StacySurgery - PDF document

1 Surgery surgery StacySurgery Institute,G
Surgery surgery StacySurgery Institute,GeneralSurgery, Received Preamble Surgerysurgerygery . That statement wasdevelopedphysicians,policymakers,regardingefcacysurgeryindex Introduction haveburdenindividuallarge.Overworldwideprevalence ClevelandAvenue,Cleveland,aminiaa@ccf.org women I developinghypertension,gain. https://doi.org/10.1016/j.soard.2018.05.0251550-7289/©2018Surgery.Elsevierreserved. Surgery factors.Severalhaveshownfattyliverobstructivepolycysticovaryy . Excess weight is increasingly recognized as an im- portant risk factoractor . A largeshowedwasthyroid,women,gallbladder,weakerpositive(relativemanyobservedd . A meta-analysis of 89 studies showedoverweight/obesityhypertension,gestivefailure,stroke,gallbladderoverweightsevereobesity,overweightobesity,showingeffectfect . From a mortality standpoint, an adjusted collaborativetiveshowedoverallwaslowestsexesAbovewasvascular;survivalwass . It is important to mention that BMI alone is a poor indicator of adiposity,cardiovascu-Individualshavedifferentgivendifferentfatversusrsus . Forexample,fatwouldhealthyindividualAltogether,ex

2 pectancyy . Therefore, class I obesity d
pectancyy . Therefore, class I obesity deserveseffective Nonsurgicaltreatment efcacyfactors obesity,effectiveindividualsbeginnonsurgicaltherapysurgerytheyachievesufcientimprovementnonsurgicalgical . Lifestyle modication programs designed to improvephysicalactivityobesity,givenlowadverseevents.However,overregaininter-ventionention . Pharmacotherapyeffectsinterventionsindividualsobesity.Currently,approvednaltrexone–bupropion)differentHowever,adverseeventsents . Endoscopic intraluminal procedures including temporary intragastricgastricgastrointestinalhavedevelopedeffectssurgerygery . However,haveSpecically,safety,tolerability,efcacy,Forobesity,nonsurgicalobesity.individualsregainreviewsexercise,pharmacotherapy,behav-therapyhavebeyondyond . Nonetheless, within the total group of participants stud- ied in these trials and within the general practice of bariatric medicine, approximately 25% to 50% of individ-achievehaveseveralconsider-surgicalanyindividual,nonsurgicaltherapyalwayshowever,haveeffective,individualexpectancy Surgery effective,therapy,surgery CurrentPositionSurgery Confere

3 nce, developmentgastrointestinalsurgerys
nce, developmentgastrointestinalsurgerysurgerygery . A synthesis of the viewssurgerynewhaveparoscopylargelysurgery,levelsevidencenowavailableregardingimprovedsurgerygery . Givenhaveviewnowavailable,contextsurgerygery . Despite attempts to update the recommendations of the original guidelines [7,8] , privateabovesurgeryoffersfavorableprovider,payer.lar,surgeryobesity.relevantnonsurgicalevidencesurgicalprovidecost-effective FederationSurgeryDisorders comprehensivereviewsurgerygery . This position state- ment outlined the following:surgery level,indexpredictor.Patientsachievenonsurgicaltherapysurgery.surgeryindividualprehensiveevaluationpatient’ssurgeryfailuresurgicaltherapy.surgeryburdenlevels.evaluatedlikelysurgeryhowthey JointOrganizations SurgerywasconvenedorganizationsdevelopsurgerySurgeryworldwidee . The guidelines state that metabolic surgeryhyper- CareExcellence, evidence-basedwass , stating that an assessment for bariatric surgeryhavetheyreceivingreceiveEngland’scovers surgeryfor robustefcacysurgeryobesity. Surgery , 16 obser-vationaltional on outcomes of bariatric surgerygery

