Georgiadou et al (2014) described brand new readily available evidence concerning the effectiveness and you may coverage of laparoscopic mini-gastric bypass (LMGB)

These investigators performed a scientific look throughout the books, and PubMed and you will site listing were scrutinized (end-of-search date: ). Towards review of your eligible stuff, the fresh new Newcastle-Ottawa top quality assessment size was used. A maximum of ten qualified degree was basically included in this studies, reporting studies to the cuatro,899 people. Based on all incorporated training, LMGB induced nice pounds and you will Body mass index protection, also good-sized additional weight losses. Additionally, solution otherwise change in all of the biggest relevant medical problems and you can upgrade from inside the overall Intestinal Lifestyle Index rating was indeed recorded. Major hemorrhaging and you may anastomotic ulcer was in fact the essential commonly stated issue. Re-entry rate varied of 0 % so you’re able to eleven %, whereas the pace away from upgrade procedures varied away from 0.step three % to 6 %. The second were conducted on account of multiple medical grounds for example ineffective otherwise excessively fat loss, malnutrition, and you can higher gastro-intestinal bleeding. In the long run, new death price varied between 0 % and you can 0.5 % certainly no. 1 LMGB actions. The fresh new article authors determined that LMGB stands for an excellent bariatric techniques; their defense and you will restricted blog post-operative morbidity have a look exceptional. It stated that randomized relative education check mandatory towards after that analysis away from LMGB.

Bariatric Operations having Kind of-2 Diabetic issues

  1. customers that have carrying excess fat greater than or equivalent to amount II (which have co-morbidities) and
  2. clients having diabetes mellitus + carrying excess fat more than otherwise equal to degree We.

The new Swedish Overweight Subjects (SOS) is a potential paired cohort studies presented within twenty-five surgical divisions and you may 480 primary healthcare locations inside Sweden

These types of boffins sparky incorporated 10 knowledge which have a total of 342 clients one to generally investigated a model of your DJBL. For the highest-level fat customers, short-identity additional weight loss is observed. To your leftover patient-related endpoints and patient communities, evidence is often not available or ambiguousplications (mostly lesser) took place 64 in order to a hundred % off DJBL people compared to the 0 to help you twenty seven % about control groups. Gastro-intestinal bleeding was noticed in 4 % away from people. The latest authors do not yet , highly recommend the system to possess routine explore.

Parikh et al (2014) compared bariatric surgery versus intensive medical weight management (MWM) in patients with type 2 diabetes mellitus (T2DM) who do not meet current National Institutes of Health criteria for bariatric surgery and examined if the soluble form of receptor for advanced glycation end products (sRAGE) is a biomarker to identify patients most likely to benefit from surgery. A total of 57 patients with T2DM and BMI 30 to 35, who otherwise met the criteria for bariatric surgery were randomized to MWM versus surgery (bypass, sleeve or band, based on patient preference). The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance (HOMA-IR) and diabetes remission. Secondary outcomes included changes in HbA1c, weight, and sRAGE. The surgery group had improved HOMA-IR (-4.6 versus +1.6; p = 0.0004) and higher diabetes remission (65 % versus 0 %, p < 0.0001) than the MWM group at 6 monthspared to MWM, the surgery group had lower HbA1c (6.2 versus 7.8, p = 0.002), lower fasting glucose (99.5 vs 157; P = 0.0068), and fewer T2DM medication requirements (20% vs 88%; P < 0.0001) at 6 months. The surgery group lost more weight (7. vs 1.0 BMI decrease, P < 0.0001). Higher baseline sRAGE was associated with better weight loss outcomes (r = -0.641; p = 0.046). There were no mortalities. The authors concluded that surgery was very effective short-term in patients with T2DM and BMI 30 to 35. Baseline sRAGE may predict patients most likely to benefit from surgery. However, they stated that these findings need to be confirmed with larger studies.

Sjostrom et al (2014) noted that short-term studies showed that bariatric surgery causes remission of diabetes. The long-term outcomes for remission and diabetes-related complications are not known. These researchers determined the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery. Of patients recruited between , 260 of 2,037 control patients and 343 of 2,010 surgery patients had type-2 diabetes at baseline. For the current analysis, diabetes status was determined at SOS health examinations until . Information on diabetes complications was obtained from national health registers until . Participation rates at the 2-, 10-, and 15-year examinations were 81%, 58%, and 41% in the control group and 90%, 76%, and 47% in the surgery group. For diabetes assessment, the median follow-up time was 10 years (interquartile range [IQR], 2 to 15) and 10 years (IQR, 10 to 15) in the control and surgery groups, respectively. For diabetes complications, the median follow-up time was 17.6 years (IQR, 14.2 to 19.8) and 18.1 years (IQR, 15.2 to 21.1) in the control and surgery groups, respectively. Adjustable or non-adjustable banding (n = 61), vertical banded gastroplasty (n = 227), or gastric bypass (n = 55) procedures were performed in the surgery group, and usual obesity and diabetes care was provided to the control group. Main outcome measures were diabetes remission, relapse, and diabetes complications. Remission was defined as blood glucose less than 110 mg/dL and no diabetes medication. The diabetes remission rate 2 years after surgery was 16.4 % (95 % CI: 11.7 % to 22.2 %; ) for control patients and 72.3 % (95 % CI: 66.9 % to 77.2 %; ) for bariatric surgery patients (odds ratio [OR], 13.3; 95 % CI: 8.5 to 20.7; p < 0.001). At 15 years, the diabetes remission rates decreased to 6.5 % (4/62) for control patients and to 30.4 % () for bariatric surgery patients (OR, 6.3; 95 % CI: 2.1 to 18.9; p < 0.001). With long-term follow-up, the cumulative incidence of microvascular complications was 41.8 per 1,000 person-years (95 % CI: 35.3 to 49.5) for control patients and 20.6 per 1,000 person-years (95 % CI: 17.0 to 24.9) in the surgery group (hazard ratio [HR], 0.44; 95 % CI: 0.34 to 0.56; p < 0.001). Macrovascular complications were observed in 44.2 per 1,000 person-years (95 % CI: 37.5-52.1) in control patients and 31.7 per 1,000 person-years (95 % CI: 27.0 to 37.2) for the surgical group (HR, 0.68; 95 % CI: 0.54 to 0.85; p = 0.001). The authors concluded that in this very long-term follow-up observational study of obese patients with type 2 diabetes, bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care. Moreover, they stated that these findings require confirmation in randomized trials.


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