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Surgical Treatments of Obesity
Published in Ruth Chambers, Paula Stather, Tackling Obesity and Overweight Matters in Health and Social Care, 2022
Laparoscopic Roux-en-Y gastric bypass (LRYGB): this procedure has been in practice for over 58 years and has stood the test of time—hence, some people refer to it as the ‘gold standard’. In the United States and Europe, gastric bypass surgery is widely used as a first-line procedure in obesity surgery. A 25–30-ml segment of the proximal stomach is isolated from the rest of the stomach and is anastomosed to the proximal jejunum, bypassing most of the stomach and the entire duodenum. This restricts food intake in the same way as gastroplasty does, as well as inducing a degree of malabsorption. This double action is what makes gastric bypass surgery so effective in inducing and maintaining long-term weight loss. Gastric bypass surgery is a bigger and more technically demanding operation than gastroplasty, and malabsorption of iron, folate and vitamin B12 can occur post-operatively, requiring supplements and careful monitoring for life. The excess weight loss of >50% is maintained at five years in most patients, and this can be sustained at ten years, too.
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Decreased intake or abnormal absorption: Poor nutrition in alcoholism.Chronic vomiting (e.g. hyperemesis gravidarum).Total parental nutrition.Gastric bypass surgery.Restrictive diets.Hyperthyroidism: increased metabolism and utilization of thiamine may result in a relative deficiency.
Lifestyle management
Published in Janet Titchener, Diabetes Management, 2020
While weight loss, exercise and ‘healthy’ eating are all considered important components of lifestyle management, it is unclear which of these components is the most important. Some claim weight loss to be the most important.12–17 Yet the remarkable remission of diabetes in those who receive gastric bypass surgery prior to losing any significant amounts of weight suggest dietary changes might be more important.18
Efficacy of laparoscopic gastric bypass vs laparoscopic sleeve gastrectomy in treating obesity combined with type-2 diabetes
Published in British Journal of Biomedical Science, 2021
Y Yan, F Wang, H Chen, X Zhao, D Yin, Y Hui, N Ma, C Yang, Z Zheng, T Zhang, N Xu, G Wang
Surgical methods have been recently recommended for the treatment of morbid obesity for some patients, especially for patients with a BMI of >32 kg/m2 for more than 5 years and severe complications. Sundbom et al. conducted a 5-year study and reported that the Roux-en-Y gastric bypass surgery can remarkably decrease the BMI and improve obesity-related complications of type-2 diabetes, hypertension, dyslipidemia and sleep apnoea, as well as fasting glucose and glycated haemoglobin [20]. Another study revealed that in patients with obesity, surgery may decrease the risk of breast cancer but not the increased the risk of colorectal cancer [21]. In a recent review, the authors suggested that metabolic surgery for type-2 diabetes is recommended as a primary indication for patients with BMI = 40 kg/m2 [22]. In the present study, it was found that both laparoscopic gastric bypass and laparoscopic sleeve gastrectomy could lead to effective treatment results for obesity patients with BMI>20 kg/m2 combined with type-2 diabetes.
Effect of parathyroidectomy on osteopontin and undercarboxylated osteocalcin in patients with primary hyperparathyroidism
Published in Endocrine Research, 2018
Raelene E. Maser, M. James Lenhard, Ryan T. Pohlig, P. Babu Balagopal, Raafat Abdel-Misih
Table 1 provides participants’ physical characteristics and metabolic parameters before and 1 month following parathyroidectomy. As expected PTH and calcium levels were significantly lower following surgery. In addition OPN, ucOC, and the ucOC/OC ratio, were also significantly reduced postsurgery. OC, β-CTX, and OPG levels, however, did not change significantly, whereas lipocalin-2 concentrations were higher. Of note, two participants had a previous history of resolved malignant disease that did not require current treatment. Three of the females in this study were premenopausal. With the exception of one female that used Premarin vaginally twice per week, none of the participants indicated that they were currently taking bisphosphonates, estrogen, or raloxifene. Four participants had a history of type 2 diabetes mellitus (T2DM) that was treated with metformin (n = 4) and a sulfonylurea (n = 2) but none were using a thiazolidinedione. One participant had a previous history of gastric bypass surgery. Because of the characteristics of the study cohort, data analysis was repeated excluding (a) premenopausal women (n = 3), (b) individuals with T2DM (n = 4), and (c) the individual with bariatric surgery. The univariate statistically significant results for OPN, ucOC, and lipocalin-2 pre- versus post-surgery remained after reanalyses, despite the exclusion of these individuals (data not shown).
Effects of anti-diabetic treatments in type 2 diabetes and fatty liver disease
Published in Expert Review of Clinical Pharmacology, 2021
Elizabeth M. Lamos, Megan Kristan, Maka Siamashvili, Stephen N. Davis
Two other techniques for body weight reduction that could benefit individuals with T2DM and NAFLD are endoscopic duodenal mucosal resurfacing and endoscopic placement of a gastrostomy tube. The former is a minimally invasive procedure involving hydrothermal ablation of duodenal mucosa and subsequent mucosal healing. The goal of this procedure is to mimic the positive effects of gastric bypass surgery in a less invasive manner. In the first human study, obese individuals with T2DM demonstrated improvements in fasting plasma glucose and HbA1c and modest weight loss (2.5 kg) over 6-month follow-up [57]. The authors suggest that the glucose improvement primarily seen in fasting values may reflect changes in hepatic glucose production resultant on improved insulin sensitivity. Future studies aim to elucidate the role of the duodenum in metabolism regulation and the clinical effectiveness and benefits of this technique. Endoscopic placement of a gastrostomy tube assisted by an external accessory device enables the infusion of liquid and aspiration of approximately 30% of calories consumed. In conjunction with lifestyle modification, the goal of the procedure is to reduce caloric ingestion and increase physical activity. In a multi-site study over 1-year, obese individuals who were randomized to the aforementioned procedure lost a mean of 32% of excess body weight compared to lifestyle modification alone [58]. There was also a modest improvement in blood pressure and lipid profiles. This procedure is designed for long-term treatment (unlike gastric balloon technique) and may provide an acceptable and reversible option between diet and lifestyle changes and more invasive bariatric procedures. No studies have included individuals with T2DM and NAFLD.