4 . In the last 5 years, there is mountin
. In the last 5 years, there is mounting evidencesurgicalsity.havereviewss (for a total of 11), and 8 RCTs [65–80] (for a total of 12) examiningcacysurgerymarkedimprovementtherapyobesity. reviewsTable wasevaluatedvariousevaluatedshowedachieveviewloww conducted a literature reviewvarioussurgeriesTheyexaminingdiversiongastric(RYGB),gastricsleevegastrec-gastric(AGB).TheyRYGBgastricrespectively)Parikhh published a largereviewvarietysurgicalinterventionsexaminingobesity.Theywasinterval,per-AGBlowestgastricRYGBTheylowreviewAgencyexaminingcacysurgicalinterventionversusfollow-upw-up . This comprehen- siveshowedfavorable surgeryinterventions.reviewevidenceefcacyRYGB,AGB,evidencewaslowfewerImprovementshypertension,low-densityobstructivegastroesophagealsurgicaladverseeventssurgeryrelativelylow.AGBwasintervention.showedunwantedexcessivewouldveryy published a largevarietysurgicalinterventionsobesity.TheyundergoingsurgeryversushavingversuswouldalleviatesurgeryexcessivereviewAGBsurgerieswassurgeries.givingAdegbolagbola reviewedAGBexcessTheyimprovementhyperlipidemia,obstructivedevel-Adverseevent

5 sMuller-StichStich published a largeview
sMuller-StichStich published a largeviewsurgicalversustherapyfollow-upcaveatreviewwassurgerywass 14), higher rate of glycemic control (OR: 8), and lowerleveldifference:difference:hypertension,lowersurgery. Surgery revieww examinedeffectRYGBwasTheywasPanunzianunzi performed a meta-analysis to study the efcacysurgeryversusaverageexperiencedsurgerywasrespectively).meta-regressionpreoperativewasfactorwasimprovementwastiveaveragewasRYGB,AGB,, published a meta-analysis of 11 RCTs. Theysurgicalinterventionversusinterventionfollow-upintervalswassurgicalinterventionwasAGB.theysurgeryimprovesreviewtheylevelevidenceHowever,Recently,, conducted a meta-analysis on 5 RCTs to assess the impact of RYGBfollow-up,RYGBimprovedintervalintervalrespectively).wasfollow-surgery. controlledTable haveintervalal published since the last position statement for a total of 12 high- quality clinical trials. Some of the RCTs were later up- dated with longer follow-upfollow-upTabledeservee published the rst RCT to exam-AGBversustherapy.therapybehavioralverylow-caloriepharmacotherapy.AGBexcesstherapy follow-upfollow

6 -upsurgicalimprovedsurgicalnonsurgicalad
-upsurgicalimprovedsurgicalnonsurgicaladverseevents,butsurgicalreoperativee . This group published a long-term follow-surgerygery . The surgicalexcesswasnonsurgicalOverall,removall . Parikhh studied 57 patients with class I obesity and type 2 diabetes. Twenty-eightinvolvingexer-Twenty-ninesurgerydergoRYGB,AGB,wassurgicalfollow-upversusfastingsurgicallowerversusversusinvestigatorsattributeddifferencefactnormotensivehavehyper-preoperatively.Sevenoversurgicalexperiencedfollowfailuresurgicaltherapy.surgicalintravenoushydrationdehydration,developedloped . Wentworthrth studied the effectsurgery,AGB,overweightOverall,AGBwaswass and 5 years after randomiza- tion [68] . There wasdifferenceaverageversussurgicalrespectively.surgicalachievednor-offgastricfewerglucose-loweringaveragedoverfollow-upwaslower Surgery improvementwasobservedsurgery.TwosurgicalrevisionAGB.powerfultherapyoverweightdeliversimprovementsglucose-loweringtherapyy . Ikramuddin et al. [69–71] studied 120 patients random- ized to medical therapyRYGBwass . Surgicaltherapywasexperiencingfollow-upexperiencingsurgicalexperiencedver-d

