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Mirnezami R, Ahmed A, 2018, Surgery 3.0, artificial intelligence and the next-generation surgeon, BRITISH JOURNAL OF SURGERY, Vol: 105, Pages: 463-465, ISSN: 0007-1323
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Kamocka A, McGlone ER, Perez-Pevida B, et al., 2018, Surgical revision of candy cane after Roux-en-Y gastric bypass, Obesity Update 2018, Pages: CD2.3-CD2.3, ISSN: 1470-3947
Hameed S, Salem V, Tan T, et al., 2018, Beyond weight loss: establishing a postbariatric surgery patient support group - what do patients want?, Journal of Obesity, Vol: 2018, Pages: 1-7, ISSN: 2090-0708
Purpose: There are limited resources for long-term specialist follow-up after bariatric surgery. In selected centres, patients can access a postoperative support group, but there is no clear evidence to guide their delivery. Materials and Methods: A retrospective study of bariatric surgery patients (n = 152) who had been discharged from specialist follow-up (mean time since surgery 5.5 years), covering weight history, physical and psychosocial comorbidities, and the need for a postoperative bariatric support group. Results: Fifty-eight percent wanted a postbariatric surgery patient support group. This was not associated with operation type or the amount of weight lost or regained. However, those who wanted a support group were significantly more likely to be struggling to keep the weight off, to be unhappy with the way they look, or to be experiencing difficulties returning to work.Conclusions: These data point to an unmet patient requirement for a postoperative support group that is independent of weight loss success. More research is required to ascertain how such a group should be delivered, but our data would suggest that supporting patients with weight loss maintenance, body image, and return to work is an important part of postoperative care, and these needs extend well beyond the immediate period of specialist follow-up.
Glaysher M, Mohanaruban A, Prechtl CG, et al., 2017, A randomised controlled trial of a duodenal-jejunal bypass sleeve device (EndoBarrier) compared with standard medical therapy for the management of obese subjects with type 2 diabetes mellitus, BMJ Open, Vol: 7, ISSN: 2044-6055
Introduction The prevalence of obesity and obesity-related diseases, including type 2 diabetes mellitus (T2DM), is increasing. Exclusion of the foregut, as occurs in Roux-en-Y gastric bypass, has a key role in the metabolic improvements that occur following bariatric surgery, which are independent of weight loss. Endoscopically placed duodenal-jejunal bypass sleeve devices, such as the EndoBarrier (GI Dynamics, Lexington, Massachusetts, USA), have been designed to create an impermeable barrier between chyme exiting the stomach and the mucosa of the duodenum and proximal jejunum. The non-surgical and reversible nature of these devices represents an attractive therapeutic option for patients with obesity and T2DM by potentially improving glycaemic control and reducing their weight.Methods and analysis In this multicentre, randomised, controlled, non-blinded trial, male and female patients aged 18–65 years with a body mass index 30–50 kg/m2 and inadequately controlled T2DM on oral antihyperglycaemic medications (glycosylated haemoglobin (HbA1c) 58–97 mmol/mol) will be randomised in a 1:1 ratio to receive either the EndoBarrier device (n=80) for 12 months or conventional medical therapy, diet and exercise (n=80). The primary outcome measure will be a reduction in HbA1c by 20% at 12 months. Secondary outcome measures will include percentage weight loss, change in cardiovascular risk factors and medications, quality of life, cost, quality-adjusted life years accrued and adverse events. Three additional subgroups will investigate the mechanisms behind the effect of the EndoBarrier device, looking at changes in gut hormones, metabolites, bile acids, microbiome, food hedonics and preferences, taste, brain reward system responses to food, eating and addictive behaviours, body fat content, insulin sensitivity, and intestinal tissue gene expression.
