgery are female. Some doctors suggest that single-port bariatric surgery may not be recommended in patients with BMI of more than 50 kg/m2, height of more than 180 cm, and xiphoid–umbilicus distance of more than 20 cm. Sleeve gastrectomy (SG) is now the most widely performed bariatric surgery worldwide and single-port SG (SPSG) is already established as a routine procedure in various institutions. Current evidence shows that SPSG is less painful and demonstrates higher rates of patient satisfaction regarding the wound. SPSG is feasible and is recommendable in patients who meet certain criteria. Furthermore, endoscopic treatment modalities such as intragastric balloons and endoluminal malabsorptive devices are being developed to bridge the gap between medical and surgical treatments. Nevertheless, there is still insufficient evidence to prove the superiority of LESS bariatric surgery over conventional laparoscopic surgery. Large, well-designed prospective analyses are needed to determine the criteria for selecting patients suitable to undergo LESS bariatric surgery and to predict the procedure’s role in the growth of bariatric surgery.

Functional bowel disorders among bariatric surgery candidates before and after surgery: A prospective cohort study

Sharif Yassin,Noa Sori,Ophir Gilad,Mati Shnell,Relly Richer,Nir Bar,Yishai Ron,Nathaniel Aviv Cohen,Subhi Abu-Abeid,Danit Dayan,Shai Meron Eldar,Shira Zelber-Sagi,Sigal Fishman 소화기인터벤션의학회 2024 International journal of gastrointestinal interven Vol.13 No.1

Background: Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS), are common worldwide. Recently, increasingly many bariatric surgical procedures have been performed in response to rising obesity rates. However, data on the association between FBDs and bariatric surgery are scarce. We examined the prevalence of FBDs among candidates for bariatric surgery and prospectively investigated the association between FBDs and bariatric surgery. Methods: This prospective cohort study included 112 bariatric surgery candidates at the Tel Aviv Medical Center from 2019 to 2020. Before and after surgery, patients completed the Rome III questionnaire. Data regarding demographics, socioeconomic status, and gastrointestinal symptoms were recorded. The rates of FBDs—IBS, functional constipation (FC), functional diarrhea (FDi), and unspecified functional bowel disorder (UFBD)—were then compared from before surgery to 6 months after the procedure. Results: Of 112 candidates with obesity at baseline, 68 underwent surgery and completed the postoperative questionnaire. Overall, the respective prevalence rates of FBDs, IBS, FC, FDi, and UFBD were 37.5%, 2.7%, 17.9%, 5.4%, and 11.6%. Female sex and single status were particularly common among patients with FBDs, whereas divorced status was more frequent in the group without FBDs. However, these factors were not independently associated with FBD presence upon multivariable analysis. IBS was more prevalent after surgery than before (8.8% vs. 1.5%, P = 0.06), but FBDs in general did not share this trend (44.1% vs. 36.8%, P = 0.44). Conclusion: Bariatric surgery appears to increase the risk of developing IBS, while not impacting the overall risk of FBDs.

Thromboprophylaxis after bariatric surgery

Feras M. Almarshad,Mosaad Almegren,Turki Alshuaibi,Nadiah Alobaodi,Ali Almutawa,Hajer Basunbl,Farjah AlGahtani,Bader Al Rawahi 대한혈액학회 2020 Blood Research Vol.55 No.1

BackgroundVenous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pul-monary embolism (PE), is a known cause of morbidity and mortality after bariatric surgery. However, the data concerning appropriate thromboprophylaxis after bariatric surgery is uncertain. The objective of this study was to evaluate the efficacy and safety of extended duration thromboprophylaxis in post-bariatric surgery patients.MethodsWe conducted a retrospective study of consecutive patients who underwent bariatric sur-gery from November 2014 to October 2018 at King Fahad General Hospital in Jeddah, Saudi Arabia. All included patients were treated with extended duration thromboprophylaxis.ResultsWe identified 374 patients who underwent bariatric surgery during the study period. Of these, 312 patients (83%) were followed for at least 3 months. The most common type of surgery was a laparoscopic sleeve gastrectomy (N=357) and the median weight was 110 kg. The cumulative incidence of symptomatic postoperative VTE at 3 months was 0.64% (95% confidence interval, 0.20‒1.52). All events occurred after hospital discharge. The most commonly used pharmacological prophylaxis (91%) for VTE prevention after bariatric surgery was enoxaparin 40 mg subcutaneously twice daily for 10‒14 days after hospital discharge. There were no reported cases of bleeding or VTE related mortality after 3 months.ConclusionExtended thromboprophylaxis after bariatric surgery appears to be an effective and safe strategy for VTE prevention. Large prospective studies are needed to evaluate the optimal thromboprophylaxis regimen after bariatric surgery.

