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Approach to the Patient: Management of the Post-Bariatric Surgery Patient With Weight Regain.
Istfan, NW, Lipartia, M, Anderson, WA, Hess, DT, Apovian, CM
The Journal of clinical endocrinology and metabolism. 2021;(1):251-263
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Abstract
CONTEXT Weight regain (WR) after bariatric surgery is emerging as a common clinical problem due to the increase in the number of procedures performed. Early interventions are necessary to curtail the potential recurrence of comorbid conditions. However, it is often difficult to recognize WR early enough to introduce mitigating measures because there are no current guidelines for timely diagnosis and assessment of the severity of this condition. OBJECTIVE We present a practical approach for the early recognition of WR, based on 11-year follow-up data from our multiethnic bariatric surgery patient population. METHODS We classify WR according to the rate of increase in weight relative to nadir weight, normalized per 30-day interval. We also review pertinent literature about the etiologic factors contributing to WR after bariatric surgery. RESULTS According to our algorithm, mild, moderate, and rapid WR are defined as weight increases of 0.2% to <0.5%, 0.5% to 1.0%, and more than 1.0% of nadir weight per 30 days, respectively. Treatment options, including dietary counseling, use of antiobesity medication, and consideration of surgical revision, are described. A case is presented to illustrate the utility of timely identification of WR and the importance of collaboration between bariatric surgeons, obesity medicine specialists, and dietitians. CONCLUSION Our approach emphasizes the importance of regular long-term follow-up for all bariatric surgery patients.
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Effectiveness and Safety of Bariatric Surgery in Patients with End-Stage Chronic Kidney Disease or Kidney Transplant.
Guggino, J, Coumes, S, Wion, N, Reche, F, Arvieux, C, Borel, AL
Obesity (Silver Spring, Md.). 2020;(12):2290-2304
Abstract
OBJECTIVE This study aimed to evaluate (1) the effectiveness, complications, and postoperative access to transplantation in end-stage chronic kidney disease (ECKD) and (2) the effectiveness and complications of bariatric surgery in patients who had already undergone kidney transplant. METHODS A systematic review and meta-analysis of mortality and complications rates were performed. Thirty studies were reviewed. RESULTS After bariatric surgery, patients with ECKD had similar postoperative weight loss to patients from the general population. Meta-analysis showed post-bariatric surgery rates of 2% (95% CI: 0%-3%) for mortality and 7% (95% CI: 2%-14%) for complications. Approximately one-fifth of the patients had access to a transplant. This rate may be underestimated because of the short duration of follow-up. The lack of control groups did not allow for a conclusion on the role of bariatric surgery in facilitating access to kidney transplantation. In patients who had received a kidney transplant, bariatric surgery seemed to improve renal function but increased graft-rejection risk, possibly because of changes in the bioavailability of immunosuppressant drugs. CONCLUSIONS Bariatric surgery yields significant weight loss in patients with ECKD that improves patients' chances of accessing a transplant but does not guarantee it; however, the risk for complications and death is higher than in other patients. After transplantation, bariatric surgery-induced weight loss appeared to positively impact the function of the grafted kidney, but careful monitoring of immunosuppressant medications is required.
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[Not Available].
Magain, AC, Richard, T, De Becker, B, Rorive, S, Benahmed, A, Vanhaeverbeek, M
Revue medicale de Bruxelles. 2016;(1):26-34
Abstract
In Belgium and around the world, the weight-control surgery has grown significantly since the beginning of the 21st century. The principal argument in favour of this type of surgery is the expected reduction of the obesity-associated morbidities. However, the expectatif reduction of mortality associated with this kind of surgery is based on a low level of evidence. Besides the mechanical complications, there are a number of health-related problems associated with the post-operative metabolic changes. Authors of the present article have observed four cases presenting with serious affections consecutive to bariatric interventions and reviewed the literature. The most frequent consequence of bariatric surgery is anaemia (15%), which is either due to iron or cyanocobalamine deficiency, followed by neuropathies, bone mineral loss, substance abuse or postprandial hypoglycaemia syndrome. Rare but severe complications are Wernicke's encephalopathy, fulminant hepatitis or hyperoxaluric tubular disease. The prevention, diagnosis and management of these new diseases are becoming a major public health concern.
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Neurologic complications of bariatric surgery.
Kumar, N
Continuum (Minneapolis, Minn.). 2014;(3 Neurology of Systemic Disease):580-97
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Abstract
PURPOSE OF REVIEW The increasing utilization of bariatric surgery has been accompanied by an increased incidence and awareness of related neurologic complications. The purpose of this review is to provide up-to-date information on the neurologic complications related to bariatric surgery. RECENT FINDINGS Neurologic complications related to bariatric surgery are predominantly due to nutrient deficiencies. Common early complications include Wernicke encephalopathy due to thiamine deficiency, and late complications include myelopathy or myeloneuropathy due to vitamin B12 or copper deficiency. SUMMARY Early recognition and prompt institution of treatment is essential to prevent long-term disability. Often, life-long supplementation may be required.
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[Bariatric surgery in inflammatory bowel disease; case report and review of the literature].
Tenorio Jiménez, C, Manzano García, G, Prior Sánchez, I, Corpas Jiménez, MS, Molina Puerta, MJ, Benito López, P
Nutricion hospitalaria. 2013;(3):958-60
Abstract
Inflammatory bowel disease (IBD) is rarely associated with obesity, as malabsorption is a common feature of these diseases (1). However, some patients may experience morbid obesity and associated complications refractory to dietary treatment and benefit from bariatric surgery. It has even been postulated that surgery may result in improvement of IBD by reducing inflammatory markers (2). However, patients may experience a higher incidence of complications following surgery in the context of immunosuppressive therapy and prior malabsorption. Therefore, if surgery is performed, careful patient selection and individualization of technique are essential. We present a patient diagnosed with ulcerative colitis who presented severe protein malnutrition after bariatric surgery type bilio-pancreatic diversion and review the available literature.
