Bariatric Surgical Practice and Patient Care

Obesity is one of the most important risk factors for complications of internal jugular vein (IJV) cannulation. The efficacy and safety of positive end-expiratory pressure (PEEP) are still under debate in obese patients. The aim of this prospective randomized ultrasound study was to investigate effects of different PEEP levels on the cross-sectional area (CSA) of right IJV and overlap with carotid artery (CA) in anesthetized obese patients.

Seventy-two obese patients undergoing various elective surgeries under general endotracheal anesthesia were enrolled. We measured CSA of right IJV, margin of safety (MOS), and degree of overlap between CA and IJV at PEEP 0 (P0), 5 (P5), and 12 (P12) cm H₂O levels. We defined a ≥20% increase in CSA as clinically relevant.

Data were collected for all the 72 patients enrolled in the study. Application of 12, but not 5 cm H₂O PEEP, resulted in a clinically significant increase in CSA of right IJV. When compared to P0, application of P5 and P12 increased both degree of overlap (p < 0.001 each) and MOS (p < 0.001 each). None of the patients experienced severe hypotension or bradycardia.

Application of 12 cm H₂O PEEP provides a clinically significant increase in CSA of right IJV without relevant reduction of MOS in anesthetized obese patients.

Obesity is associated to elevated surgical and anesthetic risk due to the multiple pathologies related to it. Some authors consider that preoperative weight loss can improve health status, thus reducing peri and postoperative morbimortality, especially in bariatric surgery. If such weight loss should be indispensable before bariatric surgery continues to be a matter of debate.

Prospective study included all patients submitted to bariatric surgery from January 2013 to January 2015. A preoperative diet (1200 kcal for women and 1500 kcal for men) was prescribed and surgery was performed only to patients presenting >10% of excess weight loss (%EWL). The primary objective was to analyze changes in weight loss (body mass index and %EWL) and their preoperative impact over biochemical (glucose, HbA1c%, total cholesterol, high density lipoprotein [HDL], low density lipoprotein, triglycerides, alanine aminotransferase, aspartate aminotransferase, and uric acid) and clinical parameters (systolic and diastolic blood pressure). Secondarily, a perioperative and morbidity analysis was performed.

A total of 200 patients were enrolled. The mean time between diet onset and surgery was 102.9 ± 40.9 days, resulting in a mean EWL of 22.2%. There was a significant improvement in every parameter, except for the HDL cholesterol and uric acid. There were 20 (10%) early complications without mortality. Reoperation by any cause was observed in two patients.

A loss of >10% of excess weight before bariatric surgery ensures an optimal health status of candidates based on the significant improvement of their metabolic, lipid, hepatic, and clinical profiles and is independent of any parallel medical treatment.

To examine Australian patients’ motivations for seeking bariatric surgery.

The reasons for seeking bariatric surgery are incompletely understood. This information is needed to inform health-service planning and therapeutic decisions.

Ten focus groups were audio-recorded, transcribed verbatim, and analyzed thematically.

Thirty-two women and 17 men (mean age 55 years; range 23–72) who had received or were waitlisted for publicly- or privately funded bariatric surgery engaged in the study. Novel findings highlighted the importance of other bariatric surgery recipients, health professionals’ recommendations (e.g., bariatric surgeons, medical specialists, and general practitioners), the media (e.g., televisions shows on bariatric surgery), and having private health insurance. We also confirmed previous findings that people seek surgery for physiological and psychological health, and because of previous failed weight loss attempts and significant others (e.g., wanting to live longer for children).

Many individual, societal and environmental factors influence people to seek bariatric surgery. Exposure to recipients of bariatric surgery and recommendations made by health professionals appear to be common factors prompting a surgical pathway not previously reported. Bariatric surgery uptake may spread in social networks, which has growing implications for health service planning as more people seek this pathway.

Bariatric surgery requires patients to implement permanent lifestyle changes that are affected by several factors. Psychological assessment seems to be essential for optimal weight loss and maintenance. The burden remains in identifying potential psychosocial predictors that might influence the long-term outcome. Therefore, this study was designed to identify those predictors for the long-term outcome after primary vertical-banded gastroplasty (VBG).