Tharakan G, Behary P, Wewer Albrechtsen NJ, et al., 2017, Roles of increased glycemic variability, GLP-1 and glucagon in hypoglycaemia after Roux-en-Y gastric bypass., European Journal of Endocrinology, Vol: 177, Pages: 455-464, ISSN: 0804-4643
Objective Roux-en-Y Gastric Bypass (RYGB) surgery is currently the most effective treatment for diabetes and obesity. An increasingly recognized complication of RYGB surgery is postprandial hypoglycemia (PPH). The pathophysiology of PPH remains unclear with multiple mechanisms suggested including nesidioblastosis, altered insulin clearance and increased glucagon-like-1 peptide (GLP-1) secretion. Whilst many PPH patients respond to dietary modification, some have severely disabling symptoms. Multiple treatments have been trialled ranging from acarbose, to both GLP-1 agonists and antagonists, even to reversal of RYGB. A greater understanding of the pathophysiology of PPH could guide the development of new therapeutic strategies. Methods We studied a cohort of PPH patients at the Imperial Weight Center. We performed continuous glucose monitoring to characterize their altered glycemic variability. We also performed a mixed meal test (MMT) and measured gut hormone concentrations. Results We found increased glycemic variability in our cohort of PPH patients, specifically a higher Mean Amplitude Glucose Excursion (MAGE) score of 4.9. We also demonstrated significantly greater and earlier increases in insulin and GLP-1 concentration in patients who had hypoglycemia in response to an MMT (MMT Hypo) relative to those that did not (MMT Non-Hypo). There was a significantly increased glucagon secretion in the MMT Hypo group versus the Non-hypo group. No significant differences in oxyntomodulin, GIP or peptide YY secretion were seen between these two groups. Conclusion An early peak in GLP-1 and glucagon, due to post-operative L-cell hypertrophy and aberrant processing of proglucagon, may trigger an exaggerated insulinotropic response to eating in patients with PPH.
Rogers CA, Reeves BC, Byrne J, et al., 2017, Adaptation of the By-Band randomized clinical trial to By-Band-Sleeve to include a new intervention and maintain relevance of the study to practice., Br J Surg, Vol: 104, Pages: 1207-1214
BACKGROUND: Recruitment into surgical RCTs can be threatened if new interventions available outside the trial compete with those being evaluated. Adapting the trial to include the new intervention may overcome this issue, yet this is not often done in surgery. This paper describes the challenges, rationale and methods for adapting an RCT to include a new intervention. METHODS: The By-Band study was designed in the UK in 2009-2010 to compare the effectiveness of laparoscopic adjustable gastric band and Roux-en-Y gastric bypass for severe obesity. It contained a pilot phase to establish whether recruitment was possible, and the grant proposal specified that an adaptation to include sleeve gastrectomy would be considered if practice changed and recruitment was successful. Information on changing obesity surgery practice, updated evidence and expert opinion about trial design were used to inform the adaptation. RESULTS: The pilot phase recruited over 13 months in 2013-2014 and randomized 80 patients (79 anticipated). During this time, major changes in obesity practice in the UK were observed, with gastric band reducing from 32·6 to 15·8 per cent and sleeve gastrectomy increasing from 9·0 to 28·1 per cent. The evidence base had not changed markedly. The British Obesity and Metabolic Surgery Society and study oversight committees supported an adaptation to include sleeve gastrectomy, and a proposal to do so was approved by the funder. CONCLUSION: Adaptation of a two-group surgical RCT can allow evaluation of a third procedure and maintain relevance of the RCT to practice. It also optimizes the use of existing trial infrastructure to answer an additional important research question. Registration number: ISRCTN00786323 (http://www.isrctn.com/).
