21 results on '"Patel, Ameet"'
Search Results
2. Peripheral inflammation associated with depression and reduced weight loss: a longitudinal study of bariatric patients.
- Author
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McLaughlin AP, Lambert E, Milton R, Mariani N, Kose M, Nikkheslat N, Patsalos O, Ferraro L, Chamseddine G, Panagiotopoulos S, Chang A, Ramar S, Patel A, Rubino F, and Mondelli V
- Subjects
- Humans, Child, Longitudinal Studies, C-Reactive Protein analysis, Depression epidemiology, Interleukin-6, Inflammation, Obesity complications, Obesity surgery, Obesity psychology, Weight Loss, Bariatric Surgery psychology, Obesity, Morbid complications, Obesity, Morbid surgery
- Abstract
Background: Research implicates inflammation in the vicious cycle between depression and obesity, yet few longitudinal studies exist. The rapid weight loss induced by bariatric surgery is known to improve depressive symptoms dramatically, but preoperative depression diagnosis may also increase the risk for poor weight loss. Therefore, we investigated longitudinal associations between depression and inflammatory markers and their effect on weight loss and clinical outcomes in bariatric patients., Methods: This longitudinal observational study of 85 patients with obesity undergoing bariatric surgery included 41 cases with depression and 44 controls. Before and 6 months after surgery, we assessed depression by clinical interview and measured serum high-sensitivity C-reactive protein (hsCRP) and inflammatory cytokines, including interleukin (IL)-6 and IL-10., Results: Before surgery, depression diagnosis was associated with significantly higher serum hsCRP, IL-6, and IL-6/10 ratio levels after controlling for confounders. Six months after surgery, patients with pre-existing depression still had significantly higher inflammation despite demonstrating similar weight loss to controls. Hierarchical regression showed higher baseline hsCRP levels predicted poorer weight loss ( β = -0.28, p = 0.01) but had no effect on depression severity at follow-up ( β = -0.02, p = 0.9). Instead, more severe baseline depressive symptoms and childhood emotional abuse predicted greater depression severity after surgery ( β = 0.81, p < 0.001; and β = 0.31, p = 0.001, respectively)., Conclusions: Depression was significantly associated with higher inflammation beyond the effect of obesity and other confounders. Higher inflammation at baseline predicted poorer weight loss 6 months after surgery, regardless of depression diagnosis. Increased inflammation, rather than depression, may drive poor weight loss outcomes among bariatric patients.
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- 2024
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3. Role of Ursodeoxycholic Acid in the Prevention of Gallstones Formation in Bariatric Patients-a Systematic Review and Meta-Analysis of Randomised Trials.
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Sharma A, Shanti H, Nageswaran H, Best LMJ, and Patel AG
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- Humans, Ursodeoxycholic Acid therapeutic use, Randomized Controlled Trials as Topic, Gallstones prevention & control, Gallstones surgery, Gallstones etiology, Obesity, Morbid surgery, Bariatric Surgery adverse effects, Bariatric Surgery methods, Gastroplasty
- Abstract
The aim of this meta-analysis was to assess whether treatment with ursodeoxycholic acid (UDCA) in patients who have undergone bariatric surgery reduces gallstone formation. A systematic literature search was performed using electronic databases (MEDLINE, Embase, CENTRAL, Web of Science, PROSPERO, Google Scholar and the WHO International Clinical Trials Registry platform). RCTs without restrictions on study language, year, status of publication and patient's age were used. Pooled risk ratios were calculated using a random-effects model. Subgroup analyses for drug dose, duration and procedure types were performed. Sensitivity analyses and a summary of findings table were generated to assess the robustness and the level of evidence provided, respectively. Fourteen trials were included (3619 patients, 2292 in UDCA vs 1327 in control group). Procedures included SG, RYGB, OAGB, AGB and Gastroplasty. UDCA dose ranged from 300 to 1200 mg per day. Gallstone formation occurred in 19.3% (8.3% in UDCA vs 38.1% in the control group). UDCA significantly reduced the risk of gallstone formation (14 trials, 3619 patients; RR 0.27, 95% CI 0.18-0.41; P < 0.001). UDCA significantly reduced the risk of symptomatic gallstone disease (6 trials, 2458 patients; RR 0.30, 95% CI 0.21-0.43; P < 0.001). No subgroup difference was found for different doses, duration and type of procedure performed. Oral UDCA treatment significantly reduces the risks of developing gallstones in postoperative bariatric patients from 38 to 8%. The use of 500 to 600 mg UDCA for 6 months is effective and should be implemented in all patients post-bariatric surgery., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2023
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4. The efficacy of GLP-1RAs for the management of postprandial hypoglycemia following bariatric surgery: a systematic review.
