Objective To systematically evaluate the effectiveness of frequently-used bariatric surgery versus conventional medical therapy for obese patients with type 2 diabetes. Methods Such databases as The Cochrane Library (Issue 12, 2012), PubMed, CNKI, CBM, VIP and WanFang Data were searched to collect the randomized controlled trails (RCTs) about frequently-used bariatric surgery vs. conventional therapy for obese patients with type 2 diabetes. The retrieval time was from inception to May, 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality. Then the meta-analysis was performed using RevMan 5.1.2 software. Results A total of three RCTs involving 340 patients were included finally. The results of meta-analysis showed that, compared with conventional medical therapy, bariatric surgery could improve the diabetes remission, decrease both glycated hemoglobin level and patient’s weight. At the same time, the postoperative complications were fairly mild. Conclusion Frequently-used bariatric surgery is superior to conventional medical therapy when treating obese patients with type 2 diabetes, and it deserves to be recommended in clinic. However more studies are required to further confirm this conclusion because of the quality and quantity limitation of the included studies.
Objective To formulate an individualized evidence-based treatment for a patient with severe obesity. Methods According to the PICO (patient intervention comparison outcome) principle, the evidence was collected and critically assessed after the clinical issues were put forwarded. The patient’s preference was also taken into account in the decision making process. Results Nine clinical guidelines, eight systematic reviews or meta-analyses and three randomized controlled trials (RCTs) were included. According to the data from the included studies and patient’s special condition, a reasonable surgical treatment regime was made to reduce the weight, relieve all kinds of complications and improve the life quality which were all regarded as the expected target. After one year’s follow-up, the patient’s weight reduced by 20 kg, and some obesity-related co-morbidities such as sleep apnea syndrome and hyperlipoidemia were also improved significantly. Conclusion The laparoscopic adjustable gastric band is an effective operation for severely obese individuals. This procedure can not only achieve weight loss, but also improve some obesity-related co-morbidities.
ObjectiveTo systematically review the efficacy and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) versus laparoscopic sleeve gastrectomy (LSG) for obesity and type 2 diabetes mellitus (T2DM). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 8, 2014), CNKI and WanFang Data from inception to December 2014, to collect randomized controlled trials (RCTs) of LRYGB vs. LSG for obesity and T2DM. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 8 RCTs including 828 patients were included. The results of meta-analysis showed that:There were no significant differences between the LRYGB group and the LSG group in body mass index (MD=-1.02, 95%CI -2.90 to 0.86, P=0.29), remission rate of T2DM (OR=1.11, 95%CI 0.71 to 1.73, P=0.64), reoperation rate (OR=2.74, 95%CI 1.01 to 7.42, P=0.05), level of fasting plasma glucose (MD=2.71, 95%CI -0.80 to 6.21, P=0.13), and level of serum low density lipoprotein (MD=-23.85, 95%CI -47.20 to -0.50, P=0.05). However, the LSG group had lower postoperative complication rate (OR=2.28, 95%CI 1.43 to 3.62, P=0.000 5) than that of the LRYGB group. ConclusionIn short term, both LRYGB and LSG were equally efficient in the treatment of obesity and T2DM, but LSG has lower postoperative complication rate than LRYGB. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To systematically review the effect of bariatric surgery for male’s erectile function. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, VIP and WanFang Data from inception to May 30th 2016, to collect randomized controlled trials and before-after studies about bariatric surgery therapies for erectile function in obese male. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then RevMan 5.3 software was used for meta-analysis. Results A total of 7 before-after studies involving 270 patients were included. The results of meta-analysis showed that: compared with before treatment, bariatric surgery could significantly improve 1-year erectile function score (MD=5.05, 95%CI 3.52 to 6.59, P < 0.000 01), 1-year sexual desire score (MD=0.99, 95%CI 0.47 to 1.51, P=0.000 2), 1-year contact satisfaction score (MD=2.70, 95%CI 0.21 to 5.19, P=0.004) and 1-year total satisfaction score (MD=1.68, 95%CI 0.27 to 3.09, P=0.002), but there was no significant difference in orgasm function score (MD= –0.21, 95%CI –0.74 to 0.33, P=0.45) between before and after treatment. Conclusion Bariatric surgery is effective in improving the erectile function, sexual desire and sexual satisfaction in morbidly obese male. Due to the limited quality and quantity of the included studies, the above conclusion needs to be verified by more large-scale high-quality studies.