7 ifferedlow-densitywasRYGBOveradverseeven
ifferedlow-densitywasRYGBOveradverseeventsRYGBwascerebrovasculareventRYGBsurgerygery . A subgroup analysis of 71 participants with BMI 30 to 35 kg/m 2 at 2 years showedRYGBhowever,achievedTaiwaneseanese . Schauer et al. [73] recently published their 5-year out- come data for their SurgicalTreatmentEfciently(STAMPEDE)intensivether-apy,RYGB,YGB, . In total, 37% of the pa- tients had a preoperativetheyfollow-upsurgicaltherapyy . Patientssur-levelceivedtherapyversusobservedRYGBmedical-therapyRYGB,medical-therapy respectively),levellevelsurgicalexceptxcept . As illustrated in Fig. 1 , there is a similar decrease in postoperativepreoperativesurgery.shownpostoperativepreoperativeaveragelikelybody’sphysiologicmitigatesurgeryexcessive Table prospectiveretrospectiveobservationalhaveshownefcacyvarioussurgicalical . Se- lected literature has been summarized in Tablesurgicalsevereobesity.Improvementhypertension,fattyliverobstructivegastroesophagealfollow-up,how-ever,observationalwasvariabilityexcessiveTableNotably,efcacysurgeryvery surgery shownTablessurgeryverylowobesity.CollegeSurgeonsindivid

8 ualwassurgeryexceptpostoperativepostoper
ualwassurgeryexceptpostoperativepostoperativemorbidity,morbidity,respectively. Surgery SurgicalTreatmentEfciently(STAMPEDE)versussurgicalsleeveindex SurgicalTreatmentEfciently(STAMPEDE)indexversussurgicalsleeve indexsurgerywaswasfactorsurgerylowerdifferentunder-RYGB AGBRYGBsurgicalRYGBAGB Surgery indexoverversussurgicalsleevehave SurgeryTablereviewssurgeryindex Author,TypessurgicalinterventionAverage RYGB,SAGB,GB, AGB,RYGB,SAGB,Parikhh AGB,RYGB,SAGB,GB, AGB,RYGB,Improvementsments AGB,RYGB,SAGB,SG-IT,Average:AGB:RYGB:SAGB:AverageAGB:RYGB:SAGB:Adegbolagbola AGBImprovementMuller-Stich-Stich AGB,RYGB,Improvementment RYGBimprovementPanunzinunzi AGB,RYGB,YGB, AGB,RYGB,improvementment RYGBimprovement index;RYGBdiversion;SAGBsleevefastingAGBsleevelowobstructivesleeveexcess versusnausea/vomitinggastrointestinalRYGB; Cost-effectiveness efcacysurgerysufceadvocacysurgeryobesity.evaluationcost-effectivenesssurgerycost-effectivenesssurgeryovertherapyseveresity,Recently,severalreviewsexaminedvaluesurgeryobesity. cost-effectivenesssurgeryover(QALY)gainedversusconventionalwouldcost-effectivenessQ

9 ALYgained).robustsensitivitysurgeryregai
ALYgained).robustsensitivitysurgeryregainsurgery.Importantly,favorablegainssurgerycost-effectivenessobesity,QALYgainedversusconventionalInterestingly,surgery,achievedvagaltherapynaltrexone/bupropiontherapy SurgeryTablesurgeryindex Author,YearFollow-upFollow-upWeight 30–40 2 yr 92% AGBimprovementcardiovascularsurgerytherapyy 30–35 10 yr 78% AGBimprovementsurgical/crossovertherapyy Mean: 30 1 yr 94% RYGBimprovementmarkers,surgerytherapytherapyExenatideenatide 25–35 5 yr 80% SAGBimprovementSAGBParikhh 30–35 6 mo 77% RYGB,AGBimprovementsurgerytherapyWentworthh 25–30 5 yr 88% AGBimprovementsurgerytherapyy 30–42 (n = 13 with BMI 35) 1 yr 100% RYGBimprovementcardiovascularsurgerytherapyy 30–39.9 (n = 71 with BMI 35) 3 yr 85% RYGBimprovementsurgerytherapyy 30–40 (n = 26 with BMI 35) 3 yr 85% RYGBimprovementsurgeryAGBtherapyy 30–45 (n = 15 with BMI 35) 1 yr 90% AGBtherapyy 30–45 (n = 11 with BMI 35) 1 yr 100% RYGBimprovementsurgerytherapyy 27–43 (n = 49 with BMI 35) 5 yr 90% RYGBimprovementcardiovascularsurgerytherapy index;AGBexcessRYGBSAGBsleevegastrectomy. SurgeryTableobservationalsu

