Roux-en-Y Gastric Bypass versus a Variant of Biliopancreatic Diversion in a Non-Superobese Population: Prospective Comparison of the Efficacy and the Incidence of Metabolic Deficiencies

Skroubis, George; Anesidis, Stathis; Kehagias, Ioannis; Mead, Nancy; Vagenas, Kostas; Kalfarentzos, Fotis

doi:10.1381/096089206776327251

Cited by 88 publications

(66 citation statements)

References 11 publications

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“…Deficiency after gastric bypass is most common in menstruating women. 179 Women of childbearing age should be closely monitored for folic acid deficiency, and if found, folic acid should be repleted before pregnancy. Episodes of intractable vomiting, sometimes seen in the early post-bariatric surgery phases, can lead to thiamin deficiencies.…”

Section: Postoperative Management Dietmentioning

confidence: 99%

Bariatric Surgery and Cardiovascular Risk Factors

Poirier¹,

Cornier²,

Mazzone³

et al. 2011

Circulation

288

127

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T he rate of obesity is rising logarithmically, especially in those with severe obesity (body mass index [BMI] Ͼ40 kg/m 2 ). Cardiologists, endocrinologists, internists, family practitioners, and most healthcare professionals are increasingly confronted with the severely obese patient and with postoperative bariatric patients because obesity is associated with significant morbidity and increased mortality. In addition, more adolescents these days are severely obese. Substantial long-term successes of lifestyle modifications and drug therapy have been disappointing in this population. The National Institutes of Health has suggested that surgical therapy be proposed to those patients with BMI Ͼ40 kg/m 2 or Ͼ35 kg/m 2 with serious obesity-related comorbidities such as systemic hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. When indicated, surgical intervention leads to significant improvements in decreasing excess weight and comorbidities that can be maintained over time. These include diabetes mellitus, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction. Recent prospective, nonrandomized, observational, or case-control population studies have also shown bariatric surgery to prolong survival in the severely obese. Different types of bariatric procedures are being performed. Historically, operative mortality was between 0.1% and 2.0% with more recent data not exceeding 1%. Early complications include pulmonary embolus (0.5%), anastomotic leaks (1.0% to 2.5%), and bleeding (1.0%). Late complications include anastomotic stricture, anastomotic ulcers, hernias, band slippage, and behavioral maladaptation. The number of bariatric operations being performed is increasing tremendously as a result of increasing medical need and the evolution of safer surgical techniques and guidelines. Currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present.

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Section: Postoperative Management Dietmentioning

confidence: 99%

Bariatric Surgery and Cardiovascular Risk Factors

Poirier¹,

Cornier²,

Mazzone³

et al. 2011

Circulation

288

127

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“…Secondary hyperparathyroidism due to vitamin D malabsorption following BPD has been reported regularly the last decade [13][14][15]. Severe malabsorption commonly results in radiographic changes compatible with osteomalacia and occasionally leads to subperiostal bone resorption [11].…”

Section: Discussionmentioning

confidence: 99%

“…A recent prospective comparison of the incidence of nutritional deficiencies of the standard Roux-en Y gastric bypass versus BPD showed that BPD patients had consistently lower levels of serum calcium and higher values of PTH despite a daily multivitamin and mineral supplement [15].…”

