Current challenges in providing bariatric surgery in France

Czernichow, Sébastien; Païta, Michel; Nocca, David; Msika, Simon; Basdevant, Arnaud; Millat, Bertrand; Fagot-Campagna, A.

doi:10.1097/md.0000000000005314

Cited by 34 publications

(13 citation statements)

References 14 publications

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“…However, VAT was not assessed in their study. It would be of interest to further compare RYGB and sleeve gastrectomy concerning this particular point, as sleeve gastrectomy has recently become the most commonly performed procedure in several countries [ 37 – 39 ].…”

Section: Discussionmentioning

confidence: 99%

The Reduction of Visceral Adipose Tissue after Roux-en-Y Gastric Bypass Is more Pronounced in Patients with Impaired Glucose Metabolism

et al. 2018

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PurposeVisceral adipose tissue (VAT) is associated with cardiometabolic risk factors and insulin resistance. The physiological mechanisms underlying the benefits of Roux-en-Y gastric bypass surgery (RYGB) on glucose metabolism remain incompletely understood. The impact of RYGB on VAT was assessed among three groups of patients stratified by their glucose tolerance before surgery.MethodsForty-four obese women were categorized into normoglycemia (n = 21), impaired glucose tolerance (IGT, n = 18) and diabetes (n = 5) before surgery. Body composition measured by dual-energy X-ray absorptiometry (DXA) was performed before surgery, 6 months and 12 months after.ResultsThe three groups had comparable mean age (mean 38.6 ± SD 9.9) and BMI at baseline (41.9 ± 4.3 kg/m2). After 12 months, total weight loss (mean 35.1% ± 7.5) and excess weight loss (91.1% ± 25.1) were similar between groups. Pre-surgery mean VAT was significantly higher in diabetes (mean 2495 ± 616 g) than in normoglycemia (1750 ± 617 g, p = 0.02). The percentage of VAT to total body fat was significantly higher in diabetes (mean 4.4% ± 0.9) compared to normoglycemia (2.9% ± 0.8, p = 0.003). Twelve months after surgery, VAT loss was significantly greater among patients with diabetes (mean 1927 ± 413 g) compared to normoglycemia (1202 ± 450, p = 0.009).ConclusionsRYGB leads to important VAT loss, and this loss is greater in patients with diabetes prior to surgery. As VAT is associated with insulin resistance, this reduction may account for the profound impact of this surgery on glucose metabolism.

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Section: Discussionmentioning

confidence: 99%

The Reduction of Visceral Adipose Tissue after Roux-en-Y Gastric Bypass Is more Pronounced in Patients with Impaired Glucose Metabolism

et al. 2018

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“…The SNDS database, one of the largest databases in the world, has been used extensively to guide public health policies in France, as these data allow systematic follow‐up of all medical care received in France. Several studies of bariatric surgery based on SNDS data have already been published.…”

Section: Methodsmentioning

confidence: 99%

Multicentre cohort study of antihypertensive and lipid-lowering therapy cessation after bariatric surgery

Thereaux

Lesuffleur

Czernichow

et al. 2018

British Journal of Surgery

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Background Few studies have assessed changes in antihypertensive and lipid‐lowering therapy after bariatric surgery. The aim of this study was to assess the 6‐year rates of continuation, discontinuation or initiation of antihypertensive and lipid‐lowering therapy after bariatric surgery compared with those in a matched control group of obese patients. Methods This nationwide observational population‐based cohort study used data extracted from the French national health insurance database. All patients undergoing gastric bypass or sleeve gastrectomy in France in 2009 were matched with control patients. Mixed‐effect logistic regression models were used to analyse factors that influenced discontinuation or initiation of treatment over a 6‐year interval. Results In 2009, 8199 patients underwent primary gastric bypass (55·2 per cent) or sleeve gastrectomy (44·8 per cent). After 6 years, the proportion of patients receiving antihypertensive and lipid‐lowering therapy had decreased more in the bariatric group than in the control group (antihypertensives: –40·7 versus –11·7 per cent respectively; lipid‐lowering therapy: –53·6 versus –20·2 per cent; both P < 0·001). Gastric bypass was the main predictive factor for discontinuation of therapy for hypertension (odds ratio (OR) 9·07, 95 per cent c.i. 7·72 to 10·65) and hyperlipidaemia (OR 11·91, 9·65 to 14·71). The proportion of patients not receiving treatment at baseline who were subsequently started on medication was lower after bariatric surgery than in controls for hypertension (5·6 versus 15·8 per cent respectively; P < 0·001) and hyperlipidaemia (2·2 versus 9·1 per cent; P < 0·001). Gastric bypass was the main protective factor for antihypertensives (OR 0·22, 0·18 to 0·26) and lipid‐lowering medication (OR 0·12, 0·09 to 0·15). Conclusion Bariatric surgery is associated with a good discontinuation of antihypertensive and lipid‐lowering therapy, with gastric bypass being more effective than sleeve gastrectomy.

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“…Since 2004, payments for hospital care have been based on a diagnosis‐related group model. As public and private hospitals are funded on the basis of this system, this database covers all hospitals in France.…”

Section: Methodsmentioning

confidence: 99%