10 rgeryindex Author,YearFollow-upFollow-up
rgeryindex Author,YearFollow-upFollow-upWeight ProspectiveRYGBRYGB.offBerry,, RetrospectiveimprovementNAFLDImprovement:ment: RetrospectiveimprovementirregularityKular,, RetrospectiveSAGBSAGB.offf RetrospectiveTwosurgeryery (19), RYGB/SAGBversustherapyversusversussurgicalsurgicalimprovementsurgicalsurgicalnextpage SurgeryTable Author,YearFollow-upFollow-upWeight RetrospectiveRYGBRemission/improvementment ProspectiveRYGBlowestpostoperativeRYGB.offoffofff Prospectivee RetrospectiveRYGBAGBoffoffParikh,rikh, ProspectiveAGBImprovementment RetrospectiveAGBAGB. index;RYGBsleeveexcessNAFLDfattyliverobstructiveSAGBdiversion;AGB Surgery haveindexindexsurgeryrelative cost-effectivenessQALYgainedined . In another analysis, the cost-effectivenessRYGBindividualswasQALYgainedversusQALYgained(againcost-effectiveness,QALYgained)ined) . A cost-effectivenessevaluationAGBshowedsurgerywasnonsurgicalbutimprovedcost-effectivenessachievesitivitysurgicalcost-effectiveintensivewasQALYsurgi-cost-effectivewass . The reduction in the incremental cost-effectivenessdrivenexperiencingsur-nonsurgical Preferredproced

11 ure regardingtakepar- gastroesophagealst
ure regardingtakepar- gastroesophagealstroesophageal . In the BMI 30- to 35- kg/m 2 group and for bariatric surgerypredictiveachieveCaregivershaveinformativeCurrently,high-levelAGB,RYGBRYGBeffectsprovideide Fig. 4 ]. In the nal analysis, it remains up to the judg- ment of the treating physiciantheypatient’s recommendations exacer-longevity,Patientsnonsurgicalineffectiveachievingmajor,existingsurgery—excludingindividualsobesity—was Surgery surgerysurgerywastoday.evidenceefcacy,cost-effectiveness,excludedlife-savingsurgicalsurgeryForachieveimprovementnonsurgicalsurgeryofferedindividu-surgicalinterventionfailurenonsurgicalParticularlygivensurgeryAGB,RYGBhaveshowneffectiveefcacylow-BMIsevereobesity.Perioperativenonsurgicalprovidedsurgerygery . 8. Currently,evidencesurgeryexists Acknowledgments (ADA)Sur-(SAGES). Disclosures authorscommercialinterestrelationarticle. References ASMBS Clinical Issues Committee Bariatric surgeryindexSurgg NCD Risk FactorTrendsindexx Afshin A , Forouzanfareffectsoverweightover Availablewww.cdc.gov// Recognition of obesity as a disease [monograph on the Inte

12 rnet]. Chicago: American Medical Associa
rnet]. Chicago: American Medical Association House of Delegates;gates; yr mo d]. Feb 1, 2018, Availablehttp://www.npr.org/obesity.pdf.pdf Gastrointestinal surgerysevereDevelopmentelopment DeMaria EJ , Schauer P , Pattersonsurgicalsuper-obeseSurgInnovv Sugerman HJ . Summary: consensus conference on surgerysevereobesity.Surgg Busetto L , Dixon J , De Luca M , ShikorasurgerySurgerySurgg Carnethon MR , De ChavezJAMAA Colditz GA , WillettRotnitzkyWeightfactorwomen.. Chan JM , Rimm EB , Colditz GA , et al. Obesity,fatdistribution,factorsactors Nguyen NT , Magno CP , Lane KT , et al. Association of hyperten- sion, diabetes, dyslipidemia, and metabolic syndrome with obesity: ndings from the National Health and Nutrition Examination Sur-vey,Surgg Dixon JB . The effectfect Guh DP , Zhang W , Bansback N , Amarsi Z , Birmingham CL , Anis AH . The incidence of co-morbidities related to obesity and over-revieww Haslam DW , James WP . Obesity.. Hartemink N , Boshuizen HC , Nagelkerkevanobserva-differentexposureindexx Ni Mhurchu C , Rodgers A , PanWoodwardPacicdexvascularAsia-PacicRegion:overviewi