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Llewellyn DC, Logan Ellis H, Aylwin SJB, Oštarijaš E, Green S, Sheridan W, Chew NWS, le Roux CW, Miras AD, Patel AG, Vincent RP, and Dimitriadis GK
- Subjects
- Humans, Quality of Life, Bariatric Surgery adverse effects, Glucagon-Like Peptide-1 Receptor agonists, Glucagon-Like Peptide-1 Receptor therapeutic use, Hypoglycemia etiology, Hypoglycemia prevention & control
- Abstract
Objective: Postprandial hyperinsulinemic hypoglycemia with neuroglycopenia is an increasingly recognized complication of Roux-en-Y gastric bypass and gastric sleeve surgery that may detrimentally affect patient quality of life. One likely causal factor is glucagon-like peptide-1 (GLP-1), which has an exaggerated rise following ingestion of carbohydrates after bariatric surgery. This paper sought to assess the role of GLP-1 receptor agonists (GLP-1RAs) in managing postprandial hypoglycemia following bariatric surgery., Methods: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Scopus were systematically and critically appraised for all peer-reviewed publications that suitably fulfilled the inclusion criteria established a priori. This systematic review was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P). It followed methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions and is registered with PROSPERO (International Prospective Register of Systematic Reviews; identifier CRD420212716429)., Results and Conclusions: Postprandial hyperinsulinemic hypoglycemia remains a notoriously difficult to manage metabolic complication of bariatric surgery. This first, to the authors' knowledge, systematic review presents evidence suggesting that use of GLP-1RAs does not lead to an increase of hypoglycemic episodes, and, although this approach may appear counterintuitive, the findings suggest that GLP-1RAs could reduce the number of postprandial hypoglycemic episodes and improve glycemic variability., (© 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)
- Published
- 2023
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5. Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis.
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Sheridan W, Da Silva AS, Leca BM, Ostarijas E, Patel AG, Aylwin SJ, Vincent RP, Panagiotopoulos S, El-Hasani S, le Roux CW, Miras AD, Cardozo L, and Dimitriadis GK
- Subjects
- Behavior Therapy, Female, Humans, Quality of Life, Bariatric Surgery, Obesity complications, Obesity epidemiology, Obesity surgery, Urinary Incontinence epidemiology, Urinary Incontinence etiology, Weight Loss
- Abstract
Women with obesity are at risk of pelvic floor dysfunction with a 3-fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index ≥30 kg/m
2 should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta-analysis will assess this recommendation to aid in the counselling of women with obesity-related urinary incontinence (UI). Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov, and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence. Thirty-three studies and their outcomes were meta-analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI-20, SMD -0.774 (95% CI [-1.236, -0.312]). This systematic review and meta-analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity-related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomized control trials assessing the effect of bariatric surgery on women with obesity-related UI are needed to confirm this study's findings., (© 2021 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)- Published
- 2021
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6. Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery.
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Rubino F, Cohen RV, Mingrone G, le Roux CW, Mechanick JI, Arterburn DE, Vidal J, Alberti G, Amiel SA, Batterham RL, Bornstein S, Chamseddine G, Del Prato S, Dixon JB, Eckel RH, Hopkins D, McGowan BM, Pan A, Patel A, Pattou F, Schauer PR, Zimmet PZ, and Cummings DE
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- Bariatric Surgery trends, COVID-19, Coronavirus Infections epidemiology, Disease Management, Humans, Obesity epidemiology, Pneumonia, Viral epidemiology, Postoperative Care trends, Postoperative Complications epidemiology, Postoperative Complications prevention & control, SARS-CoV-2, Bariatric Surgery methods, Betacoronavirus, Coronavirus Infections surgery, Obesity surgery, Pandemics, Pneumonia, Viral surgery, Postoperative Care methods
- Abstract
The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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7. Male Obesity Associated Gonadal Dysfunction and the Role of Bariatric Surgery.
