The Obese Brain—Effects of Bariatric Surgery on Energy Balance Neurocircuitry
Abstract Obesity is a highly prevalent disease in the world and with a major impact on global health. While genetic components are also involved in its pathogenesis, in recent years, it has shown a critical role of the innate and adaptive immune cell response in many tissues triggered by excess of nutrients such as lipids and glucose. Free fatty acids and other nutrient-related signals induce damage such as insulin resistance in the peripheral tissues but also in the brain. Specifically in the hypothalamus, these metabolic signals can trigger significant changes in the control of energy balance. Recent studies have shown that saturated fat disrupts melanocortin signaling of hypothalamic neuronal subgroups pivotal to energy control. Bariatric surgery is a treatment option for obesity when other tools have failed, because it is more effective than pharmacotherapy concerning of weight loss itself and in improvement of obesity-related comorbidities. Here, we review the mechanisms by which Roux-en Y gastric bypass (RYGB) can change peripheral signals that modulate melanocortin circuits involved in the regulation of energy balance.
With the advent of the obesity epidemic and the development of minimally invasive surgical techniques, Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) has emerged and remained one of the most effective and common bariatric operations of the past two decades [1-4]. There was a time during the evolution of this procedure when the sheer excitement of completing such a highly complex procedure laparoscopically offered some surgeons a license to cut corners in the name of efficiency. After all, the mantra of “economy of motion” was taught to many of us by those very pioneers who advanced the technical elements of the operation.
I would like to congratulate Pechman DM, et al. on their contribution to the pertinent area of bariatric surgery in elderly patients. Many articles have outlined the safety of both Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy in geriatric patients. Here, the authors use American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data to estimate the morbidity and mortality in patients over the age of 70 who had bariatric surgery.
Several studies have demonstrated minorities and Hispanic ethnicities have disproportionally greater burden of morbid obesity in the United States. However, the majority of bariatric procedures are performed in the non-Hispanic white population.
Nonalcoholic Fatty Liver Disease (NAFLD) prevalence is rising worldwide, as a direct consequence of the obesity epidemic. Bariatric Surgery provides proven NAFLD amelioration, although questions remain if Roux-en-Y Gastric Bypass (RYGB) or Laparoscopic Sleeve Gastrectomy (LSG) is more effective. To answer this question, we conducted a Systematic review and meta-analysis exclusively comparing RYGB against LSG for amelioration of NAFLD using four separate criteria: ALT, AST, NAFLD activity score (NAS), and NAFLD fibrosis score (NFS).
We present the first case of bariatric surgery in a patient with Ehlers-Danlos syndrome and outline management challenges in the context of the relevant literature. A 56-year-old man with type IV Ehlers-Danlos syndrome and a body mass index of 41.8 kg/m2 was referred to the bariatric centre of the Churchill Hospital, Oxford, for consideration of surgery for morbid obesity. His comorbidity included type 2 diabetes, hypertension, dyslipidaemia and obstructive sleep apnoea. He underwent a laparoscopic Roux-en-Y gastric bypass. His initial recovery was uneventful and he was discharged on the first postoperative day. Six weeks ...
AbstractOne anastomosisgastric bypass(OAGB) is currently known as a standard bariatric procedure worldwide. A rare event after OAGB is internal hernia throgh the Petersen ’s defect.
ConclusionsBariatric surgery could not produce sustainable long ‐term weight loss or comorbidity resolution in PWS. This study suggests that bariatric surgery cannot be recommended to PWS patients as a standard treatment.
One-anastomosis gastric bypass (OAGB), also known as mini gastric bypass, is an increasingly popular bariatric surgery option worldwide. While OAGB offers advantage in terms of procedure time and technical ease, revisional operations to correct complications may be necessary.
Gut microbiota could be involved in the metabolic improvement after surgery.
AbstractBackgroundPatients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) are under risk of micronutrient deficiencies. We aimed to assess the preoperative and postoperative micronutrient deficiencies in a sample of patients with obesity who underwent LRYGB.MethodsWe evaluated 169 patients —satisfying the National Institute of Health criteria for bariatric surgery—who underwent a LRYGB from January 2014 to July 2017. Before surgery, we recorded a detailed medical history for every patient, and after surgery, we instructed them to return at 1, 6, 12, 24, 36, and 48 months after su rgery.ResultsPre...