13 nvolvinglving Renehan AG , Tysonindexrev
nvolvinglving Renehan AG , Tysonindexreviewtiveobservationalational BergstromTenetWolkOver-avoidableoidable Harvie M , Hooper L , Howellreview.Revv KuboCorleyindexreviewBiomarkersPrevv Berrington de Gonzalez A , Sweetland S , Spencer E . A meta-anal- ysis of obesity and the risk of pancreatic cancer.. MacInnis RJ , English DR . Body size and composition and prostate cancer risk: systematic reviewmeta-regressiongression Whitlock G , LewingtonProspective Surgery indexcollaborativeprospectivee Müller MJ , Lagerpusch M , Enderle J , et al. Beyondindex:Revv Thomas EL , Frost G , Taylor-RobinsonfatRevv Kragelund C , Omland T . A farewellindex?x? DeurenbergDeurenberg-YapValidityForumm HeymseldvanvanWeightstrategy:gy: Mulholland Y , NicokavouraVery-low-energyreviewlonger-termevidence.idence. BravataEfcacylow-review.JAMAA Dansinger ML , Gleason JA , GrifthSelkerWeightWatchers,JAMAA SvetkeyStevensBrantleystrategiesJAMAA HeymseldWaddenpathophysiology,obesity.. Padwalpharmacotherapyover-revieww AvenellBrowninterventionsreviewtherapy,exercise,behaviourtherapyinterventions.ntions. Smith SR , We

14 issmanMulticenter,, Gadde KM , Allison D
issmanMulticenter,, Gadde KM , Allison DB , Ryan DH , et al. Effectslow-dose,overweightQUER):: GarveyTwo-yearphenter-overweight(SEQUEL):extensionstudy.. GreenwayPlodkowskiEffecttrexonebupropionoverweightt Ponce J , WoodmanSwainPivotalTrialvestigators.pivotalprospective,pivotalobesity.Surgg SullivanEdmundowicznewemergingging Lopez-NavaVargassleeve follow-up.Surgg Brethauer SA , Chang J , GalvaoGrevedevicesSurgg Aminian A , Brethauer SA , KirwanBurgueraHowsurgery?ery? Aminian A , Jamal MH , Andalib A , et al. Is laparoscopic bariatric surgeryextremelySurgTechech Rubino F , Nathan DM , EckelDelegatesSurgerysurgeryorga-Surgg Obesity: identication, assessment and management [homepage on the Internet]. London: National Institute for Health and Care Excellence; c2018 [updated 2014 Nov;Availablewww.nice.org.uk/chapter/1-recommendationsecommendations Dixon JB , O’Brien PE , PlayfairconventionaltherapyJAMAA O’Brien PE , Dixon JB , Laurie C , et al. Treatmentintensivee Lee WJ , Chong K , Ser KH , et al. Gastric bypass vs sleeveSurgg Schauer PR , Kashyap SR , Wolskisurgeryversusintensivetherapyy

