Malabsorptive Gastric Bypass in Patients With Superobesity

Brolin, Robert E.; LaMarca, Lisa B; Kenler, Hallis A.; Cody, Ronald P.

doi:10.1016/s1091-255x(01)00022-1

Cited by 349 publications

(212 citation statements)

References 15 publications

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“…Furthermore, it did not review the data in the large series of these two procedures by Scopinaro et al 101 or Marceau and colleagues. 103 It also made conflicting statements about the three different variants of gastric bypass studied by Brolin et al 104,105 Their representation that the 'long-limb' gastric bypass is associated with excessive nutritional and vitamin deficiencies from malabsorption is incorrect, as it refers to the more malabsorptive 'distal' gastric bypass operation 104 Owing to these potential nutritional consequences, it is important to understand the anatomy of these procedures: three 'limbs' or 'tracts' of intestine are created in a Roux-en-Y procedure: the 'Roux' limb, which is attached to the stomach Evidence-based medicine obesity surgery critique HJ Sugerman and JG Kral and is also known as the 'alimentary tract'; the 'biliopancreatic tract' through which the bile and pancreatic juices drain; and the 'common channel' where food is most efficiently absorbed when mixed with the digestive juices ( Figure 1). In a randomized prospective trial omitted in the TEC report, Brolin and colleagues compared a long-limb gastric bypass with a 35 cm biliopancreatic limb and a 150 cm Roux (alimentary) limb to a standard gastric bypass with a 75 cm Roux limb.…”

Section: Resultsmentioning

confidence: 99%

“…104,105 The TEC report implies that a number of complications are specific to these malabsorptive procedures ('gastric obstruction, leaks at the anastomotic sites and nausea/vomiting caused by the altered stomach physiology', etc), but these complications are seen with equal frequency with all of the other bariatric bypass procedures.…”

Section: Rcts and Levels Of Evidencementioning

confidence: 99%

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Evidence-based medicine reports on obesity surgery: a critique

Sugerman

Kral

2005

Int J Obes

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OBJECTIVE:To evaluate evidence in recent authoritative 'Evidence-Based Medicine' (EBM) reports on surgery for severe obesity. METHODS: Focused review of Index Medicus citations and authors' own databases of publications on surgery for obesity, . RESULTS: EBM criteria for assessment of strength of evidence requiring randomized controlled studies (RCTs) in these reports are inappropriate for evaluating invasive treatments such as surgery, which have robust physiological effects, are difficult to reverse and may have more serious side effects than the drug studies for which the criteria were promulgated. Flaws in these reports include omissions of important studies demonstrating improvements in comorbidity, factual errors in descriptions of operations and faulty analyses of outcomes of laparoscopic approaches. There are misinterpretations of cited papers, and inclusion of obsolete operations as well as a study generated during the 'learning curve' of an avowed complex procedure. CONCLUSION: EBM analyses of surgical modalities affecting access to care require relevant evaluation criteria, true peer review and expert consultation. Authors' claims of objectivity by invoking use of evidence-based criteria applicable to drug treatment and other easily reversible forms of therapy are questionable. Decisions based on flawed EBM reports may adversely affect access to care for millions of severely obese patients.

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Section: Resultsmentioning

confidence: 99%

Section: Rcts and Levels Of Evidencementioning

confidence: 99%

Evidence-based medicine reports on obesity surgery: a critique

Sugerman

Kral

2005

Int J Obes

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“…Déficits nutricionais são usualmente subdiagnosticados e a necessidade de suplementação vitamínica é frequentemente negligenciada 68,69 . A deficiência de vitaminas e nutrientes com frequência tem um papel importante na gênese de sintomas encontrados em transtornos psiquiátricos ou mesmo nas síndromes mentais orgânicas.…”

Section: Seguimento Pós-operatóriounclassified

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Gordon

Kaio²,

Sallet³

2011

Rev. psiquiatr. clín.

