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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity is considered a primary risk factor for cardiovascular disease and related mortality. The current study aimed to investigate the efficacy of minimal invasive gastric banding (GB) surgery for reducing caloric intake in morbid obesity, and to analyze the effects of weight loss on body composition and metabolic and psychosocial outcomes. Twenty-six adult severely obese patients (mean body mass index [BMI], 48.1 kg/m(2); range, 42 to 56) underwent adjustable silicone laparoscopic GB. Nine additional obese patients who declined surgery were treated with metformin (2 g daily) and served as a small additional group (BMI, 50.5 kg/m(2); range, 41 to 68). Presurgery and 17 +/- 2.2 months postoperatively, body composition (fat mass [FM], lean body mass [LBM], body water) and serum parameters (lipids, glucose, thyrotropin-stimulating hormone [TSH]) were determined. Quality of life (QoL) was evaluated by a standardized self-rating questionnaire (Short Form-36 [SF-36]), and supplemented by measures of physical complaints and psychological distress. After GB, weight loss was 21 +/- 14.9 kg (14%, P <.001). It was associated with a decrease in FM by 14 +/- 8.6 kg (18%, P <.001), LBM by 4 +/- 2.7 kg (5%, P <.001), body water by 4 +/- 3.4 L (7%, P <.01), systolic blood pressure by 16 +/- 26.3 mm Hg (10%, P <.05), total cholesterol by 0.69 +/- 1.29 mmol/L (12%, P <.05), and low-density lipoprotein cholesterol (LDL-C) by 0.38 +/- 0.39 mmol/L (10%, P <.05). Highly significant interactions between surgery and time were noted for weight (P <.005), BMI (P <.005), and FM (P <.007, analysis of variance [ANOVA]). Preoperatively, 14 of 26 patients (54%) had high fasting blood sugar levels (type 2 diabetics) and 11 (42%) had impaired glucose tolerance, whereas postoperatively, for baseline glucose levels a trend to decrease was noted. Neither malabsorption nor anemia was observed. QoL improved after GB; in particular, physical functioning and well being increased (P <.01), and somatic complaints (eg, dyspnea and heart complaints, pain in legs and arms) markedly decreased (P =.008). In the metformin group, neither relevant weight loss nor a significant decrease of biochemical values was observed. Minimal invasive GB is a successful therapeutic tool for reducing FM in morbidly obese patients. Weight loss resulted in improved metabolic parameters, suggesting a lowered atherogenic risk.
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PMID:Metabolic and psychosocial effects of minimal invasive gastric banding for morbid obesity. 1466 54

Weight loss after biliopancreatic diversion or duodenal switch is due to decreased calorie absorption secondary to fat malabsorption. Fat malabsorption may also cause essential fat-soluble vitamin deficiencies, which may have severe clinical consequences and alter calcium metabolism. Serum vitamins A, D, E, and K, zinc, parathyroid hormone, corrected calcium, and alkaline phosphatase levels were measured in a cohort of patients who had previously undergone biliopancreatic diversion. Two bariatric surgery units were involved in the study: New York University School of Medicine (New York, NY), and the Wesley Medical Center (Brisbane, Australia). A total of 170 patients completed the study. The incidence of vitamin A deficiency was 69%, vitamin K deficiency 68%, and vitamin D deficiency 63% by the fourth year after surgery. The incidence of vitamin E and zinc deficiency did not increase with time after surgery. The incidence of hypocalcemia increased from 15% to 48% over the study period with a corresponding increase in serum parathyroid hormone values in 69% of patients in the fourth postoperative year. There is a progressive increase in the incidence and severity of hypovitaminemia A, D, and K with time after biliopancreatic diversion and duodenal switch. Calcium metabolism is affected with an increasing incidence of secondary hyperparathyrodisim and evidence of increased bone resorption in 3% of patients. Long-term nutritional monitoring is necessary after malabsorptive operations for morbid obesity.
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PMID:Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. 1474 35

Bariatric surgery is a safe and effective method for achieving durable weight loss for patients with morbid obesity. Gastric restrictive procedures include vertical banded gastroplasty and gastric banding. Malabsorptive procedures include long-limb gastric bypass, biliopancreatic diversion, and biliopancreatic diversion with duodenal switch. The gastric bypass has features of both restriction and malabsorption. The laparoscopic approach to bariatric surgery has substantially improved postoperative recovery. Careful patient selection and preoperative work-up are extremely important. A number of medical comorbidities are improved after surgically-induced weight loss.
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PMID:The state of the art in bariatric surgery for weight loss in the morbidly obese patient. 1536 12

Over the next several years, the number of patients who will have had bariatric surgery for morbid obesity will reach close to a million. Several well-described nutritional problems such as B12 and iron deficiency will be noted in these patients. Many of these patients will be lost to the original surgeon and will now be in the care of the "other physicians." These and other mineral and vitamin problems will need to be screened and treated. If these problems are left undiagnosed, severe and irreparable problems can result. Early problems, such as vomiting and dumping syndrome, will be easily recognized and treated, but other long-term problems, such as changes in bone metabolism, will need to be monitored. Again, if some of these long-term problems are not addressed in a timely fashion, then eventual treatment becomes much more difficult. This commentary will cover the common as well newer problems that are now developing in the patient who has had bariatric surgery. Patients who have undergone bariatric surgery require medical follow-up for reasons that are often determined by the type of surgical procedure performed. The majority of this review will deal with patients who have had the standard Roux-en-Y gastric bypass, which is a primarily restrictive procedure with a mild component of noncaloric malabsorption. At the end of this report, a short section will be devoted to the problems associated with the malabsorptive procedures.
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PMID:Follow-up of nutritional and metabolic problems after bariatric surgery. 1567 21