Gomez NF, Markakis C, Tsironis C, et al., 2017, BARIATRIC SURGERY AFTER NISSEN'S FUNDOPLICATION Revisional surgery, Publisher: SPRINGER, Pages: 1138-1138, ISSN: 0960-8923
Mcglone ER, Kamocka A, Pevida BP, et al., 2017, IS REVISION OF THE 'CANDY CANE' AFTER ROUX-EN-Y GASTRIC BYPASS (RYGB) WORTHWHILE? Revisional surgery, Publisher: SPRINGER, Pages: 944-944, ISSN: 0960-8923
Gomez NF, Yeung D, Tsironis C, et al., 2017, MANAGEMENT OF BILE DUCT STONES AFTER ROUX-EN-Y GASTRIC BYPASS Gastric bypass procedures including Roux-en-Y gastric bypass (RYGB) and One Anastomosis gastric bypass (OAGB)/MGB, Publisher: SPRINGER, Pages: 620-620, ISSN: 0960-8923
Gomez NF, Hakky S, Markakis C, et al., 2017, OPTIMIZING RE-SLEEVE GASTRECTOMY FOR WEIGHT REGAIN Sleeve gastrectomy, Publisher: SPRINGER, Pages: 997-997, ISSN: 0960-8923
Gomez NF, Hakky S, Markakis C, et al., 2017, DETECTIVE BARIATRIC SURGEON: REVISIONAL SURGERY OF UNCOMMON BARIATRIC PROCEDURES Revisional surgery, Publisher: SPRINGER, Pages: 1174-1174, ISSN: 0960-8923
Markakis C, Gomez NF, Wilson F, et al., 2017, LAPAROSCOPIC REUX-EN-Y GASTRIC BYPASS IN A PATIENT FOUND TO HAVE MIDGUT NON-ROTATION Gastric bypass procedures including Roux-en-Y gastric bypass (RYGB) and One Anastomosis gastric bypass (OAGB)/MGB, Publisher: SPRINGER, Pages: 541-541, ISSN: 0960-8923
Markakis C, Yeung KTD, Mok KWJ, et al., 2017, THE USE OF CYANOACRYLATE GLUE FOR THE CLOSURE OF MESENTERIC DEFECTS IN LAPAROSCOPIC GASTRIC BYPASS New (Non Standard) Surgical Techniques, Publisher: SPRINGER, Pages: 1190-1190, ISSN: 0960-8923
Nedelcu M, Manos T, Gagner M, et al., 2017, Cost analysis of leak after sleeve gastrectomy., Surgical Endoscopy, Vol: 31, Pages: 4446-4450, ISSN: 0930-2794
BACKGROUND: Leaks after laparoscopic sleeve gastrectomy (LSG) are serious complications of this procedure. The objective of the present study was to evaluate the costs of leaks after LSG. SETTING: Private hospital, France. METHODS: A retrospective analysis was conducted on a prospective cohort of 2012 cases of LSG between September 2005 and December 2014. Data were collected on all diagnostic and therapeutic measures necessary to manage leaks, ward, and intensive care unit (ICU) length of stay. Additional outpatient care was also analyzed. RESULTS: Twenty cases (0.99%) of gastric leak were recorded. Fifteen patients had available data for cost analysis. Of these, 13 patients were women (86.7%) with a mean age of 41.4 years (range 22-61) and mean BMI of 43.2 kg/m(2) (range 34.8-57.1). The leaks occurred after 7.4 days (±2.3) postoperatively. Only one gastric leak was recorded for the last 800 cases in which absorbable staple line reinforcement was used. Mean intra-hospital cost was 34398 € (range 7543-91,632 €). Prolonged hospitalization in ICU accounted for the majority of hospital costs (58.9%). Mean additional outpatient costs for leaks were 41,284 € (range 14,148-75,684€). CONCLUSIONS: Leaks after LSG are an expensive complication. It is therefore important to take all necessary measures to reduce their incidence. Our data should be considered when analyzing the cost effectiveness of staple line reinforcement usage.