Section: Discussionmentioning

confidence: 99%

A Brown Tumor after Biliopancreatic Diversion for Severe Obesity

Benhalima¹,

Mertens²,

Annick³

et al. 2009

Endocr J

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Abstract. A case of a brown tumor due to iatrogenic malabsorption following biliopancreatic diversion (BPD) is presented. A 52 year old women with a history of BPD 2 years before was referred to orthopedic surgery because of a painful lytic lesion of the left ankle. A bone biopsy revealed a giant cell tumor compatible with the diagnosis of a brown tumor. Subsequent metabolic evaluation showed severe 25-hydroxy vitamin D deficiency and secondary hyperparathyroidism (PTH 60 ng/L or twice the upper normal limit). Bone mineral density was decreased at the femoral neck (0.50 g/cm 2 ; T score of -3.92 or 66% of the expected value) and lumbar spine (T score of -1.75 or 93% of the expected value). A brown tumor can be the presenting symptom of iatrogenic malabsorption due to BPD. This case illustrates the severity of potential bone complications after BPD and the necessity of lifelong surveillance and vitamin supplements after BPD. We report an unusual case of a brown tumor, due to severe vitamin D deficiency and secondary hyperparathyroidism after biliopancreatic diversion operation (BPD) for severe obesity. Methods Tissue processing and histologyThe biopsy and currettage specimens were fixed in 6% formalin. After decalcification, the specimens were both entirely processed for paraffin embedding and staining with hematoxylin and eosin (H and E) for histopathological evaluation. No immunohistochemistry was performed. Biochemically measurementsCalcium was measured spectrophometrically (0-cresolphtalein in compexon method) and alkaline phosphatase activity was determined according to the

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“…Normalmente, para atender essas orientações, o paciente pode utilizar suplementos proteicos em pó de alto valor biológico. 19,20 Outra variável que parece ter relação com uma maior adesão aos CACB é o tempo após a realização da CB, em que os pacientes que operaram há menos tempo também apresentaram maior adesão ao CA, IF e AF. Esse resultado corrobora com os achados de Freire et al 21 , em que foi verificado que a má qualidade da dieta, sedentarismo e falha em acompanhamento nutricional em longo prazo foram os principais fatores associados à falha na manutenção do peso perdido após 5 anos de CB.…”

Section: Resultados Resultados Resultados Resultados Resultadosunclassified

Comportamentos associados à manutenção dos resultados após cirurgia bariátrica

Antonini¹,

Hintze²,

Silva

et al. 2014

Medicina (Ribeirão Preto)

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A Cirurgia Bariátrica (CB) é um método de tratamento da obesidade que vem recebendo destaque principalmente devido aos resultados positivos no tratamento das comorbidades associados ao excesso de peso. No entanto, esse tipo de intervenção necessita de uma fase de adaptação e mudanças de estilo de vida principalmente devido a complicações pós-cirúrgicas relacionadas à deficiência de algumas vitaminas e minerais. Nesse sentido, o objetivo do estudo foi associar o perfil antropométrico, composição corporal e tempo desde a realização da CB com a adesão a comportamentos alimentares saudáveis de pacientes submetidos a esse procedimento. Estudo do tipo transversal realizado com 98 pacientes submetidos ao bypass gástrico em Y de Roux. Foram avaliados peso, estatura, circunferência da cintura (CC) e quadril, massa de gordura, massa muscular esquelética e o comportamento alimentar por meio do questionário Bariatric Surgery Self-management Questionnaire Seven, que possui 7 domínios referentes ao comportamento alimentar (CA), à ingestão de fluidos (IF), à atividade física (AF), à gestão da síndrome de dumping (GSD), à admissão de suplementos (AS), ao consumo de frutas, vegetais e grãos integrais (CFVGI) e à ingestão de proteínas (IP). Foi verificada associação entre adesão total dos comportamentos alimentares, CFVGI, IP com o estado nutricional e CC após a CB. Observamos também menor peso, IMC e CC e menor % e quantidade de gordura em pacientes que apresentaram boa adesão nesses domínios. Nos domínios, CA, IF e AF os pacientes com menor tempo após a realização da CB apresentaram melhor adesão a esses comportamentos. Os sujeitos mais jovens apresentaram maior adesão à AF comparados aos mais velhos. Em conclusão, a adesão aos comportamentos alimentares após a CB se associou com o estado nutricional e CC, bem como com o tempo após a realização à CB. Sugere-se a realização de estudos que proponham modelos de intervenção para o melhor controle e manutenção dos comportamentos alimentares dos pacientes submetidos a esse procedimento.

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Roux-en-Y Gastric Bypass versus a Variant of Biliopancreatic Diversion in a Non-Superobese Population: Prospective Comparison of the Efficacy and the Incidence of Metabolic Deficiencies

Cited by 88 publications

References 11 publications

Bariatric Surgery and Cardiovascular Risk Factors

Bariatric Surgery and Cardiovascular Risk Factors

A Brown Tumor after Biliopancreatic Diversion for Severe Obesity

Comportamentos associados à manutenção dos resultados após cirurgia bariátrica

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