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Sultan S, Patel AG, El-Hassani S, Whitelaw B, Leca BM, Vincent RP, le Roux CW, Rubino F, Aywlin SJB, and Dimitriadis GK
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- Gonadal Disorders etiology, Gonadal Disorders pathology, Gonadal Disorders surgery, Humans, Male, Bariatric Surgery methods, Gonadal Disorders prevention & control, Obesity complications
- Abstract
Obesity is an ever growing pandemic and a prevalent problem among men of reproductive age that can both cause and exacerbate male-factor infertility by means of endocrine abnormalities, associated comorbidities, and direct effects on the precision and throughput of spermatogenesis. Robust epidemiologic, clinical, genetic, epigenetic, and preclinical data support these findings. Clinical studies on the impact of medically induced weight loss on serum testosterone concentrations and spermatogenesis is promising but may show differential and unsustainable results. In contrast, literature has demonstrated that weight loss after bariatric surgery is correlated with an increase in serum testosterone concentrations that is superior than that obtained with only lifestyle modifications, supporting a further metabolic benefit from surgery that may be specific to the male reproductive system. The data on sperm and semen parameters is controversial to date. Emerging evidence in the burgeoning field of genetics and epigenetics has demonstrated that paternal obesity can affect offspring metabolic and reproductive phenotypes by means of epigenetic reprogramming of spermatogonial stem cells. Understanding the impact of this reprogramming is critical to a comprehensive view of the impact of obesity on subsequent generations. Furthermore, conveying the potential impact of these lifestyle changes on future progeny can serve as a powerful tool for obese men to modify their behavior. Healthcare professionals treating male infertility and obesity need to adapt their practice to assimilate these new findings to better counsel men about the importance of paternal preconception health and the impact of novel non-medical therapeutic interventions. Herein, we summarize the pathophysiology of obesity on the male reproductive system and emerging evidence regarding the potential role of bariatric surgery as treatment of male obesity-associated gonadal dysfunction., (Copyright © 2020 Sultan, Patel, El-Hassani, Whitelaw, Leca, Vincent, le Roux, Rubino, Aywlin and Dimitriadis.)
- Published
- 2020
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8. Bariatric Surgery in Cirrhotic Patients: Is It Safe?
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Younus H, Sharma A, Miquel R, Quaglia A, Kanchustambam SR, Carswell KA, and Patel AG
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- Humans, Liver Cirrhosis complications, Retrospective Studies, Bariatric Surgery, Non-alcoholic Fatty Liver Disease complications, Obesity, Morbid surgery
- Abstract
Introduction: Ten percent of cirrhotic patients are known to have a high risk of postoperative complications. Ninety percent of bariatric patients suffer from non-alcoholic fatty liver disease (NAFLD), and 50% of them may develop non-alcoholic steatohepatitis (NASH) which can progress to cirrhosis. The aim of this study was to assess whether the presence of cirrhosis at the time of bariatric surgery is associated with an increased rate and severity of short- and long-term cirrhotic complications., Methods: A cohort of 110 bariatric patients, between May 2003 and February 2018, who had undergone liver biopsy at the time of bariatric surgery were reassessed for histological outcome and divided into two groups based on the presence (C, n = 26) or absence (NC, n = 84) of cirrhosis. The NC group consisted of NASH (n = 49), NAFLD (n = 24) and non-NAFLD (n = 11) liver histology. Medical notes were retrospectively assessed for patient characteristics, development of 30-day postoperative complications, severity of complications (Clavien-Dindo (CD) classification) and length of stay. The C group was further assessed for long-term cirrhosis-related outcomes., Results: The C group was older (52 years vs 43 years) and had lower BMI (46 kg/m
2 vs 52 kg/m2 ) and weight (126 kg vs 145 kg) compared to the NC group (p < 0.05). The C group had significantly higher overall complication rate (10/26 vs 14/84, p < 0.05) and severity of complications (CD class ≥ III, 12% vs 7%, p < 0.05) when compared to the NC group. The length of stay was similar between the two groups (5 days vs 4 days). The C group had significant improvement in model end-stage liver disease scores (7 vs 6, p < 0.01) with median follow-up of 4.5 years (range 2-11 years). There were no long-term cirrhosis-related complications or mortality in our studied cohort (0/26)., Conclusion: Bariatric surgery in cirrhotic patients has a higher risk of immediate postoperative complications. Long-term cirrhosis-related complications or mortality was not increased in this small cohort. Preoperative identification of liver cirrhosis may be useful for risk stratification, optimisation and informed consent. Bariatric surgery in well-compensated cirrhotic patients may be used as an aid to improve long-term outcome.- Published
- 2020
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9. Preoperative liver shrinking diet for bariatric surgery may impact wound healing: a randomized controlled trial.
