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Background & Aims: There is a lack of a meta-analysis to comprehensively assess the effectiveness of higher protein intake in addition to the recommended value on body composition post-bariatric surgery. We aimed to perform a meta-analysis of randomized controlled trials to determine the effects of protein intake higher than the recommended value on body composition changes after bariatric surgery., Methods: Electronic databases, including Scopus, PubMed/Medline, and Web of Sciences, were searched until July 2023. Studies that assessed the effect of protein intake higher than the recommended value on postoperative body composition, i.e., weight, body mass index (BMI), fat mass (FM), fat-free mass (FFM), percent fat mass (PFM), and percent total weight loss (%TWL), were eligible. For each outcome, the mean and standard deviation (for changes from baseline) were used to synthesize the data., Results: Eight trials were included in the current study. The results of the meta-analysis indicated protein intake higher than the recommended value after bariatric surgery led to more weight loss by 4.95 kg (95 % CI: -9.41 to -0.49) and FM loss by 7.64 kg (95 % CI: -14.01 to -1.28) compared with the control group. However, it had no significant effects on postoperative changes in BMI, FFM, PFM, or %TWL. There were no significant differences in body composition between protein sources obtained from diet and supplementation. When data was stratified based on the amount of added protein, we found a significant reduction in weight (MD: -7.80 kg; 95 % CI: -14.50 to -1.10) in patients who consumed protein ≥ 40 g/d in addition to the recommended value. Besides, protein intake higher than the recommended value declined FFM loss in patients who underwent laparoscopic sleeve gastrectomy (LSG) (MD: 6.52 kg; 95 % CI: 0.99 to 12.02)., Conclusion: The results of the current meta-analysis indicated that protein intake higher than the recommended value might cause greater weight and FM loss after bariatric surgery than a normal protein diet. However, our findings did not support the role of additional protein in the preservation of FFM, except in patients with LSG., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Purpose: Prior studies have demonstrated that both dietary components and bariatric surgery modify the gut microbiota's composition. However, there is a scarcity of research that has examined the relationship between post-surgical dietary intake and changes in the gut microbiota. The aim of this study was to assess changes in gut microbiota following bariatric surgery and examine their association with postoperative dietary intake., Materials and Methods: The present study involved a sample of 42 adult women who were potential candidates for bariatric surgery, i.e., laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG). The assessment of dietary intake was conducted through the use of three-day food records, both at baseline and six months following the surgical procedure. The gut microbiota was determined through the detection of 16S ribosomal RNA (16S rRNA) gene sequencing., Results: After six months, a significant increase in abundance of Firmicutes (P = 0.01), Bifidobacterium (P = 0.01), and Ruminococcus (P = 0.04) in the LSG group was found. In contrast to the observed rise in Enterobacteria (P = 0.02) levels in the LRYGB group, no significant changes were detected in the composition of other gut microbiota over the 6-month monitoring period subsequent to LRYGB. The results of our study indicate that there is not a statistically significant relationship between dietary consumption and changes in the composition of the gut microbiota in individuals who have undergone LRYGB and LSG., Conclusion: Our findings suggest that there may not be a significant correlation between dietary intake following LRYGB and LSG, and the observed alterations in the gut microbiota during a six-month period of observation. Nevertheless, it is important to acknowledge that the sample size utilized in our study was limited, potentially leading to reduced statistical power and the possibility of yielding findings that do not accurately reflect reality., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Measurement of small bowel length is an essential step in performing bariatric surgery. Surgeons need to measure bowel length in order to create alimentary and biliopancreatic limbs. Inaccurate bowel measurement may affect the outcome of surgery. However, it is not clear how accurate the measurement of bowel length is by surgeons., Methods: Two image quizzes marking certain lengths of jejunum were sent to participants. They were asked to estimate the length of marked bowels in maze quizzes. The Error of estimation, prevalence of significant error (error greater than 30 percent of actual length), and the relationship between different participant characteristics was investigated., Results: A total of 86 participants answered the questionnaire. The mean error of estimation was 4.62 cm (27%). Twenty-eight participants (33%) had significant errors in estimation of bowel length., Conclusion: While there are surgeons that can estimate bowel length with decent accuracy, significant errors in estimation of bowel length are not uncommon among surgeons. Surgeons should consider adopting techniques for accurate measurement of the small intestine., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 MIrzaee, Golzarand, Parsaei, Toolabi and Amirbeigi.)