ObjectivesTo compare the effects of different bariatric surgeries on reducing hemoglobin A1c (HbA1c) in overweight/obese patients with type 2 diabetes.MethodsRandomized controlled trials (RCTs) of bariatric surgery were systematically searched in PubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, WanFang Data and VIP databases from inception to February 20th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 14.0 software and R 3.6.2 software.ResultsA total of 24 RCTs were included. Compared with non-surgical treatments, 5 out of 9 procedures significantly reduced HbA1c, and the probability order for the effect was as follows: sleeve gastrectomy with transit bipartition (SGTB) (MD=−3.60%, 95%CI −5.89 to −1.31, P=0.002), mini-gastric bypass (MGB) (MD=−2.36%, 95%CI −4.13 to −0.58, P=0.009), duodenal-jejunal bypass liner (DJBL) (MD=−1.85%, 95%CI −2.75 to −1.96, P<0.000 01), sleeve gastrectomy (SG) (MD=−1.48%, 95%CI −2.49 to −0.47, P=0.004), and Roux-en-Y gastric bypass (RYGB) (MD=−1.31%, 95%CI −2.02 to −0.59, P=0.003). The effects of biliopancreatic diversion with duodenal switch and gastric plication were uncertain. Adjustable gastric banding and Roux-en-Y gastrojejunostomy had no significant effects on HbA1c. Because of the limitations of small sample size and high risk of bias, the results of SGTB requires further validation. ConclusionsThe current evidence suggests that the bariatric surgeries that have relatively beneficial effects for lowering HbA1c treatment are MGB, DJB, SG and RYGB in sequence.
ObjectiveTo evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity with different degrees of obesity.MethodsThe clinicopathologic data of patients received LSG in this hospital from October 2016 to October 2018 were analyzed retrospectively. The effect of LSG on postoperative weight loss in patients with different degrees of obesity were analyzed too.Results① A total of 161 patients with simple obesity were included in this study, including 40 cases of degree Ⅰ obesity, 41 cases of degree Ⅱ obesity, 61 cases of degree Ⅲ obesity, and 19 cases of super obesity. All operations were successfully completed, there was no conversion to laparotomy or mortality. The postoperative bleeding occurred in 4 (2.5%) cases, nausea and vomiting occurred in 97 (60.2%) cases during hospitalization, and 143, 130, and 122 cases were followed up in 1-, 2-, and 3-year after operation. The body mass indexes (BMIs) were decreased significantly in postoperative 1-, 2-, and 3-year (P<0.05) as compared with their preoperative values, respectively. The excess BMI loss percentage(EBMIL%) in postoperative 1-, 2-, and 3-year were (87.4±25.7)%, (84.6±30.5)%, and (88.8±20.4)%, respectively. The rates of weight regaining were 3.8% (5/130) and 4.9% (6/122) in 2- and 3-year following-up, respectively. ② There were no remarkable changes in the trend of BMI in patients with degree Ⅰ and Ⅱ obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–2.3±1.1)% and (3.3±1.5)%, respectively]. Conversely, there were remarkable changes in the trend of BMI in patients with degree Ⅲ obesity and super obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–7.1±1.9)% and (–11.6±5.3)%, respectively].ConclusionsFrom the results of this study, LSG has a good effect on weight loss in the treatment of patients withdegree Ⅰ and Ⅱ obesity. The long-term efficacy of LSG in patients with degree Ⅲ and super obesity, whether to take other bariatric procedures, whether to perform the second operation, and the timing of the second operation need to be further explored.
