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Substance & Alcohol Use After Weight Loss Surgery

Substance & Alcohol Use After Weight Loss Surgery

Weight loss surgery (WLS) has been an effective treatment for many patients with clinically severe obesity and comorbid medical con­ditions. Despite its merits, WLS requires major lifestyle changes for potential candidates, and many patients may not be adequately prepared to make such changes. Studies have suggested that substance and alcohol abuse is more common among patients undergoing WLS, but this research has been limited by the lack of preoperative baseline data as well as longitudinal data. The symptom substitution theory states that eliminating a particular symptom without treating the underlying cause will lead to the development of a substitute symptom. Under this theory, it’s possible that the risk of substance use may rise after WLS; while the surgery helps eliminate excessive eating, it doesn’t address any potential underlying psychopathology. Since drugs, alcohol, and other substances trigger responses in the brain similar to that of food, it’s possible that they can serve as a food substitute in the WLS population. A Closer Look At Substance Use After Weight Loss Surgery My colleagues and I had a study published in JAMA Surgery that examined the likelihood of WLS patients to develop substance use—specifically alcohol, cigarettes, and recreational drugs—after their operation. We analyzed 155 patients undergoing WLS—100 who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery and 55 who received laparoscopic adjustable gastric band (AGB) surgery. Participants undergoing either RYGB or AGB surgery reported significant increases in the frequency of substance use—using a composite of drug use, alcohol use, and cigarette smoking—when assessed 2 years after surgery. Notably, patients in the RYGB group reported a significantly higher frequency of alcohol use at 2...

The 2012 ASMBS Annual Meeting

New research was recently presented at the 2012 Annual Meeting of the American Society for Metabolic & Bariatric Surgery, or the ASMBS, from June 17-22 in San Diego. The features below highlight just some of the studies that emerged from the meeting. Heart Attack Risk Low After Gastric Bypass The Particulars: Obesity has been identified in the medical literature as a leading preventable risk factor for heart disease. Prior research has also shown that gastric bariatric surgery appears to be an effective, long-lasting treatment for morbid obesity and many related conditions. Data Breakdown: Following gastric bypass surgery, a team of Stanford University researchers analyzed changes in 11 cardiac risk factors that have previously been shown to increase the likelihood of future heart attacks or coronary artery disease. In about 7 years of follow-up, patients experienced a 56% loss of excess weight, a 40% increase in HDL levels, a 66% decrease in fasting insulin levels, and a 55% decrease in triglycerides. Gastric bariatric surgery patients also experienced an 80% decrease in high sensitivity C-reactive protein levels and a 40% decrease in Framingham Risk Score. Take Home Pearl: At up to 7 years, 11 risk factors for heart attack appear to remain low following gastric bypass surgery. Bariatric Surgery Leads to Remission of Diabetic Nephropathy The Particulars: Nearly 7 million Americans have diabetic kidney disease, a figure that has increased by 34% from 20 years ago. Researchers have hypothesized that bariatric surgery may halt the progression of diabetic nephropathy. Data Breakdown: In a study, nearly 60% of obese patients who had diabetic nephropathy prior to undergoing bariatric surgery were in remission at...
Laparoscopic Banded Gastric Bypass

Laparoscopic Banded Gastric Bypass

In the presented video, we show a primary BRnYGB in a 38-year-old woman. The operation is performed as a two-surgeon procedure. The patient is positioned in the lithotomic position and reversed Trendelenburg tilt. The surgeon stands between the patient’s legs and one assistant stands on the left side of the patient. After insufflation of the capnoperitoneum via a 12 mm separator trocar (Applied Medical, Rancho Santa Margerita, CA), four working trocars are placed under direct view as shown (Figure 4). After lifting the left lobe of the liver aside, the subcardiac region is exposed. As shown in the film, the dissection is now started in the area of the angle of His, using the LigaSure™ instrument (Covidien, Dublin, Ireland). Then, the dissection is continued at the lesser curvature, 7-8 cm below the cardia. Here the omentum minor is dissected, and preparation is continued towards the left crus of the diaphragm. After insertion of a 32 F gastric tube the dimension of the pouch is now marked, and the gastric pouch can be separated using 3 to 4 linear staplers (blue cartridge, Covidien, Dublin, Ireland). The 32 F gastric tube should be removed prior to stapling. The pouch volume should be 15 to 25 ml [9]. The stapling line of the pouch is oversewn with a 3-0 resorbable running suture. Now the GaBP Ring is placed 2 cm from the distal end-point of the pouch. It is closed and fixed with two non-resorbable sutures. We usually use rings with a circumference of 6 to 6.5 cm. The alimentary limb is created by dividing the jejunum 50 cm below the ligament...

Bariatric Surgery for Diabetes: Significant Benefits Observed

In the United States, more than 90% of 25.8 million adults with diabetes have type 2 disease, according to the CDC. More than 1.9 million cases were diagnosed in 2010 alone among adults aged 20 and older. Approximately 90% of type 2 diabetes has been attributable to excess weight and obesity. “The results of noninvasive interventions for type 2 diabetes and obesity, such as lifestyle changes and pharmacotherapy, have been disappointing,” says Jon C. Gould, MD. “Bariatric surgery appears to be one of the most effective, long-lasting treatments for obesity. In many clinical trials, these procedures have been quite effective for individuals who are obese and have type 2 diabetes.” Riveting New Data on Bariatric Surgery Results In the June 2011 Archives of Surgery, a systematic review was published demonstrating that bariatric surgery leads to marked and long-lasting weight reduction, and may be capable of improving or even curing type 2 diabetes. The analysis reviewed findings from nine studies that followed obese patients with diabetes who underwent either gastric bypass or gastric banding for 1 year. Rick Meijer, MD, and colleagues from Amsterdam found that Roux-en-Y gastric bypass led to a reversal rate of type 2 diabetes of 83%. Adjustable gastric banding led to a reversal rate of 62%, and this effect was achieved later after surgery (Figure 1). “The presence of diabetes is a compelling argument to perform bariatric surgery in eligible patients according to nationally recognized criteria for the procedure,” says Dr. Gould. “Dr. Meijer’s study showed that glycemic control improved in the months after laparoscopic adjustable gastric banding, but it improved more rapidly and completely after...

Comparing Efficacy of Weight-Loss Procedures

When compared with laparoscopic bypass procedures, Roux-en-Y gastric bypass (RYGB) surgery appears to have similar rates of overall complications and lower rates of reoperations when these operations are performed in high-volume centers by expert surgeons, according to a University of California, San Francisco study. Excess weight loss (36% vs 64%), resolution of diabetes (50% vs 76%), and quality-of-life measures were better in the RYGB group in the analysis, conferring a better risk-benefit profile than laparoscopic bypass procedures. [xyz_lbx_custom_shortcode id=3] [xyz_lbx_custom_shortcode...
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