Morbid obesity is defined as obesity with body mass index (BMI) > or = 40 kg/m2 with secondary serious diseases. Conservative treatment generally fails to produce long-term weight loss in these patients, since several bariatric surgical techniques have been developed which are based on gastric restriction and/or gastric malabsorption resulting in permanent weight loss over years. Preoperative evaluation might detect suitable patients and reduce both non-surgical and surgical complications. Postoperative follow-up in a multidisciplinary program, including specialists in various fields of medicine, e.g. surgery, internal medicine, radiology, paediatrics and nutritional surveillance are mandatory in the treatment of patients after obesity surgery. Bariatric surgery results in a major weight loss, with amelioration of most obesity-associated conditions. The most serious side effect of some surgical procedere is malnutrition.
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PMID:[Indication for bariatric surgery]. 1573 47

The mini-invasive treatment of morbid obesity represents a priority of our surgical team. The majority of the patients have been operated on restrictive bariatric procedures. The technique we are presenting is indicated for the extreme and super obese patients (BMI >50 kg/m2) for whom the restrictive procedures are less efficient. In these situations we have performed a mixed procedure, combining two principles restriction and malabsorption by creating a low capacity gastric tube connected to the jejunum through a linear stapled anastomosis. The name of these procedure is mini gastric bypass and our experience is consisting of 7 patients, with BMI between 52.7 and 71.69 kg/m2, with very important comorbidities. In this paper we are describing the specifics of the laparoscopic approach and the postoperative results at 3-18 months. We have recorded one conversion to the open surgery, two hemorrhagic postoperative complications and one marginal ulcer (3 month post-operatively); all complications were treated conservatively. All the patients lost weight, the EWL at 12 months was between 45.26% and 77.65%, while the co-morbidities had a significant good evolution. The procedure was efficient, well accepted and tolerated by the patients.
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PMID:[Laparoscopic mini gastric bypass for the treatment of morbid obesity. Initial experience]. 1573 71

Convinced that morbid obesity was not due to food excess but rather to a metabolic disorder, we searched in the literature for data in favor of a metabolic disorder. We have found evidence in support of the thesis that the cause of morbid obesity is the inability to burn excessive caloric intake normally. It would involve the difficulty to increase heat with the amount of calories taken, which would be faulty and force fat deposition. This mechanism called dietinduced thermogenesis (DIT) allows the dispersion by heat of excessive calories to obtain energy balance. Results from bariatric surgery and particularly biliopancreatic diversion (BPD) give further support to this thesis. BPD would improve heat production to a meal (DIT) by one of these mechanisms: increased insulin sensitivity, change in intestinal hormone secretion, or chronic lipid malabsorption. Available results show that surgery, to be efficient, must change the physiology and not solely decrease food intake.
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PMID:Contribution of bariatric surgery to the comprehension of morbid obesity. 1576 Apr 94

Obesity and particularly morbid obesity is a lifelong problem that currently cannot be cured but can be controlled. Attempted control of obesity non-surgically results in 98% recividism. Weight loss is readily attainable, but weight loss maintenance is recalcitrant. Surgery currently provides the only long-term control of obesity. Surgery at best is a tool that the patient can use to effect the weight loss and weight loss maintenance. We have celebrated the golden anniversary of bariatric surgery in 2004. Obesity surgery is thus a relatively young field which is evolving. Operations currently used for the treatment of obesity fall into 3 categories: 1) restrictive operations such as vertical banded gastroplasty, silastic ring gastroplasty and gastric banding; 2) malabsorptive operations which include all the variations of the intestinal bypass; and 3) combined operations which utilize both restriction and malabsorption which include all the variations of short-limb gastric bypass, long-limb or distal gastric bypass and biliopancreatic diversion. The choice of the operation will be guided by the extent of the patient's obesity, the age of the patient, other co-morbid conditions of the patient, the cost of the operation, the patient's choice, and the surgeon's choice based on training, experience and geographical location. First and foremost, the operation chosen should be effective in causing weight loss and providing long-term weight loss maintenance with acceptable morbidity and mortality. Recommendations are made for choosing an operation for weight control based on effectiveness and safety.
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PMID:Choosing an operation for weight control, and the transected banded gastric bypass. 1576 May 9

The neurologic form of beriberi has been described in multiple case reports following bariatric surgery for morbid obesity. Thiamine deficiency occurs due to marked emesis and/or altered absorption secondary to the reconfiguration of the gastrointestinal tract to achieve the malabsorption needed to achieve weight loss. This case report illustrates the typical presentation of a patient after gastric bypass, and highlights the symptoms that bariatric surgeons must detect and reviews the treatment.
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PMID:Peripheral polyneuropathy from thiamine deficiency following laparoscopic Roux-en-Y gastric bypass. 1597 66

Bariatric surgery for the treatment of morbid obesity or overweight refractory to medical therapy was born at the beginning of second half of the twentieth century, and its first steps were uncertain and with a not jet well definite purpose. In fact the main result to be pursued seemed to be simply the reduction of body weight, and any change of anatomy of the digestive tract able to reduce the absorbtion of nutrients was judged adequate. But very early the adverse consequences of malabsorption so obtained became evident, and other operations possibly free from those complications were devised and clinically tested. So aside the by-pass operations many other surgical procedures found their room, all of them aiming to fight the ever more diffuse obesity of the people. This historical review of the various surgical procedures attempted in these last sixty years for morbid obesity is very interesting for a better understanding of the problem and to have a solid basis for future rational choices.
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PMID:[History and pathophysiologic analysis of the various techniques in bariatric surgery]. 1669 15


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