Objective To investigate the clinical application value of unsymmetrical four-port laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of 114 patients with obesity who were admitted to Mianyang Central Hospital from June 2021 to May 2022 were retrospective analyzed. All the 114 patients underwent unsymme-trical four-port LSG, and were observed their surgical and postoperative conditions, complications and follow-up the patient’s esthetic satisfaction of wounds at 3 months after surgery. Results All 114 patients underwent unsymmetrical four-port LSG successfully, without conversion to open surgery. The operative time was 68–160 min, average (104.2±26.1) minutes; volume of intraoperative blood loss was 2–50 mL, average (10.7±7.6) mL; the duration of postoperative hospital stay was 3–6 d, average (4.0±0.7) days. Of the 114 patients, 8 patients (7.0%) had fat liquefaction of wounds, 68 patients (59.6%) had postoperative nausea and vomiting in the 24 hours after operation, and all patients had no serious complications such as gastrointestinal bleeding, intraperitoneal hemorrhage, or gastric leakage. One hundred and fourteen patients were followed-up for 3–14 months, with a median follow-up of 6 months. Forty patients (35.1%) had hair loss, 3 patients (2.6%) had mild anemia. Of the 114 patients, 2 (1.8%) were dissatisfied with the cosmetic effects of wounds, 64 (56.1%) were satisfied, and 48 (42.1%) were very satisfied. The satisfaction rate was 98.2% (112/114). Conclusion The unsymmetrical four-port LSG is safe and feasible, it does not affect esthetic satisfaction of wounds.
ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
ObjectiveTo systematically review the impact of different electronic health technologies on weight loss outcomes in overweight and simple obesity populations. MethodsThe Cochrane Library, Embase, PubMed and WOS databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to May 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 and Stata 18 software. ResultsA total of 9 RCTs involving 2 416 patients with overweight or simple obesity were included. The meta-analysis results showed that body weight (MD=−0.81, 95%CI −1.1 to −0.52, P<0.001), BMI (MD=−0.63, 95%CI −0.89 to −0.37, P<0.001), waist circumference (MD=−1.06, 95%CI −1.70 to −0.42, P<0.001) and energy intake (SMD=−0.44, 95%CI −0.75 to −0.13, P=0.005) in the e-health technology group were significantly improved compared with the control group. But there was no statistically significant difference in physical activity between two groups. ConclusionThe available evidence suggests that e-health technology is an effective tool for weight loss. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the effect of stomach intestinal pylorus sparing surgery in metabolic surgery for weight loss.MethodThe literatures about stomach intestinal pylorus sparing surgery were reviewed by searching domestic and foreign literatures.ResultsIn recent years, stomach intestinal pylorus sparing surgery had been gradually applied in clinical practice. Compared with other weight-loss surgeries, it had better clinical effects in weight reduction and blood glucose control. It not only provided a new surgical treatment for patients with severe obesity, but also promoted the development of weight-loss metabolic surgery.ConclusionAs a new metabolic surgery, stomach intestinal pylorus sparing surgery is safe and feasible for weight loss.
ObjectiveTo compare the curative effect of biliopancreatic diversion with duodenal switch (BPD/DS) with different gastrointestinal anastomotic position in the rat with obese diabetes. MethodsThe obese diabetic rat models were induced by high-fat feeding for 1 month combined with intraperitoneal injection of low-dose streptozotocin (35 mg/kg), then which were divided into modified BPD/DS (M-BPD/DS), BPD/DS, sleeve gastrectomy (SG), and sham operation (SO) groups according to the operation performed. Eight rats in each group were randomly selected for following experimental observation. The situation of weight loss, glucose reduction, nutrition, and esophagitis were compared among 4 groups, especially between the M-BPD/DS and BPD/DS groups. Results① The body mass and food intake of rats in the M-BPD/DS and BPD/DS groups at 1–4 month(s) after operation (except food intake at the 4th month) were lower than those in the SO group (P<0.05), but it was found that the food intake of the M-BPD/DS group was higher than that of the BPD/DS group at the first month after operation (P<0.05). ② The fasting blood glucose levels of the M-BPD/DS and BPD/DS groups were lower than those of the SO group (P<0.05) and were lower than those before the operation (P<0.05), but which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). ③ The area under receiver operating characteristic curve (AUC) of blood glucose level by oral glucose tolerance test, insulin tolerancetest (ITT), and the homeostasis model assessment-insulin resistance index at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were lower of the SO group (P<0.05) and before operation (P<0.05), but which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). It was also found that the AUCs of ITT values at the 4th month after operation of the M-BPD/DS and BPD/DS groups were higher than those of the 1st month after operation (P<0.05). ④ The AUCs of the glucagon like peptide-1 (GLP-1) levels at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were higher than those of the SO group (P<0.05), while the AUCs of the insulin index were lower than those of the SO group (P<0.05) at 1 and 4 months after operation. At the 1st and 4th month after operation, the AUCs of the GLP-1 were higher and the insulin were lower than those before operation (P<0.05) in the M-BPD/DS and BPD/DS groups, which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). ⑤ The albumin, calcium, and ferrum at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were statistically lower than those of the SO group (P<0.05) and lower than those before operation (P<0.05). ⑥ The thickness of esophageal squamous epithelium and rate of nipple elongation of the M-BPD/DS group were lower than those of the BPD/DS group (P<0.05). ConclusionThe results of this experiment suggest that moving the gastrointestinal anastomosis above the pylorus simplifies the operationof BPD/DS without affecting its weight loss and glucose lowering effect , and may have a protective effect on the esophagus.