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Chakravartty S, Vivian G, Mullholland N, Shaikh H, McGrath J, Sidhu PS, Jaffer O, and Patel AG
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- Adult, Collagen Type I analysis, Female, Humans, Male, Middle Aged, Postoperative Complications physiopathology, Preoperative Care, Treatment Outcome, Bariatric Surgery methods, Diet, Reducing, Liver physiology, Obesity, Morbid diet therapy, Obesity, Morbid surgery, Wound Healing physiology
- Abstract
Background: In bariatric surgery, preoperative very low-calorie diets (VLCD) may better meet the technical demands of surgery by shrinking the liver. However, diets may affect tissue healing and influence bowel anastomosis in an as-yet-undefined manner., Objective: This randomized controlled trial aimed to examine the effect on collagen deposition in wounds in patients on a 4-week VLCD before laparoscopic gastric bypass., Setting: University hospital., Methods: The trial was undertaken in patients undergoing laparoscopic Roux-en-Y gastric bypass, with a control group (n = 10) on normal diet and an intervention group (n = 10) on VLCD (800 kcal) for 4 weeks. The primary outcome measured was expression of collagen I and III in skin wounds, with biopsies taken before and after the diet and 7 days postoperatively as a surrogate of anastomotic healing. Secondary outcome measures included liver volume and fibrosis score, body composition, operating time, blood loss, hospital stay, and complications., Results: Patients in both groups were similar in age, sex, body mass index (53.4 versus 52.8 kg/m
2 ), co-morbidities, liver volume, and body composition. Expression of mature collagen type I was significantly decreased in diet patients compared with controls after 4 weeks of diet and 7 days after surgery. This was significant decrease in liver volume (23% versus 2%, P = .03) but no difference in operating times (129 versus 139 min, P = .16), blood loss, length of stay, or incidence of complications., Conclusions: Preoperative diets shrink liver volume and decrease expression of mature collagen in wounds after surgery. Whether the latter has a detrimental effect on clinical outcomes requires further evaluation., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)- Published
- 2019
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10. Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study.
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Younus H, Chakravartty S, Sarma DR, and Patel AG
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- Duodenum physiology, Feasibility Studies, Humans, Jejunum physiology, Length of Stay, Operative Time, Postoperative Complications, Bariatric Surgery adverse effects, Bariatric Surgery instrumentation, Bariatric Surgery statistics & numerical data, Obesity, Morbid surgery
- Abstract
Background: Obesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk, based on age, body mass index, sex and other comorbidities such as hypertension and history of pulmonary embolism. High-risk patients not only have a higher mortality but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (Endobarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness. The aim of this study was to assess if pre-operative insertion of endobarrier in high-risk patients can decrease morbidity and length of stay after bariatric surgery., Materials and Methods: Between 2012 and 2014, a cohort of 11 high-risk patients had an Endobarrier inserted (E&BS group) for 1 year prior to definitive bariatric surgery. These patients were compared against a similar group undergoing primary bariatric surgery (PBS group) during same duration. The two groups were matched for age, gender, body mass index, comorbidities, surgical procedure and OS-MRS using propensity score matching. Outcome measures included operative time, morbidity, length of stay, intensive therapy unit (ITU) stay, readmission rate, percentage excess weight loss (%EWL) and percentage total weight loss (%TWL)., Results: Patient characteristics and OS-MRS were similar in both groups (match tolerance 0.1). There was no significant difference in total length of stay, readmission rate, %EWL and %TWL. Operative time, ITU stay, post-operative complications and severity of complications were significantly less in the E&BS group (p < 0.05) with significant likelihood of planned ITU admissions in the PBS group (p < 0.05)., Conclusion: Endobarrier could be considered as a pre bariatric surgical intervention in high-risk patients. It may result in improved post-operative outcomes in high-risk bariatric patients.