The Effect of Bariatric Surgery on Diabetic Retinopathy: Good, Bad, or Both?

Dora M. Gorman,Carel W. le Roux,Neil G. Docherty 대한당뇨병학회 2016 Diabetes and Metabolism Journal Vol.40 No.5

Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.

특집 -비만 : 비만/대사 수술이 체중 감소와 당뇨병 관해를 일으키는 기전

조영민 ( Young Min Cho ) 대한내과학회 2013 대한내과학회지 Vol.84 No.5

The greatest achievement in the treatment of obesity and diabetes would be the development of bariatric/metabolic surgery. At the beginning, bariatric surgeries were developed to simply reduce body weight in morbidly obese subjects. Before long, it was discovered that diabetes and other metabolic complications of obesity could be placed in remission. The remission rate of diabetes after bariatric surgery is strikingly high and, in the case of Roux-en-Y gastric bypass surgery, diabetes remission commonly occurs immediately after the surgery, when significant weight loss does not take place. Therefore, the concept of bariatric surgery has evolved into metabolic surgery. Physiologic changes in gastrointestinal endocrine system following the anatomical changes made by bariatric/metabolic surgery are regarded as the major mechanisms of weight loss and diabetes remission. In this regard, the foregut and hindgut hypotheses were suggested as the mechanisms associated with diabetes remission. With the advent of sleeve gastrectomy, which does not bypass the foregut (duodenum and proximal jejunum) but increases the secretion of glucagon-like peptide-1, the foregut hypothesis is currently under attack. However, a single mechanism is not enough to explain the metabolic effect of bariatric/metabolic surgery. Further studies are warranted to elucidate the mechanisms of metabolic improvements after bariatric/metabolic surgery. (Korean J Med 2013;84:629-639)

The improvement of quality of life in patients treated with bariatric surgery in Korea

Sung-Hee Oh,Hyun Jin Song,Jin-Won Kwon,Do-Joong Park,Yeon-Ji Lee,Hyejin Chun,Sunyoung Kim,Kyung-Won Shim 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.84 No.3

Purpose: Bariatric surgery is considered an efficient treatment for severe obesity, but postoperative complications and psychosocial problems may impact quality of life (QoL). Although QoL is an important aspect of bariatric surgery, few studies have evaluated the changes in QoL. We examined whether severely obese patients who had undergone bariatric surgery had better QoL compared with severely obese adults who had not undergone bariatric surgery in Korea. Methods: Data were obtained from 78 participants in two groups; bariatric surgery group (n = 53) and nonsurgery group (n = 25). EuroQoL-5D (EQ-5D), the impact of weight on quality of life-lite (IWQoL-lite) and the obesity-related psychosocial problem scale (OP-scale) were used to assess the improvement of QoL. Results: A total of 78 patients completed the QoL forms as part of their surgical consultation. In the EQ-5D, the changes of EQ-5D 3 level and EQ-5D visual analogue scale in the surgery group was 0.174 and 24.6 versus 0.017 and 17.8 in the nonsurgery group (P = 0.197 and P = 0.179). The changes of IWQoL-lite and OP-scale were significantly improved after bariatric surgery. In the IWQoL-lite, the mean changes in the surgery group was 33.4 versus 14.3 points in the nonsurgery group (P = 0.000). In the OP-scale, the mean changes in the surgery group patients scored 39.3 versus 9.0 points in the nonsurgery group (P = 0.000). Conclusion: We demonstrated significant improvement of QoL observed after bariatric surgery compared to nonsurgical procedure. The results of this comparative study favor bariatric surgery for the treatment of severe obesity.

A Novel Endoscopic Surgical Device for Gastric Volume Reduction Bariatric Surgery

김윤진,최혁순,김경남,김병곤,금보라,홍대희,전훈재,송용남 한국정밀공학회 2016 International Journal of Precision Engineering and Vol.17 No.4

Endoscopic bariatric surgeries have been widely studied to minimize surgical invasion to the patients and operation time. Although some of previous endoscopic bariatric devices have reported successful weight loss in animal and human models, operation time in these surgeries was too long for severely obese patients. We aimed to develop a new endoscopic bariatric surgery device that would complete an entire surgery in a short time and provide clinically effective stomach volume reductions. A new anchoring device and suction system were developed from our successive suturing system. Our surgery reduced the fundus area of the stomach by creating a loop of anchors. We performed endoscopic bariatric surgeries in 32 porcine stomachs. Significantly reduced stomach volumes were found following our new bariatric surgeries (before surgery: 999.53±642.39 mm3, after surgery: 703.13±445.48 mm3, Student’s t-test, p<0.05). Surgery durations were measured to be 14.23±3.01 min in 16 selected stomachs. The new device was tested in three live pigs, and all simulated surgical conditions were successfully completed without any technical difficulties. We successfully developed a new endoscopic device for bariatric surgery, and demonstrated 30% stomach volume reductions, which is comparable volume reductions in clinically proven devices.