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ResumoContexto: Nas últimas décadas, diversos estudos longitudinais têm demonstrado a eficácia da cirurgia bariátrica no controle de peso em longo prazo e na redução da mortalidade resultante de complicações clínicas associadas à obesidade. Contudo, os estudos também revelam aumento significativo da mortalidade devida a suicídio e comportamento impulsivo, por razões largamente desconhecidas, o que demonstra a escassez de informações relativas ao manejo clínico de pacientes bariátricos. O presente estudo tem como objetivo sintetizar o estado atual de conhecimentos referentes ao acompanhamento psiquiátrico de pacientes bariátricos. Método: Revisão seletiva da literatura envolvendo artigos indexados no Medline e PubMed até junho de 2010, utilizando-se os termos: "bariatric surgery", "psychiatry", "binge eating", "follow-up" e "outcome". Resultados: Há relativo consenso na literatura de que não haja contraindicação psiquiátrica absoluta para a cirurgia bariátrica, embora a avaliação pré-operatória seja de extrema importância para o diagnóstico e tratamento de eventuais transtornos psiquiátricos, objetivando assegurar aderência ao tratamento multidisciplinar, melhor qualidade de vida e, possivelmente, melhor prognóstico pós-cirúrgico. Entre os transtornos mais prevalentes nessa população, encontra-se o transtorno da compulsão alimentar periódica (TCAP), que está relacionado com menor perda ponderal e pior qualidade de vida, especialmente quando presente no pós-operatório. No acompanhamento pós-operatório, também se deve atentar para o surgimento de sintomas impulsivos, incluindo abuso de álcool e outras substâncias. Conclusão: Diversos estudos indicam elevada prevalência de transtornos mentais e alterações psicopatológicas na população de pacientes bariátricos. Embora a maioria dos pacientes apresente adequado controle ponderal e melhora na qualidade de vida em médio e longo prazo, alguns pacientes desenvolvem alterações relativas ao comportamento alimentar, abuso de álcool e outras substâncias e complicações associadas a comportamento impulsivo, o que remete a hipóteses etiológicas que vão desde modelos neuroquímicos até teorias psicossociais. Por todas essas razões, é de fundamental importância que os profissionais de saúde mental integrem as equipes que avaliam e acompanham os pacientes bariátricos. Gordon PC, et al. / Rev Psiq Clín. 2011;38(4):148-54Palavras-chave: Obesidade, cirurgia bariátrica, psiquiatria, transtorno da compulsão alimentar periódica. AbstractBackground: In recent decades, several longitudinal studies show the efficacy of bariatric surgery on long-term weight control and reductions in mortality due to clinical complications associated with obesity. However, studies also show significantly increased mortality due to suicide and impulsive behavior, for reasons largely unknown, which demonstrates the paucity of information concerning the clinical management of bariatric patients. This study aims to synthesize the current state of knowledge regarding the psychiatric care of bariatric patients. Meth...

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“…Protein energy malnutrition is most likely to occur with malabsorptive procedures, such as biliopancreatic diversion and distal GBP (107)(108)(109). Thiamine deficiency has occurred in patients without preoperative risk factors or concurrent alcohol abuse and has developed as early as 1 week to 2 months post-WLS (110 -112).…”

Section: Postoperative Vomitingmentioning

confidence: 99%

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

et al. 2005

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Criteria for patient selection and multidisciplinary evaluation and treatment of the weight loss surgery patient. Obes Res. 2005;13:234 -243. Objective: To provide evidence-based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS). Research Methods and Procedures: Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail. Results: We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity-related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well-defined postsurgical diet progression. Discussion: Obesity-related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short-and long-term risks include: comprehensive medical screening; appropriate pre-, peri-, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long-term nutrition education/counseling.

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Malabsorptive Gastric Bypass in Patients With Superobesity

Cited by 349 publications

References 15 publications

Evidence-based medicine reports on obesity surgery: a critique

Evidence-based medicine reports on obesity surgery: a critique

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

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