- Published
- 2018
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11. The Effect of Intraoperative N-Acetylcysteine on Hepatocellular Injury During Laparoscopic Bariatric Surgery. A Randomised Controlled Trial.
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Belgaumkar AP, Carswell KA, Hughes RD, Quaglia A, Dhawan A, Mitry RR, and Patel AG
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- Adolescent, Adult, Aged, Bariatric Surgery methods, Body Mass Index, Comorbidity, Cytokines blood, Female, Free Radical Scavengers therapeutic use, Gastrectomy, Humans, Intraoperative Care methods, Intraoperative Complications blood, Intraoperative Complications prevention & control, Keratin-18 blood, Laparoscopy adverse effects, Liver pathology, Male, Middle Aged, Obesity, Morbid physiopathology, Postoperative Period, Single-Blind Method, Treatment Outcome, Weight Loss, Young Adult, Acetylcysteine therapeutic use, Bariatric Surgery adverse effects, Liver injuries, Obesity, Morbid surgery
- Abstract
Background: The combination of pneumoperitoneum and intraoperative retraction of the left lobe of the liver leads to hepatocellular injury during laparoscopic gastric surgery. Fatty livers are more susceptible to ischaemic insults. This trial investigated whether the antioxidant N-acetylcysteine (NAC) reduced liver injury during laparoscopic sleeve gastrectomy (LSG)., Methods: Patients undergoing LSG were randomised (single blinded) to receive intraoperative NAC infusion or standard anaesthetic treatment. Blood samples were taken before and after surgery (days 0 to 4). Primary endpoints included serum aminotransferases. Secondary measures were C-reactive protein, weight cell count (WCC), cytokines (interleukin 6 and 10) and cytokeratin-18 as markers of apoptosis. Intraoperative liver biopsy samples were assessed using a locally developed injury score., Results: Twenty patients (14 females, mean age 44.5 (SEM ± 2.9) years, mean BMI 60.8 (SEM ± 2.4) kg/m(2)) were recruited (NAC n = 10, control n = 10). The trial was stopped early after a planned interim analysis. Baseline liver function was similar. The peak rise in liver enzymes was on day 1, but levels were not significantly different between the groups. Rates of complications and length of stay were not significantly different. Secondary outcome measures, including white cell count (WCC), cytokines and cytokeratin (CK)-18 fragments, were not different between groups. Liver injury scores did not differ significantly., Conclusions: NAC did not reduce intraoperative liver injury in this small number of patients. The heterogenous nature of the study population, with differences in co-morbidities, body mass index and intraabdominal anatomy, leads to a varied post-operative inflammatory response. Significant hepatocyte injury occurs through both necrosis and apoptosis.
- Published
- 2016
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12. The effect of bariatric surgery on intestinal absorption and transit time.
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Carswell KA, Vincent RP, Belgaumkar AP, Sherwood RA, Amiel SA, Patel AG, and le Roux CW
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- Adult, Body Mass Index, Cross-Sectional Studies, England, Female, Gastric Bypass, Gastrointestinal Tract surgery, Gastroplasty, Humans, Intestinal Mucosa, Lactulose metabolism, Male, Middle Aged, Rhamnose metabolism, Treatment Outcome, Xylose metabolism, Bariatric Surgery, Gastrointestinal Tract metabolism, Gastrointestinal Transit, Intestinal Absorption, Obesity, Morbid metabolism, Obesity, Morbid surgery
- Abstract
Background: Bariatric surgical procedures are classified by their presumed mechanisms of action: restrictive, malabsorptive or a combination of both. However, this dogma is questionable and remains unproven. We investigated post-operative changes in nutrient absorption and transit time following bariatric surgery., Methods: Participants were recruited into four groups: obese controls (body mass index (BMI) >30 kg/m2, n = 7), adjustable gastric banding (n = 6), Roux-en-Y gastric bypass (RYGB, n = 7) and biliopancreatic diversion with duodenal switch (DS, n = 5). Participants underwent sulphasalazine/sulphapyridine tests (oro-caecal transit time); fasting plasma citrulline (functional enterocyte mass); 3 days faecal collection for faecal elastase 1 (FE-1); calprotectin (FCp); faecal fatty acids (pancreatic exocrine function, gut inflammation and fat excretion, respectively); and 5 h D-xylose, L-rhamnose and lactulose test (intestinal absorption and permeability)., Results: Age and gender were not different but BMI differed between groups (p = 0.001). No difference in oro-caecal transit time (p = 0.935) or functional enterocyte mass (p = 0.819) was detected. FCp was elevated post-RYGB vs. obese (p = 0.016) and FE-1 was reduced post-RYGB vs. obese (p = 0.002). Faecal fat concentrations were increased post-DS vs. obese (p = 0.038) and RYGB (p = 0.024) and were also higher post-RYGB vs. obese (p = 0.033). Urinary excretion of D-xylose and L-rhamnose was not different between the groups; however, lactulose/rhamnose ratio was elevated post-DS vs. other groups (all p < 0.02), suggesting increased intestinal permeability., Conclusions: Following RYGB, there are surprisingly few abnormalities or indications of severe malabsorption of fats or sugars. Small bowel adaptation after bariatric surgery may be key to understanding the mechanisms responsible for the beneficial metabolic effects of these operations.