Patients who underwent primary VBG between 2001 and 2004 completed a number of psychological questionnaires. Additional postal questionnaires were sent to retrieve the latest medical outcome. Patients were categorized as failed or successful based on their excess weight loss at last follow-up.

This study identified a number of potential predictors. Failed patients showed more esthetic expectations, a more dominant character, more work absenteeism before surgery, and depend more on the procedure than successful patients (SPs). SPs showed that positive emotions are an inhibitory factor for eating and less underwent revisional surgery.

This study shows a number of possible predictors, mainly found in the patient's character. The best way to prevent these predictors seems to be early recognition in the preoperative phase and a structured postoperative psychological follow-up to tackle any potential problems at an early stage.

The relationship between obesity and attention-deficit–hyperactivity disorder (ADHD) is shown in recent studies. In our study, we have analyzed the relationship between childhood and adulthood (ADHD) and general psychopathological features in morbidly obese individuals who have applied for bariatric surgery.

One hundred seventy-seven morbidly obese patients (body mass index ≥40) who have been referred for bariatric surgery volunteered to participate in the study. The average age of the participants is 36.60 ± 8.46, and 143 of them are female and 34 are male. All volunteers filled the Wender Utah Rating Scale short version (WURS-25), Adult ADHD Self-Report Scale (ASRS-11), and Symptom Check List (SCL-90) tests.

The ADHD rate in morbidly obese individuals was 19.20%. Also, we found that in morbidly obese individuals who applied for bariatric surgery, adult and childhood ADHD were highly related to psychopathological (somatization, obsessive compulsive, interpersonal sensitivity, depression, anxiety, anger, hostility, phobic anxiety, paranoid thoughts, psychoticism, and additional symptoms) features. Psychopathological features in a statement that ADHD was evaluated in the morbidly obese individuals are an active factor.

As a result of the findings of our study, we suggest paying attention to ADHD symptoms and psychopathological factors of morbidly obese individuals.

The aim of this study is to analyze medical and psychosocial variables among gender and morbidly obese (Class III) and super obese (Class IV) groups to examine their associations with anxiety and depression symptoms and to determine predictive factors for anxiety and depression symptoms.

This cross-sectional descriptive study was conducted with a sample of 546 obese patients. Medical, sociodemographic, anxiety, depression, and eating disorder information were obtained from all participants.

The study included 358 women (65.6%) with an average age of 42.71 (Standard deviation [SD] = 10.50) years, and 188 men (34.4%) whose average age was 41.80 (SD = 9.13) years. We found that eating disorder symptoms were positive and statistically significant predictors of anxiety and depression symptoms (p < 0.001). This finding was confirmed by multiple linear regression analysis (p < 0.001).

Among Class III and IV obese patients, eating disorder symptoms were clearly associated with anxiety and depression levels. Therefore, interventions directed toward these symptoms would likely be beneficial.

Changes in weight and body composition, and rates of parameter change within and between genders, were studied preoperatively and serially within the first postoperative year after Roux-en-Y Gastric Bypass (RYGB). Analysis included 146 patients (115 women and 31 men) who were compliant with all visits. Preoperative variables included weight (Wt), body mass index (BMI), and body composition evaluated using ElectroLipoGraphy. Postoperatively, changes in those variables, percent excess weight loss (%EWL), and %Lean Lost (lean mass lost/weight loss) were evaluated.

Both genders demonstrated significantly favorable Wt, BMI, %EWL, and body composition changes. %Lean Lost was the only parameter that did not significantly change for both genders. Between-gender changes were significant for all variables except BMI, %EWL, fat mass, and lean mass lost. No slopes of changes differed significantly between genders.

RYGB effectively accomplishes favorable weight and body compositions for both genders during the first postoperative year. Findings were used to suggest gender-specific, evidence-based clinical practice guidelines to assess body composition changes. Monitoring changes can help both genders achieve a healthier body weight primarily from fat mass loss while sparing lean mass.