ObjectiveTo explore the effect of laparoscopic sleeve gastrectomy (LSG) on obesity and its comorbidities.MethodThe literatures about LSG in the treatment of obesity and its comorbidities were collected and summarized.ResultsLSG could not only effectively reduce the weight of patients with obesity, but also obviously alleviate comorbidities related to obesity, such as type 2 diabetes mellitus, obstructive sleep apnea syndrome, polycystic ovary syndrome, essential hypertension, hyperlipidemia, and so on.ConclusionsLSG has a definite and effective long-term weight loss effect, which is equal to other common weight loss methods. It has been recognized by more and more patients and clinicians because it has advantages of simple operation, safety, high efficiency and fewer complications. However, therapeutic effects of some comorbidities, such as gastroesophageal reflux disease, are still controversial and need further tobe studied.
ObjectiveTo compared weight loss and metabolic improvement effects of laparoscopic sleeve gastrectomy (LSG) in treatment of obese males and females. MethodsAccording to the inclusion and exclusion criteria, the obese patients were retrospectively collected, who underwent LSG from January 2020 to June 2021 in the Affiliated Hospital of Xuzhou Medical University, and there were complete preoperative data and postoperative follow-up data at month 1, 3, 6, and 12. The weight loss and metabolic improvement effects of obese males and females were compared, as well as the remissions of diabetes and hyperlipidemia at the 12th month after surgery were observed. ResultsA total of 129 eligible obese patients were included, including 44 obese males and 85 obese females. The preoperative body mass index (BMI), fasting blood glucose (FBG) level, and insulin level of the obese males were higher than those of the obese females (P<0.05). ① Weight loss effect after LSG: For both obese males and females, the change value (Δ) of BMI (all change values of the indexes were the difference between preoperative and postoperative value in this study), the percentage of excess body weight loss (EWL%), and percentage of total body weight loss showed continuous upward trends within the observation time range (P<0.05). And it was found that the obese males’ ΔBMI was higher than that of the obese females at the 1st and 3rd month after surgery (P<0.05), and the EWL% of the obese males was lower than that of the obese females at the 3rd, 6th, and 12th month after operation (P<0.05). ② Metabolic improvement effect after LSG: Blood glucose and lipid metabolism indicators in both male and female patients（ΔFBG, ΔINS, ΔHbA1c, ΔTC and ΔTG) changed the fastest at 1 month after operation, and the change became flat after 3 months, except for males ΔTC index (P>0.05), the overall difference between male and female patients at each time point after operation was statistically significant (P<0.05). After operation, the ΔFBG (at the 1st, 3rd, 6th, and 12th month) and Δinsulin (at the 3rd, 6th, and 12th month) in the obese males were higher than those in the obese females (P<0.05). The remission rates of diabetes and hyperlipidemia in the obese males and females at the 12th month after surgery were both higher, but there was no significant difference between the two groups [64.7% (11/17) versus 81.0% (17/21), χ2=0.578, P=0.447; 73.9% (17/23) versus 84.4% (27/32), χ2=0.378, P=0.539]. ConclusionsFrom the results of this study, LSG is an effective method in treatment of obesity and its complications for both males and females. Bariatric surgery should be suggested to perform as soon as possible for obese males with poor metabolic status.
