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Georgiadou et al (2014) summarized the latest available research about the efficacy and you can defense off laparoscopic mini-gastric bypass (LMGB)
Georgiadou et al (2014) summarized the latest available research about the efficacy and you can defense off laparoscopic mini-gastric bypass (LMGB)

Such detectives did a systematic lookup in the literature, and you can PubMed and you will site listings was basically scrutinized (end-of-search big date: ). Into the comparison of qualified articles, the fresh new Newcastle-Ottawa top quality testing measure was applied. A maximum of 10 eligible studies were among them research, reporting investigation to your 4,899 patients. Centered on all of the incorporated knowledge, LMGB triggered large lbs and Body mass index cures, in addition to big additional weight losses. Also, solution or change in all of the significant associated scientific afflictions and you may update within the complete Gastrointestinal Total well being Directory rating was in fact filed. Big bleeding and you may anastomotic ulcer were the quintessential aren't said difficulties. Re-entryway speed varied away from 0 % so you're able to eleven %, whereas the pace off update operations ranged from 0.3 % to help you 6 %. Aforementioned have been conducted because of numerous scientific explanations particularly useless otherwise a lot of weight loss, malnutrition, and upper gastro-intestinal hemorrhaging. Fundamentally, the death rate ranged anywhere between 0 % and you can 0.5 % certainly top LMGB procedures. New article authors concluded that LMGB represents a good bariatric procedure; their defense and you will limited article-operative morbidity look remarkable. It reported that randomized relative studies look mandatory on subsequent investigations from LMGB.

Bariatric Operations to possess Particular-dos All forms of diabetes

  1. clients with being obese higher than or comparable to amount II (that have co-morbidities) and
  2. customers having diabetes mellitus + obesity higher than or equal to degree We.

The new Swedish Overweight Victims (SOS) try a potential coordinated cohort studies used from the twenty five surgical departments and you may 480 primary health care facilities into the Sweden

These types of scientists provided 10 training that have all in all, 342 clients you to mainly investigated a prototype of the DJBL. In highest-level heavy customers, short-label excess clover bezplatná zkuÅ¡ební verze weight losses try seen. On the kept patient-relevant endpoints and you can patient populations, proof try often not available or ambiguousplications (mainly slight) took place 64 so you're able to a hundred % from DJBL customers as compared to 0 to help you twenty seven % about handle teams. Gastro-intestinal hemorrhaging is noticed in 4 % off clients. The brand new article writers don’t but really strongly recommend the machine having regime use.

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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27  .  07  .  2022

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