Ahmed A, Tharakan G, Purkayastha S, et al., 2017, Bariatric surgery outcomes in the over-60s: a single centre, observational study from 2007-2012, 8th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: Wiley, Pages: 6-6, ISSN: 1365-2168
Markakis C, Gomez NF, Aggarwal R, et al., 2017, Refashioning of gastrojejunal anastomosis and partial excision of gastric remnant in a patient presenting with haematemesis 3 years after banded gastric bypass, 8th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: Wiley, Pages: 12-12, ISSN: 1365-2168
Ahmed A, Tharakan G, Purkayastha S, et al., 2017, Management of post prandial hypoglycaemia using liraglutide - comprehensive profiling pre and post intervention, 8th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: Wiley, Pages: 7-8, ISSN: 1365-2168
Gomez NF, Hakky S, Markakis C, et al., 2017, Dismantling a butterfly gastroplasty: revision surgery of an uncommon bariatric procedure, 8th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: Wiley, Pages: 11-11, ISSN: 1365-2168
Ahmed A, Tharakan G, Purkayastha S, et al., 2017, The role of increased glycemic variability and glucagon in the pathophysiology of postprandial hypoglycemia after RYGB, 8th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: Wiley, Pages: 13-13, ISSN: 1365-2168
Pérez-Pevida B, Kamocka A, Alasfour S, et al., 2017, Long-term micronutrient deficiencies in poor responders after bariatric surgery, International Federation for Surgery for Obesity, Pages: 1-1253
McGlone ER, Kamocka A, Pevida B, et al., 2017, Is revision of the ‘candy cane’ after Roux-en-Y gastric bypass worthwhile?, International Federation for Surgery for Obesity, Pages: 1-1253
Tharakan G, Scott R, Szepietowski O, et al., 2016, Limitations of the DiaRem Score in Predicting Remission of Diabetes Following Roux-En-Y Gastric Bypass (RYGB) in an ethnically Diverse Population from a Single Institution in the UK, Obesity Surgery, Vol: 27, Pages: 782-786, ISSN: 1708-0428
PurposeThis study aimed to determine the predictive power of the DiaRem score following Roux-en-Y gastric bypass to identify patients who would have diabetes remission at 1 year in an ethnically diverse population.MethodsWe performed a retrospective review of 262 patients with type 2 diabetes mellitus who underwent RYGB at the Imperial Weight Centre, UK, from 2007 to 2014. Data was collected on the parameters required to calculate the DiaRem score as well as pre- and post-surgical weight and the ethnicity of the subjects.ResultsThe studied cohort was ethnically diverse (61.3 % Caucasian, 10.3 % Asian, 5.3 % black, 2.6 % mixed and 20.6 % other). At 1-year post-surgery, there were significant reductions in mean weight (133.4 to 94.3 kg) and BMI (46.7 to 33.3 kg/m2). The mean HbA1c decreased from 8.2 to 6.1 %, and 32.5 % of the cohort underwent either partial or complete remission. 67.8 % of the patients that were classified in group 1 of the DiaRem score (most likely to have remission) had complete remission. However, 22.9 % of the patients predicted to have the least chance of remission had either partial or complete remission.ConclusionsIn this ethnically diverse cohort, the DiaRem score remains a useful tool to predict diabetes remission in those that have a low DiaRem score (high chance for remission) but was more limited in its predictive power in those with a high DiaRem score (least likely to have remission). Caution must be used in the application of this model in populations other than the US white Caucasian population used to derive the score.
Saleh M, Cheruvu MS, Moorthy K, et al., 2016, Laparoscopic sleeve gastrectomy using a synthetic bioabsorbable staple line reinforcement material: Post-operative complications and 6 year outcomes., Annals of Medicine and Surgery, Vol: 10, Pages: 83-87, ISSN: 2049-0801
BACKGROUND: Gastric leak after laparoscopic sleeve gastrectomy (LSG) is a serious complication. Currently, the literature lacks long-term outcomes in LSG and leak rates after reinforcement of the staple line. The aims are two-fold: to present leak rates from using staple line reinforcement and six year outcomes of LSG in relation to resolution of obesity-related comorbidities and long-term weight loss. MATERIALS AND METHODS: This is a single-institution, retrospectively reviewed study of 204 patient case files. Data from all patients undergoing LSG between December 2007 and May 2013 was collected. RESULTS: The total complication rate was 6.9% (14/204), with no recorded staple line leaks. The mean postoperative Body Mass Index (BMI) at 1 year, 2 years, 3 years, 4 years, 5 years, and 6 years was 39.3 ± 8, 38.7 ± 8, 40.4 ± 9, 40.5 ± 10, 43.0 ± 10, and 42.4 ± 7, respectively. The mean % excess weight loss at 1 year, 3 years, and 6 years was 48.4 ± 19, 51.7 ± 28, and 41.0 ± 21, respectively. There were no significant differences between follow-ups at year 1 and 3 (p > 0.05), and between year 3 and 6 (p > 0.05) for the mean % excess weight loss. The resolution rates for all patients were 74%, 61%, 79%, and 90% for hypertension, hypercholesterolemia, diabetes mellitus type 2 and obstructive sleep apnea, respectively. CONCLUSION: The synthetic bioabsorbable reinforcement material shows no staple line leaks making it safe to use. LSG as a procedure had a high resolution of obesity-related comorbidities as well as sustainable long-term weight loss.