ObjectiveTo evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity with different degrees of obesity.MethodsThe clinicopathologic data of patients received LSG in this hospital from October 2016 to October 2018 were analyzed retrospectively. The effect of LSG on postoperative weight loss in patients with different degrees of obesity were analyzed too.Results① A total of 161 patients with simple obesity were included in this study, including 40 cases of degree Ⅰ obesity, 41 cases of degree Ⅱ obesity, 61 cases of degree Ⅲ obesity, and 19 cases of super obesity. All operations were successfully completed, there was no conversion to laparotomy or mortality. The postoperative bleeding occurred in 4 (2.5%) cases, nausea and vomiting occurred in 97 (60.2%) cases during hospitalization, and 143, 130, and 122 cases were followed up in 1-, 2-, and 3-year after operation. The body mass indexes (BMIs) were decreased significantly in postoperative 1-, 2-, and 3-year (P<0.05) as compared with their preoperative values, respectively. The excess BMI loss percentage(EBMIL%) in postoperative 1-, 2-, and 3-year were (87.4±25.7)%, (84.6±30.5)%, and (88.8±20.4)%, respectively. The rates of weight regaining were 3.8% (5/130) and 4.9% (6/122) in 2- and 3-year following-up, respectively. ② There were no remarkable changes in the trend of BMI in patients with degree Ⅰ and Ⅱ obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–2.3±1.1)% and (3.3±1.5)%, respectively]. Conversely, there were remarkable changes in the trend of BMI in patients with degree Ⅲ obesity and super obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–7.1±1.9)% and (–11.6±5.3)%, respectively].ConclusionsFrom the results of this study, LSG has a good effect on weight loss in the treatment of patients withdegree Ⅰ and Ⅱ obesity. The long-term efficacy of LSG in patients with degree Ⅲ and super obesity, whether to take other bariatric procedures, whether to perform the second operation, and the timing of the second operation need to be further explored.
ObjectiveTo explore a surgery of effective weight loss concentrating on gut hormone release. MethodsWistar rats were fed with high-fat diet for inducing obesity and which randomly divided into sleeve gastrectomy plus decent jejunoileal bypass (SJB) group (n=12), sleeve gastrectomy (SG) group (n=12), and sham operation (SO) group (n=11), the body weight reduction, food intake, plasma ghrelin level, and glucagon like peptide-1 (GLP-1) level were compared among three groups. ResultsThere were no differences of the body weight and food intake before operation among three groups (Pgt;0.05). Compared with the SO group, the body weight descended and the food intake decreased obviously on 1-8 weeks after operation in the SJB group (Plt;0.05), the body weight of rats on 1-8 weeks after operation in the SJB group significantly descended as compared with the SG group (Plt;0.05), and the food intake of rats on week 3, 6, 7, and 8 in the SJB group signicantly decreased as compared with the SG group (Plt;0.05). There were no differences of the levels of the plasma ghrelin and GLP-1 before operation among three groups (Pgt;0.05). Compared with SO group, the plasma ghrelin level decreased and the GLP-1 level increased in the SJB group and the SG group, meanwhile the SJB group significantly decreased level of plasma ghrelin and elevated level of plasma GLP-1 as compared with the SG group on week 8 after operation(Plt;0.05). ConclusionThe data demonstrate that SJB could represent an effective way of losing weight by interfering with food intake and obesity related hormone levels.
A lot of evidence-based medical evidence has shown that laparoscopic Roux-en-Y gastric bypass (LRYGB) is a durable and effective method for obesity and diabetes, and can significantly improve a series of obesity-related metabolic complications. This guideline provides a detailed description of the main operating steps and technical points of the symmetric three-port LRYGB, including posture layout, trocar position selection, liver suspension, gauze exposure, production of small gastric sacs, gastrojejunal anastomosis and production of biliary pancreatic branches, entero-enteric side to side anastomosis, closure of gastrointestinal anastomosis and mesenteric hiatus, greater omentum coverage, and closure of incisions. The purpose is to standardize the operating process of the symmetrical three hole method of LRYGB, providing standardized surgical operation references for clinical doctors in the field of obesity metabolic surgery.