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Flashcards in obesity Deck (13)
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1

the two most common weightloss procedures

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are two most common weight loss procedures.

2

how does RYGB and sleev gastrectomy compare in excess weight loss over time?

No significant difference was found in %EWL during about 1 year follow-up , but after that, LRYGB achieved higher %EWL than LSG

3

how does RYGB and sleev gastrectomy compare in resolution of comorbidities?

Except for type 2 diabetes mellitus (T2DM) (P<0.001), the difference between these two procedures in the resolution or improvement rate of other comorbidities did not reach a statistical significance

4

Overall, in terms of safety and efficacy, how does RYGB and seelve gastrectomy compare?

. In conclusion, LRYGB is superior to LSG in efficacy but inferior to LSG in safety.

5

bariatric surgery results in resolution of what comorbidities?

resolution of major comorbidities including
type 2 diabetes mellitus,
hypertension,
dyslipidemia,
metabolic syndrome,
non-alcoholic fatty liver disease,
nephropathy,
left ventricular hypertrophy
obstructive sleep apnea
in the majority of morbidly obese patients

6

RYGB compared to adjuctable gastric banding and resolution of comorbidities? efficacy and safety

aparoscopic Roux-en-Y gastric bypass (LRYGB) appears to be more effective than laparoscopic adjustable gastric banding (LAGB) in terms of weight loss and resolution of comorbidities. Operation-associated mortality rates after bariatric surgery are low and LAGB is safer than LRYGB.

7

is bariatric surgery safe in the morbidly obese?

In morbidly obese patients bariatric surgery is safe and appears to reduce cardiovascular morbidity and mortality.

8

COCHRANE 2014 on weight loss interventions:

Surgery results in greater improvement in weight loss outcomes and weight associated comorbidities compared with non-surgical interventions, regardless of the type of procedures used.
When compared with each other, certain procedures resulted in greater weight loss and improvements in comorbidities than others.

Outcomes were similar between RYGB and sleeve gastrectomy,
both of these procedures had better outcomes than adjustable gastric banding.


Across all studies adverse event rates and reoperation rates were generally poorly reported.
Most trials followed participants for only one or two years, therefore the long-term effects of surgery remain unclear.

9

bariatric surgery, especially RYGB, effects on glucose and diabetes ?

The acute glucose-lowering effect of certain bariatric procedures—before any significant weight loss has occurred—has been known for decades (1). In a comprehensive meta-analysis by Buchwald et al. (2), type 2 diabetes remission rates after the most common bariatric procedure, Roux-en-Y gastric bypass (RYGB), were reported to be 80%.


• Occurs immediately after the gastric bypass
• Change in insulin resistance
• Change in insulin secretion
• Changes in bile acids
• Changes in gut microbiota

10

RYGB induced changes in endocrinology?

RYGB-induced changes in gut endocrinology with the potential to improve overeating and compromised glucose homeostasis include increased secretion of the incretin (insulinotropic) hormone glucagon-like peptide(GLP)-1 and the anorexic hormones peptide YY.

upregulate genes for the cellular machinery involved in insulin secretion, stimulate β-cell proliferation.


First, surgically induced direct delivery of nutrients to the small intestine will increase the GLP-1 response to a meal and enhance the insulin response.
Second, induction of sudden negative calorie balance by any means in type 2 diabetes normalizes plasma glucose levels within days, and this is the predominant mechanism underlying the early metabolic changes after bariatric surgery.

11

anatomy after rygb:

he passage of nutrients from the gastric pouch directly to the distal part of the jejunum (through the alimentary limb). The passage of gastric, pancreatic, and bile fluids to jejunum (through the secretory limb)

12

current criteria for bariatric surgery

• BMI >40 kg/m2 with no comorbidities
• BMI > 35 kg/m2 with comorbidities

13

economics of bariatric surgery

Sept 2010 report from the Office of Health Economics
• Direct cost of obesity and related illnesses to the NHS is £4.3 billion a year
• ~ 1.1 million patients are eligible according to NICE guidelines

• If 25% had surgery the gain within 3 years would be £1.3 billion