- Published
- 2014
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13. Rhabdomyolysis in bariatric surgery: a systematic review.
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Chakravartty S, Sarma DR, and Patel AG
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- Acute Kidney Injury etiology, Adult, Body Mass Index, Female, Humans, Male, Myalgia etiology, Operative Time, Patient Selection, Postoperative Period, Risk Factors, Sex Factors, United Kingdom epidemiology, Acute Kidney Injury prevention & control, Bariatric Surgery adverse effects, Creatine Kinase blood, Myalgia blood, Obesity, Morbid surgery, Rhabdomyolysis blood, Rhabdomyolysis etiology
- Abstract
Background: Rhabdomyolysis (RML) is a rare complication of bariatric surgery. A systematic review was performed to identify risk factors and patient outcomes in morbidly obese patients undergoing bariatric surgery who develop RML., Methods: A comprehensive search was performed between January 1990 and March 2012 using relevant MeSH terms. Studies were chosen based on predefined inclusion criteria. RML was defined as a creatine kinase of more than 1,000 IU/L. The parameters assessed included patient characteristics of the RML population, type of bariatric surgery performed, operating time, complications, presentation and diagnosis of RML., Results: Twenty-two studies were analysed which included 11 case reports, two case series, six prospective and three retrospective comparative studies. Overall 145 patients with RML were reported following bariatric surgery. Acute renal failure was found in 20 patients (14 %) and was significantly more likely to occur in patients with postoperative muscle pain (p < 0.05). The mortality rate after renal failure was 25 % (n = 5). In the comparative studies, 87 RML patients were compared with 325 non-RML patients. The RML patients were more likely to be male, had a greater mean body mass index (BMI) (52 vs 48 kg/m(2), p < 0.01) and underwent a longer operation (255 vs 207 min, p < 0.01) compared to non-RML patients., Conclusions: Risk factors of developing RML following bariatric surgery include male gender, elevated BMI and prolonged operating time. Patients with a biochemical diagnosis of RML and postoperative myalgia after bariatric surgery are at increased risk of developing acute renal failure and mortality. These patients must be identified and treated promptly.
- Published
- 2013
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14. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters.
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le Roux CW, Aylwin SJ, Batterham RL, Borg CM, Coyle F, Prasad V, Shurey S, Ghatei MA, Patel AG, and Bloom SR
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- Adult, Animals, Cross-Sectional Studies, Female, Ghrelin, Glucagon-Like Peptide 1, Humans, Insulin metabolism, Male, Models, Animal, Obesity metabolism, Pancreatic Polypeptide metabolism, Peptide Hormones metabolism, Peptide YY metabolism, Rats, Rats, Wistar, Appetite physiology, Bariatric Surgery, Gastrointestinal Hormones metabolism, Obesity surgery, Weight Loss physiology
- Abstract
Objective: To study the effect of bariatric surgery on the entero-hypothalamic endocrine axis of humans and rodents., Background: Bariatric surgery is the most effective obesity treatment as it achieves substantial and sustained weight loss. Glycemic control and enhanced satiation improve before substantial weight loss occurs. Gut peptides, acting both peripherally and centrally, contribute to glycemic control and regulate food intake., Methods: We examined meal-stimulated responses of insulin, ghrelin, peptide YY (PYY), glucagon-like-peptide-1 (GLP-1), and pancreatic polypeptide (PP) in humans and rodents following different bariatric surgical techniques., Results: Compared with lean and obese controls, patients following Roux-en-Y gastric bypass (RYGB) had increased postprandial plasma PYY and GLP-1 favoring enhanced satiety. Furthermore, RYGB patients had early and exaggerated insulin responses, potentially mediating improved glycemic control. None of these effects were observed in patients losing equivalent weight through gastric banding. Leptin, ghrelin, and PP were similar in both the surgical groups. Using a rodent model of jejuno-intestinal bypass (JIB), we showed elevated PYY and GLP-1 in JIB rats compared with sham-operated rats. Moreover, exogenous PYY reduced food intake and blockade of endogenous PYY increased food intake. Thus, higher plasma PYY following JIB may contribute to reduced food intake and contribute to weight loss., Conclusions: Following RYGB and JIB, a pleiotropic endocrine response may contribute to the improved glycemic control, appetite reduction, and long-term changes in body weight.