Zhang R, Borisenko O, Telegina I, et al., 2016, Systematic review of risk prediction models for diabetes after bariatric surgery, British Journal of Surgery, Vol: 103, Pages: 1420-1427, ISSN: 1365-2168
Background: Diabetes remission is an important outcome after bariatric surgery. The purpose of this study was to identify risk prediction models of diabetes remission after bariatric surgery.Methods: A systematic literature review was performed in MEDLINE, MEDLINE-In-Process, Embase and the Cochrane Central Register of Controlled Trials databases in April 2015. All English language full-text published derivation and validation studies for risk prediction models on diabetic outcomes after bariatric surgery were included. Data extraction included population, outcomes, variables, intervention, model discrimination and calibration.Results: Of 2331 studies retrieved, eight met the inclusion criteria. Of these, six presented development of risk prediction models and two reported validation of existing models. All included models were developed to predict diabetes remission. Internal validation using tenfold validation was reported for one model. Two models (ABCD score and DiaRem score) had external validation using independent patient cohorts with diabetes remission at 12 and 14 months respectively. Of the 11 cohorts included in the eight studies, calibration was not reported in any cohort, and discrimination was reported in two.Conclusion: A variety of models are available for predicting risk of diabetes following bariatric surgery, but only two have undergone external validation.
Fakih N, Yeung DKT, Jamshidi S, et al., 2016, LAPAROSCOPIC COMMON BILE DUCT EXPLORATION AFTER ROUX-EN-Y GASTRIC BYPASS, 21st World Congress of International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: S374-S375, ISSN: 0960-8923
Macaskill A, Ahmed A, Hakky S, et al., 2016, BARIATRIC SURGERY FOR THE METABOLICALLY HEALTHY OBESE IN THE > 60 POPULATION; IS IT JUST AESTHETIC?, 21st World Congress of International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: S200-S201, ISSN: 0960-8923
Fakih N, Hakky S, Ahmed A, 2016, DISMANTLING A BUTTERFLY GASTROPLASTY : REVISION SURGERY OF AN UNCOMMON BARIATRIC PROCEDURE, 21st World Congress of International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: S273-S274, ISSN: 0960-8923
Yeung KTD, Fakih N, Hakky S, et al., 2016, COMBINED ENDOSCOPIC AND LAPAROSCOPIC PIECEMEAL REMOVAL OF ADHERENT ERODED GASTRIC BAND, 21st World Congress of International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: S233-S233, ISSN: 0960-8923
Fakih N, Yeung KTD, Jamshidi S, et al., 2016, BARIATRIC SURGERY AFTER NISSEN'S FUNDOPLICATION, 21st World Congress of International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: S197-S197, ISSN: 0960-8923
Moussa OM, Macaskill A, Fakir N, et al., 2016, OUTCOMES IN 60 YEARS AND OLDER AT A HIGH VOLUME BARIATRIC SURGERY CENTER; IS IT SAFE?, 21st World Congress of International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO), Publisher: SPRINGER, Pages: S444-S445, ISSN: 0960-8923
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