15 Li Q , Chen L , Yangeffectssurgeryindex
Li Q , Chen L , Yangeffectssurgeryindexx Reis CE , Alvarez-Leitesurgeryindexreview.Technolechnol ParikhVieirasurgeryreviewSurgg Maglione MA , Gibbons MM , LivhitssurgerynonsurgicaltherapyindexAgencyy Ngiam KY , Lee WJ , Lee YC , Cheng A . Efcacysurgeryreview.Surgg AdegbolaTayehAgrawalreviewindexSurgg Müller-StichWarschkowSurgicalver-nonseverelyreviewSurgg Rao WS , Shan CX , Zhang W , Jiang DZ , Qiu M . A meta-analysis of short-term outcomes of patients with type 2 diabetes mellitus and BMI 35 kg/m 2 undergoingWorldSurgg Panunziseverelyindividuals Surgery undergoingsurgery:Surgg Cummings DE , Cohen RV . Bariatric/metabolic surgeryery Cohen R , Le Roux CW , Junqueira S , Ribeiro RA , Luque A . Roux-en-Y gastric bypass in type 2 diabetes patients with mild obesity: a systematic reviewSurgg O’Brien PE , Brennan L , Laurie C , BrownIntensivefollow-uptiveSurgg ParikhsurgeryversusintensiveNOTsurgeryRAGEnovelbiomarkerSurgg WentworthPlayfairsurgeryoverweightt WentworthBrownFive-yearsurgeryoverweightbutt Ikramuddin S , KornerintensiveSurgeryJAMAA Ikramuddin S , Billington CJ , Lee WJ , et al

16 . Roux-en-Y gastric by- pass for diabete
. Roux-en-Y gastric by- pass for diabetes (the Diabetes Surgery5-year,, Ikramuddin S , Kornerinterventionachievingving Chong K , Ikramuddin S , Lee WJ , et al. National differencessurgery-subgroupsurgeryTaiwaneseSurgg Schauer PR , Bhatt DL , Kirwansurgeryversusintensivetherapyy Schauer PR , Bhatt DL , Kirwansurgeryversusintensivetherapyy Liang Z , Wu Q , Chen B , Yu P , Zhao H , Ouyang X . Effectsurgeryery Lee WJ , Chong K , Lin YH , Weisleeveversuseffect.Surgg Halperin F , Ding SA , Simonson DC , et al. Roux-en-Y gastric bypass surgeryintensiveJAMASurgg Courcoulas AP , Belle SH , Neibergsurgeryintervention JAMASurgg Ding SA , Simonson DC , Wewalkasurgeryery Cummings DE , ArterburnWestbrooksurgeryintensiveinterventionCROSSROADSADS Murad AJ Jr , Cohen RV , de Godoyprospectiveobesity.Surgg Berry MA , Urrutia L , Lamoza P , et al. Sleevefollow-up.Surgg Noun R , Slim R , Nasr M , et al. Results of laparoscopic sleeveconsecutivelowindexSurgg KularSevenindexSurgg Hsu CC , AlmulaiAEffectsurgeryindexlowerve-yearJAMASurgg Maiz C , AlvaradoFunkesurgerypreoperativeindexyear.Surgg Cohen RV , Pi

17 nheiro JC , SchiavonWajchen-bergEffectss
nheiro JC , SchiavonWajchen-bergEffectssurgeryobesity.. Scopinaro N , Adami GF , Papadiaeffectsdiversionoverweightprospectivestudy.Surgg Demaria EJ , WinegarPatepostoperativesurgerysurgeryexcellenceSurgg ParikhindexSurgg Angrisani L , FavrettiSurgg Aminian A , Andalib A , KhorgamisurgerynonseverelySurgg Ollendorf DA , Cameron CG , Pearson SD . EffectivenessvalueJAMAA Ollendorf DA,Controversiesrsies on the Internet], Boston: Insti- tute for Clinical and Economic Review;Availablehttps://icer-review.org/wp-content/uploads/2016/02/CTAFRevised062315.pdf. Surgery Ollendorf DA,surgery:ery: on the Internet], Boston: Institute for Clinical and Economic Review;Availablehttps://icer-review.org/wp-content/uploads/2016/02/bariatric040315.pdf.. Picot J , Jones J , Colquitt JL , et al. The clinical effectivenesscost-effectivenesssurgeryreviewevaluation.Technoliii–ivv Picot J , Jones J , Colquitt JL , LovemanCleggWeightsurgeryreviewevaluation.Surg Aminian A , Brethauer SA , Andalib A , et al. Individualizedsurgeryseverity.Surgg Mechanick JI , YoudimperioperativenonsurgicalsurgerySociety,Surgery.Sur