- Published
- 2006
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15. Changes in Bile Acid Profile After Laparoscopic Sleeve Gastrectomy are Associated with Improvements in Metabolic Profile and Fatty Liver Disease
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Belgaumkar, Ajay P., Vincent, Royce P., Carswell, Kirstin A., Hughes, Robin D., Alaghband-Zadeh, Jamie, Mitry, Ragai R., le Roux, Carel W., and Patel, Ameet G.
- Published
- 2016
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16. Single and Multiple Incision Laparoscopic Adjustable Gastric Banding: a matched comparison
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Chakravartty, Saurav, Murgatroyd, Beth, Ashton, David, and Patel, Ameet
- Published
- 2012
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17. Laparoscopic Sleeve Gastrectomy is a Novel and Effective Treatment for Obesity in Patients with Chronic Kidney Disease
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MacLaughlin, Helen L., Hall, Wendy L., Patel, Ameet G., and Macdougall, Iain C.
- Published
- 2012
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18. Bilateral Sciatic Nerve Palsy following a Bariatic Operation
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Yasin, Athar and Patel, Ameet G.
- Published
- 2007
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19. Differences in Regional Brain Responses to Food Ingestion After Roux-en-Y Gastric Bypass and the Role of Gut Peptides: A Neuroimaging Study.
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Hunt, Katharine F., Dunn, Joel T., le Roux, Carel W., Reed, Laurence J., Marsden, Paul K., Patel, Ameet G., and Amiel, Stephanie A.
- Subjects
GASTRIC bypass ,WEIGHT loss ,INGESTION ,PEPTIDES ,BRAIN imaging ,BRAIN physiology ,HYPOTHALAMUS physiology ,BARIATRIC surgery ,BRAIN ,DEOXY sugars ,HYPOTHALAMUS ,INSULIN ,MAGNETIC resonance imaging ,NEURORADIOLOGY ,PEPTIDE hormones ,RADIOPHARMACEUTICALS ,SOMATOSTATIN ,GLUCAGON-like peptide 1 ,BODY mass index - Abstract
Objective: Improved appetite control, possibly mediated by exaggerated gut peptide responses to eating, may contribute to weight loss after Roux-en-Y gastric bypass (RYGB). This study compared brain responses to food ingestion between post-RYGB (RYGB), normal weight (NW), and obese (Ob) unoperated subjects and explored the role of gut peptide responses in RYGB.Research Design and Methods: Neuroimaging with [(18)F]-fluorodeoxyglucose (FDG) positron emission tomography was performed in 12 NW, 21 Ob, and 9 RYGB (18 ± 13 months postsurgery) subjects after an overnight fast, once FED (400 kcal mixed meal), and once FASTED, in random order. RYGB subjects repeated the studies with somatostatin infusion and basal insulin replacement. Fullness, sickness, and postscan ad libitum meal consumption were measured. Regional brain FDG uptake was compared using statistical parametric mapping.Results: RYGB subjects had higher overall fullness and food-induced sickness and lower ad libitum consumption. Brain responses to eating differed in the hypothalamus and pituitary (exaggerated activation in RYGB), left medial orbital cortex (OC) (activation in RYGB, deactivation in NW), right dorsolateral frontal cortex (deactivation in RYGB and NW, absent in Ob), and regions mapping to the default mode network (exaggerated deactivation in RYGB). Somatostatin in RYGB reduced postprandial gut peptide responses, sickness, and medial OC activation.Conclusions: RYGB induces weight loss by augmenting normal brain responses to eating in energy balance regions, restoring lost inhibitory control, and altering hedonic responses. Altered postprandial gut peptide responses primarily mediate changes in food-induced sickness and OC responses, likely to associate with food avoidance. [ABSTRACT FROM AUTHOR]- Published
- 2016
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20. Two Hundred Seventy-Five Single-Incision Laparoscopic Gastric Band Insertions: What Have We Learnt?
