1.
Clinical outcomes of duodenal switch with a 200-cm common channel: a matched, controlled trial.
Lebel, S, Dion, G, Marceau, S, Biron, S, Robert, M, Biertho, L
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2016;(5):1014-1020
Abstract
BACKGROUND Biliopancreatic diversion with duodenal switch (BPD-DS) with a 100-cm common channel has been our treatment of choice for morbid obesity since the early 1990s. This procedure offers excellent long-term weight loss but can be associated with significant side effects. OBJECTIVES To assess the effect on clinical and nutritional parameters of increasing the common channel to 200 cm. SETTINGS University-affiliated tertiary care center. METHODS Patients who underwent a BPD-DS with a 200-cm common channel (study group, n = 36) were matched 1:1 for age, sex, body mass index (BMI), and main co-morbidities with patients who underwent a BPD-DS with a 100-cm common channel (control group). The strict alimentary limb was 150 cm in both groups. RESULTS The mean age was 55±9 versus 53±7 years (P = .3), with 50% women and a BMI of 49±8 kg/m(2) versus 50±6 kg/m(2) (P = .9). Follow-up rate was 97%, with a minimum follow-up of 3 years. There were no significant differences in the remission rate of major co-morbidities between the 2 groups. At 3 years, the excess weight loss was 61±22% versus 68±18% (P = .18) and the total weight loss was 33±11% versus 38±9% (P = .055) in the study group versus control group, respectively. The study group had a lower incidence of severe protein deficiency (11% versus 19%, P = .3) and hyperparathyroidism (17.1% versus 35.3%, P = .17); required a lower amount of vitamins A and D (P<.05); and had a decreased number of daily bowel movements (2.0 versus 2.9, P = .03). CONCLUSION In this population, BPD-DS with a 200-cm common channel offered similar remission rate of co-morbidities compared with standard BPD-DS. It was associated with similar weight loss at nadir, followed by a more significant weight regain. It might yield a lower rate of nutritional complications. Long-term randomized data are needed to detect other potential advantages.
2.
A new questionnaire for quick assessment of food tolerance after bariatric surgery.
Suter, M, Calmes, JM, Paroz, A, Giusti, V
Obesity surgery. 2007;(1):2-8
Abstract
BACKGROUND Bariatric surgery is often associated with reduced food tolerance and sometimes frequent vomiting, which influence quality of life, but are not included in the overall evaluation of these procedures, notably the BAROS. Our aim was to develop a simple questionnaire to evaluate food tolerance during follow-up visits. METHODS A one-page questionnaire including questions about overall satisfaction regarding quality of alimentation, timing of eating over the day, tolerance to several types of food, and frequency of vomiting/regurgitation was developed. A composite score was derived from this questionnaire, giving a score of 1 to 27. Validation was performed with a group of non-obese adults and a group of morbidly obese non-operated patients. Patients were administered the questionnaire at follow-up visits since January 1999. Data were collected prospectively. RESULTS It takes 1-2 minutes to fill out the questionnaire. Food tolerance is worse in the morbidly obese population compared with non-obese adults (24.2 vs 25.2, P=0.004). Following Roux-en-Y gastric bypass, food tolerance is reduced after 3 months (21.2), but becomes comparable to that of the normal population and remains so at 1 year postoperatively. Following gastric banding, food tolerance is already significantly reduced after 3 months (22.3), and worsens continuously over time (19.03 after 7 years). In the gastric banding population, the decision to adjust the band is based at least partially on food tolerance, and the questionnaire proved helpful in that respect. CONCLUSIONS Our new questionnaire proved very easy to use, and helpful in day-to-day practice, especially after gastric banding. It was also helpful in comparing food tolerance over time after surgery, and in comparing food tolerance between procedures. Evaluation of food tolerance should be part of the overall evaluation of the results after bariatric surgery.
3.
Effects of different training protocols on exercise performance during a short-term body weight reduction programme in severely obese patients.
Sartorio, A, Lafortuna, CL, Massarini, M, Galvani, C
Eating and weight disorders : EWD. 2003;(1):36-43
Abstract
The effects on aerobic, anaerobic and strength performance of aerobic (A) or A and strength (AS) training, integrated with a 3-week body weight reduction programme involving an energy-restricted diet, nutritional education and psychological counselling, were evaluated in 52 grade II or III obese individuals (A: n = 26; AS: n = 26). After 3 weeks, both training programmes led to a similar and significant reduction (p < 0.001) in body mass (A: 4.8%; AS: 4.4%) and an increase (p < 0.05 - p < 0.01) in maximal oxygen consumption (A: 16.8%; AS: 10.9%). A significant (p < 0.05 - p < 0.001) increase was found in absolute lower limb anaerobic power output evaluated by means of a jumping test (A: 13.7%; AS: 18.1%) and stair climbing test (A: 9.7%; AS: 4.3%), without any significant difference between A and AS. A comparable and significant (p < 0.01) increase was also found in average horizontal velocity during a short sprint running test (A: 8.1%; AS: 7.1%), with a shorter time of foot-ground contact (A: 4.9%; AS: 6.6.%) and a higher step frequency (A: 4.0%; AS: 10.4%). The maximum strength increase after the body weight reduction programme determined by one maximal repetition test of lower and upper limb muscle groups was significantly greater (p < 0.05 - p < 0.001) in the AS group, ranging from 11.4% to 25.4% (A) and from 26.7% to 41.8% (AS). These results indicate that integrating a body weight reduction programme involving diet nutritional education and psychological counselling with A or AS exercise has similar positive effects in lowering body mass and improving A and anaerobic performance. However, the addition of strength training to A conditioning increases maximum strength.