Background: A few comparative studies have assessed the incidence of symptomatic cholelithiasis after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). However, they have shown inconsistent results. The present study has been designed based on comparing LSG and LRYGB regarding the incidence of symptomatic cholelithiasis and determining factors related to symptomatic cholelithiasis development after these procedures., Methods: This retrospective cohort study was conducted on 1163 patients aged ≥ 18 years old who underwent LRYGB (n = 377) or LSG (n = 786) from July 2006 to November 2019. The participants had no previous history of gallstones. A Cox-proportional hazard regression was used to assess associations between the types of procedures and the risk of symptomatic cholelithiasis. The univariable and then multivariable analysis were used to reveal the predictors of symptomatic cholelithiasis., Results: The mean person-time follow-up was 34 months (95% CI: 32.2 to 36.1 months). The incidence of symptomatic cholelithiasis was 8.3% over the follow-up period. There was no significant association between the risk of symptomatic cholelithiasis development and the type of surgical procedure (HR: 1.35, 95% CI: 0.75 to 2.41). Females had a 2.3-fold higher risk of symptomatic cholelithiasis than males, according to the multivariable Cox regression (HR: 2.31, 95% CI: 1.23 to 4.33). In addition, there was an inverse association between the administration of UDCA and the incidence of symptomatic cholelithiasis (HR: 0.13, 95% CI: 0.01 to 0.99). Our findings indicated that age, baseline body mass index (BMI), percentage of weight loss (%WL) after three and six months following surgery, postoperative pregnancy, and obesity-related comorbidities did not predict the risk of symptomatic cholelithiasis., Conclusion: The present study illustrates no significant differences between LRYGB and LSG regarding symptomatic cholelithiasis occurrence. Our findings indicate that administration of UDCA has a protective effect against symptomatic cholelithiasis while, female gender is the main predictor of symptomatic cholelithiasis., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Histone deacetylases (HDACs) are important players in a variety of physiological and pathological conditions. Few studies have addressed HDAC expressions in human adipose tissue in obese individuals, and their association with pro-inflammatory cytokines. Here, we compared 20 non-obese and 20 obese women to investigate possible changes in gene expressions of HDAC2, 4, 5, and 6 in the subcutaneous adipose tissues (SAT) and visceral adipose tissues (VAT) of these individuals. Our findings showed decreased HDAC5 expression in SAT and elevated HDAC4 expression in VAT from the obese group compared with the non-obese group. Our analyses showed negative correlations between HDAC2, 5, and 6 and the obesity indices and positive correlations between HDAC4 and obesity indices. HDAC2 showed a positive correlation with pro-inflammatory cytokines whereas HDAC4, 5, and 6 were negatively correlated with pro-inflammatory cytokines. Our findings provide new evidence that implicates the important roles of HDACs in obesity and obesity-associated inflammation.

Purpose: Identifying the possible predictors of postoperative bleeding is advantageous to reduce healthcare costs and promote patients' recovery. The aim of this study was to determine early postoperative bleeding predictors after bariatric surgery., Materials and Methods: This retrospective study was conducted using data from 2260 patients who underwent bariatric surgery. We diagnosed early postoperative bleeding by the following symptoms: abdominal pain, hypotension, tachycardia, hematemesis, melena, decreased hemoglobin level, the need for at least two units of packed red blood cells (PRBCs) transfusion, and reoperation within the first 48 h after surgery., Results: Our results showed the odds of early postoperative bleeding in laparoscopic Roux-en-Y gastric bypass (LRYGB) were higher than in laparoscopic sleeve gastrectomy (LSG) (OR 3.49, 95% CI 1.79 to 6.80). In addition, prior intragastric balloon (IGB) (OR 3.14, 95% CI 1.18 to 8.34) and oral non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) (OR 5.91, 95% CI 1.79 to 20.63) were positively associated with the occurrence of postoperative bleeding. In contrast, there was an inverse relationship between staple line oversewing and the odds of postoperative bleeding (OR 0.18, 95% CI 0.04 to 0.81). After stratification data based on the type of the surgery, the positive association between IGB and the odds of bleeding was constant in the LRYGB group. In the LSG group, use of non-aspirin NSAIDs was linked to a higher incidence of postoperative bleeding, while oversewing of the staple line lowered the incidence of this event., Conclusions: Our results demonstrated a positive association between type of procedure, history of IGB, and oral non-aspirin NSIADs use, as well as an inverse relationship between staple line oversewing and the odds of bleeding after bariatric surgery., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Endoscopic thoracic sympathectomy/sympathotomy is gold standard of treatment for primary hyperhidrosis. Compensatory hyperhidrosis following surgery and partial response to surgery in some patients can significantly affect surgery outcome and patient satisfaction. In this study we investigated predictors of success rate, side effects, and satisfaction of our patients following ETS over a 10-year period., Methods: We retrospectively reviewed result of 200 Endoscopic thoracic sympathotomy surgeries that was performed in a single center to treat craniofacial, palmar, or axillary primary hyperhidrosis over a 10-year period. Patients were asked to report success of surgery to resolve their primary hyperhidrosis, development of compensatory hyperhidrosis, its severity, and their overall satisfaction with surgery., Results: Palmar hyperhidrosis was resolved in 167 (94%) patients. Craniofacial hyperhidrosis was resolved in 66 (84%) patients. Axillary hyperhidrosis was resolved in 68 (50%) patients. Compensatory hyperhidrosis developed in 176 (88%) patients. 44 (22%) patients had mild CHH, 79 (40%) patients developed moderate CHH, and 52 (26%) patients experienced severe CHH. A total of 173 (87%) patients were satisfied with surgery. 19 (9%) patients were not satisfied with ETS and 8 (4%) patients regretted ETS. Lower body mass index and grade IV primary hyperhidrosis were found to be independent predictors of patient satisfaction. Pure axillary primary hyperhidrosis was a negative predictor of patient satisfaction., Conclusion: Best results of ETS are achieved in patients with grade IV PHH and lower body mass indexes. Outcome of ETS for treating axillary PHH is not favorable., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