- Author
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Murgatroyd, Beth, Chakravartty, Saurav, Sarma, Diwakar, and Patel, Ameet
- Subjects
BARIATRIC surgery ,LAPAROSCOPIC surgery ,HEPATOMEGALY ,GASTRIC banding ,SURGICAL complications ,HEPATIC artery - Abstract
Single-incision surgery in the morbidly obese patient has not been widely adopted, but remains a popular choice amongst patients. In the bariatric patient, it presents its own surgical challenges with hepatomegaly and increased abdominal adiposity. Here, we present our experience of 275 single-incision laparoscopic gastric bands.Between June 2009 and April 2013, 275 obese patients underwent single-incision laparoscopic adjustable gastric banding through a single incision using a multichannel single port and via a pars flaccida approach. Prospective data collection was undertaken including operating time, additional ports and additional procedures undertaken.In this series, median operative time was 60 (range 34-170) min. An additional port was placed in 15 patients (5 %), including two conversions to four-port technique (0.7 %). Of these patients ( n = 15), the majority were male ( p < 0.0001). Reasons for additional port placement included bleeding and anatomical abnormalities. Additional port placement occurred more often within the first 50 cases (5/50, 10 % vs 10/225, 4 %). An umbilical incision resulted in more wound-related complications than a transverse incision in the upper abdomen ( p < 0.001). There were no 30-day mortality and minimal morbidity with two wound infections resulting in band removal.Single-incision laparoscopic adjustable gastric banding can be performed safely with minimal morbidity in the morbidly obese patient, and our technique has a high rate of success for all BMIs. Following 275 single-incision band insertions additional port placements were more commonly required in male patients, BMI >45 and earlier in the learning curve. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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21. Single incision laparoscopic adjustable gastric banding: 111 Cases.
- Author
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Patel, Ameet G., Murgatroyd, Beth, and Ashton, William D.
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LAPAROSCOPIC surgery ,GASTRIC banding ,BARIATRIC surgery ,DISEASE progression ,OVERWEIGHT persons ,LONGITUDINAL method - Abstract
Abstract: Background: As single incision surgery increases in popularity, the feasibility of offering this approach in bariatric surgery is further progression of this surgical technique. With the technical challenges that both operating on the morbidly obese patient and single incision surgery present, we describe our initial experience undertaking 111 single-incision gastric band insertions. Methods: From June 2009 to October 2010, 111 obese patients underwent single-incision laparoscopic adjustable gastric banding through a single transverse incision using a multichannel single port and a pars flaccida technique. Prospective data collection was undertaken, including visual analog scores. Results: In this initial series, the median operative time was 65 minutes (range 34–165). There was 1 conversion to a 5-port laparoscopic technique (.9%), and an additional port was placed in 7 patients (6%). Male patients were more likely to require an additional port (P < .05). The single-incision size ranged from 26 to 45 mm (median 35). At 23 hours postoperatively, the median pain score was 2.5 on a 0–10 visual analog score. On multivariate analysis, pain was found to increase with operation time (P < .001). The median length of stay was 24 hours (range 5.5–48). There was no mortality and minimal morbidity, with 1 wound infection necessitating band removal. Conclusions: Single-incision laparoscopic adjustable gastric banding can be performed safely with minimal morbidity and mortality in the morbidly obese patient, and our technique has a high rate of success. The benefits compared with the traditional laparoscopic approach and long-term outcomes are yet to be established. However, if the intra-abdominal operative time is >60 minutes, one should consider the placement of an additional port, especially in male patients. [Copyright &y& Elsevier]
- Published
- 2012
- Full Text
- View/download PDF
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