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[Acute liver failure after bariatric surgery. A case report and literature review].
Sagredo, S, Brahm, J, Uribe, M, Codoceo, V, Smok, G
Gastroenterologia y hepatologia. 2013;(2):76-80
Abstract
Non-alcoholic fatty liver disease is common among morbidly obese people. Bariatric surgery is increasingly used in this population to control weight but is not free of risks. We present the case of a 28-year-old morbidly obese woman who underwent gastroplasty with intestinal resection and a gastro-jejunal anastomosis. Eleven months later, and with a weight reduction of 35%, the patient developed acute liver failure. A biopsy showed severe steatohepatitis and fibrosis. After prolonged hospital stay and management that consisted of support measures, nutritional assistance, N-acetyl cysteine, zinc and vitamin E, liver function was restored. A follow-up biopsy showed marked regression of the initial findings. Bariatric surgery has many beneficial effects. However, even with the most up-to-date techniques, complications can occur. Familiarity with these complications is important for their prevention and treatment.
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Bariatric surgery and implications for oral health: a case report.
Moravec, LJ, Boyd, LD
Journal of dental hygiene : JDH. 2011;(3):166-76
Abstract
A case representative of issues dental practitioners may face when providing care to patients with a history of bariatric surgery is reviewed. Meta-analysis shows that, following bariatric surgery, 43 to 79% of diabetes, hyperlipidemia and hypertension in patients resolved to normal levels or no longer required therapy. However, bariatric surgery side effects have implications for oral health, including nutrient deficiencies impacting healing of oral tissues and gastroesophageal reflux, resulting in tooth erosion. Patients who have undergone bariatric surgery are seen with increasing frequency in dental offices and dental professionals need to be familiar with the challenges these patients present.
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Maladaptive eating patterns after weight-loss surgery.
Rusch, MD, Andris, D
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2007;(1):41-9
Abstract
Weight-loss surgery has been shown to contribute to the improved health and well-being of the clinically severe obese, and for many has been seen as their "last resort." Although the majority of patients who choose this option as a means to achieve a healthier weight are successful, for some patients it is not beneficial. Bariatric surgery is not a panacea, and its immediate and long-term success depends on the patient's ability to incorporate lifestyle and behavioral changes. Patients who are not successful in achieving and maintaining their anticipated weight loss struggle to comply with diet, exercise, and vitamin regimens. Not only do these patients exhibit diminished weight loss, they have put themselves at risk for vitamin and mineral deficiencies and protein malnutrition. Their problematic response to weight-loss surgery may or may not be due to a worsening of presurgical depression, binge eating, emotion-triggered eating, body image, or eating behaviors associated with specific situations such as social events. This paper describes clinical responses we have observed in our bariatric practice. Several case studies are presented to highlight problems we have encountered when following bariatric surgery patients in the early postoperative period, as well as in a long-term setting. Recommendations are made for screening and follow-up of at-risk patients.
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[Gastric food bezoar as a complication of bariatric surgery. Case report and review of the literature].
Zapata, R, Castillo, F, Córdova, A
Gastroenterologia y hepatologia. 2006;(2):77-80
Abstract
In the last few years bariatric surgery has become an excellent therapeutic alternative for the treatment of morbid obesity. Food bezoar as a cause for obstruction seems to be a very infrequent postoperative complication. It has only been published as anecdotal case reports. We describe a female patient with morbid obesity (weight, 131 kg; body mass index, 45) who underwent laparoscopic bariatric surgery (subtotal 95% gastrectomy with gastroyeyunoanastomosis in Roux-Y) obtaining a significant weight reduction (51 kg) in the next few months post surgery. She developed a food bezoar in the gastric remnant as a late complication of surgery (13 months after bariatric surgery) and presented as a gastric outlet acute obstruction with persistent vomiting and satiety. The diagnosis and treatment was performed through an upper GI endoscopy. It is important to consider this complication in patients with persisting vomiting after this kind of surgery. In the near future we will probably have a significant amount of patients operated due to morbid obesity and we may see this kind of complication more frequently.
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10.
[Beriberi after bariatric surgery: not an unusual complication. Report of two cases and literature review].
Alves, LF, Gonçalves, RM, Cordeiro, GV, Lauria, MW, Ramos, AV
Arquivos brasileiros de endocrinologia e metabologia. 2006;(3):564-8
Abstract
The number of patients submitted to bariatric surgery to treat morbid obesity is increasing, therefore, some nutritional deficiencies, with which many physicians are no longer familiarized, are reappearing. Postoperatively, many nutritional disorders may occur, one of them is thiamine deficiency (beriberi). The thiamine and/or vitamin B12 deficiency can correspond to 40% of the neuropathy cases after bariatric surgery. Two patients with the clinic of peripheral neuropathy and Wernicke-Korsakoff syndrome will be reported. Some months after the surgery, they presented prostration, depression, mental confusion and nystagmus, associated with pain and paresthesia in limbs (especially lower limbs). With the diagnostic hypothesis of beriberi, the treatment with thiamine started. One of the patients presented complete improvement of the neurological symptoms, however the other one remained with motor deficiency, exactly the one who spent a longer period of time between the symptoms appearance and the treatment beginning. These cases serve to alert us about the importance of nutritional vigilance after bariatric surgery.