Association between the Blautia/Bacteroides Ratio and Altered Body Mass Index after Bariatric Surgery

김윤홍,손두헌,김부경,김기현,서경원,정경원,박선자,임상현,김재현 대한내분비학회 2022 Endocrinology and metabolism Vol.37 No.3

Background: Current evidence support that the gut microbiota plays a potential role in obesity. Bariatric surgery can reduce excessweight and decrease the risk of life-threatening weight-related health problems and may also influence gut microbiota. In this study,we aimed to investigate the changes in gut microbiota before and after bariatric surgery and evaluate the association of the gut microbial shift and altered body mass index (BMI) after bariatric surgery. Methods: Between January 2019 and July 2020, stools from 58 patients scheduled for bariatric surgery were collected. Six monthsafter bariatric surgery, stools from 22 of these patients were re-collected, and the changes in gut microbiota before and after bariatricsurgery were evaluated. In addition, the differences in gut microbiota between patients with severe obesity (BMI >35 kg/m2, n=42)and healthy volunteers with normal BMI (18.8 to 22.8 kg/m2, n=41) were investigated. Results: The gut microbiota of patients who underwent bariatric surgery showed increased α-diversity and differed β-diversity compared with those before surgery. Interestingly, Blautia was decreased and Bacteriodes was increased at the genus level after bariatricsurgery. Further, the Blautia/Bacteroides ratio showed a positive correlation with BMI. To validate these results, we compared thegut microbiota from severely obese patients with high BMI with those from healthy volunteers and demonstrated that the Blautia/Bacteroides ratio correlated positively with BMI. Conclusion: In the gut microbial analysis of patients who underwent bariatric surgery, we presented that the Blautia/Bacteroides ratio had changed after bariatric surgery and showed a positive correlation with BMI.

Survey of Information Acquisition and Satisfaction after Bariatric Surgery at a Tertiary Hospital in Korea

오슬기,정성아,고창석,민사홍,공충식,이인섭,김범수,육정환,유문원 대한비만학회 2024 Journal of obesity & metabolic syndrome Vol.33 No.1

Background: To determine how patients who underwent bariatric surgery at a tertiary hospital in Korea first considered and then decided to get the surgery and identify information gaps among patients and healthcare professionals. Methods: This study included 21 patients who underwent bariatric surgery to treat morbid obesity (body mass index [BMI] ≥35 or ≥30 kg/m2 together with obesity-related comorbidities) between August 2020 and February 2022. A telephone interview was conducted with the patients after at least 6 months had elapsed since the surgery. We asked how the patients decided to undergo bariatric surgery. We also inquired about their satisfaction with and concerns about the surgery. Results: Seventy-one percent of the patients were introduced to bariatric surgery following a recommendation from healthcare professionals, acquaintances, or social media. Most of the patients (52%) decided to undergo bariatric surgery based on recommendations from healthcare professionals in non-surgical departments. Satisfaction with the information provided differed among the patients. Post-surgical concerns were related to postoperative symptoms, weight regain, and psychological illness. Conclusion: Efforts are needed to raise awareness about bariatric surgery among healthcare professionals and the public. Tailored pre- and postoperative consultation may improve quality of life after bariatric surgery.

Metabolic and Bariatric Surgery Accreditation Program and National Health Insurance System in Korea

유한모,이상권,김종한 대한내시경복강경외과학회 2019 Journal of Minimally Invasive Surgery Vol.22 No.3

Since the first laparoscopic bariatric surgery in Korea introduced in January 2003, the number of metabolic and bariatric surgery has been steadily increasing. According to the report from National Health Insurance big data analysis, the prevalence of morbid and super obesity has greatly increased and metabolic and bariatric surgery also increased in the last 10 years. As the incidence of morbid obesity is more frequent in people of poor socioeconomic status, the need for a reimbursement by the government seemed to be necessary. Finally, the national health insurance system decided to financially cover metabolic and bariatric surgery from January 2019. In order to improve the safety and qualify of metabolic and bariatric surgery, the Korean Society for Bariatric and Metabolic Surgery (KSMBS) introduced surgeon’s and institution’s accreditation system. The authors intend to introduce comprehensive overview of accreditation system of bariatric surgery and discuss the contents of national health insurance for metabolic and bariatric surgery.