ObjectiveTo investigate the difference of DNA methylation before and after bariatric surgery.MethodThe relevant literatures of the research on the changes of DNA methylation level and gene expression regulation in blood and tissues before and after bariatric surgery were retrieved and reviewed.ResultsDNA methylation was an important method of epigenetic regulation in organisms and its role in bariatric surgery had been paid more and more attention in recent years. Existing studies had found that there were changes of DNA methylation in blood and tissues before and after bariatric surgery. The degree of methylation varies with different follow-up time after bariatric surgery and the same gene had different degrees of methylation in different tissues, and some even had the opposite results.ConclusionsDNA methylation levels before and after bariatric surgery are different in different tissues. And studies with larger sample size and longer follow-up time are needed, to further reveal relationship among DNA methylation, obesity, and bariatric surgery.
ObjectiveTo understand the present situation and effect of da Vinci robot in the treatment of obesity.MethodThe literatures about the application of da Vinci surgical robot in metabolic surgery for weight loss were reviewed.Resultsda Vinci surgical robot was a minimally invasive surgical system in recent years. Because of its unique structure, it broke through the limitations of traditional laparoscopic surgery, such as lack of field of vision, two-dimensional imaging, unstable lens, limited range of movement, and so on. It provided a solution way for metabolic surgery for weight loss with narrow operation space and high technical difficulty. At present, there were differences in operation time and postoperative complications between da Vinci surgical robot and laparoscopic weight loss.ConclusionsIn recent years, da Vinci surgical robot has been widely used in metabolic surgery for weight loss. It not only overcomes many limitations of laparoscopic assisted weight loss surgery, but also it is safe, feasible, and has a similar clinical effect. It provides a new choice for metabolic surgery for weight loss.
ObjectiveTo investigate the effect of stomach intestinal pylorus sparing surgery in metabolic surgery for weight loss.MethodThe literatures about stomach intestinal pylorus sparing surgery were reviewed by searching domestic and foreign literatures.ResultsIn recent years, stomach intestinal pylorus sparing surgery had been gradually applied in clinical practice. Compared with other weight-loss surgeries, it had better clinical effects in weight reduction and blood glucose control. It not only provided a new surgical treatment for patients with severe obesity, but also promoted the development of weight-loss metabolic surgery.ConclusionAs a new metabolic surgery, stomach intestinal pylorus sparing surgery is safe and feasible for weight loss.
Objective To investigate the clinical application value of unsymmetrical four-port laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of 114 patients with obesity who were admitted to Mianyang Central Hospital from June 2021 to May 2022 were retrospective analyzed. All the 114 patients underwent unsymme-trical four-port LSG, and were observed their surgical and postoperative conditions, complications and follow-up the patient’s esthetic satisfaction of wounds at 3 months after surgery. Results All 114 patients underwent unsymmetrical four-port LSG successfully, without conversion to open surgery. The operative time was 68–160 min, average (104.2±26.1) minutes; volume of intraoperative blood loss was 2–50 mL, average (10.7±7.6) mL; the duration of postoperative hospital stay was 3–6 d, average (4.0±0.7) days. Of the 114 patients, 8 patients (7.0%) had fat liquefaction of wounds, 68 patients (59.6%) had postoperative nausea and vomiting in the 24 hours after operation, and all patients had no serious complications such as gastrointestinal bleeding, intraperitoneal hemorrhage, or gastric leakage. One hundred and fourteen patients were followed-up for 3–14 months, with a median follow-up of 6 months. Forty patients (35.1%) had hair loss, 3 patients (2.6%) had mild anemia. Of the 114 patients, 2 (1.8%) were dissatisfied with the cosmetic effects of wounds, 64 (56.1%) were satisfied, and 48 (42.1%) were very satisfied. The satisfaction rate was 98.2% (112/114). Conclusion The unsymmetrical four-port LSG is safe and feasible, it does not affect esthetic satisfaction of wounds.