A few randomized controlled trials (RCTs) have assessed the effect of brown rice consumption on metabolic parameters compared to white rice, with inconsistent findings. Therefore, the present systematic review and meta-analysis was designed to evaluate the effect of brown rice on adiposity indices, lipid profile, and glycemic markers in adult subjects compared to white rice. In this study, PubMed/Medline, Scopus, Web of Sciences, and Embase databases were comprehensively searched until March 2021. Thirteen RCTs were selected and then included in the meta-analysis. As reported, brown rice significantly reduced weight by -1.63 kg (95% CI: -2.15 to -1.11, I 2 =97%, n = 6), body mass index (BMI) by -0.58 kg/m 2 (95% CI: -0.78 to -0.37, I 2 =96%, n = 6), and waist circumference by -2.56 cm (95% CI: -4.86 to -0.26, I 2 =88%, n = 5) compared with white rice. Moreover, it had no significant effect on lipid profile and glycemic markers. Besides, pre-germinated brown rice significantly declined weight (-1.75 kg, 95% CI: -2.70 to -0.81, I 2 =99%, n = 4), total cholesterol (-24.22 mg/dl, 95% CI: -33.03 to -15.41, I 2 =78%, n = 5), triglyceride (TG) (-43.28 mg/dl, 95% CI: -74.05 to -12.50, I 2 =90%, n = 5), low-density lipoprotein (LDL) (-20.05 mg/dl, 95% CI: -29.57 to -10.52, I 2 =71%, n = 5), and fasting blood glucose (FBG) (-15.83 mg/dl, 95% CI: -25.20 to -6.46, I 2 =91%, n = 5). In accordance with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the certainly of the included evidence was low and very low. The results of the present study indicate that, brown rice has anti-obesity effects in comparison with white rice; however, it has no beneficial effects on lipid profile and glycemic markers. Contrary to brown rice, it was shown that, pre-germinated brown rice significantly decreases body weight and improves lipid profile and FBG levels compared to white rice. Accordingly, our results indicate that, pre-germinated brown rice has better functional effects on promoting lipid profile and FBG compared to brown rice.

Purpose: This cohort study was designed to compare the efficacy and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) for the management of morbid obesity during the 11-year experience., Materials and Methods: This study was conducted between July 2006 and August 2019. Annually we recorded data about the weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage of weight loss (%WL), weight regain, and postoperative complications into a prospectively collected database., Results: A total of 1146 patients (LRYGB=396 and LSG=750) aged >18 years old were included in the study. Over the first 7 years after surgery, the weight loss rate was significantly higher in the LRYGB-treated group than the LSG-treated group, and weight regain was significantly lower in the LRYGB-treated group in comparison with the LSG-treated group. Our results revealed that statistically, but not clinically, the efficacy of LRYGB and LSG is equivalent in terms of %WL, %EWL, and weight regain within 8 years and more. Besides, there were no significant differences in surgery-related mortality and severe complications between the two procedures., Conclusion: Our study's results indicated that the clinical efficacy of LRYGB in the management of obesity is better than LSG during the 11-year experience. But the differences in weight loss and weight regain were not statistically relevant at 8 years and more after the surgery. Also, a comparison of severe complications did not indicate significant differences between the two groups.

BACKGROUND Postoperative pain, nausea, and vomiting are the most common side effects of laparoscopic cholecystectomy (LC). In the present study, we investigated the differences in postoperative pain, nausea, and vomiting between Veress needle and direct trocar entry methods among patients undergoing LC. METHODS 96 patients with gallstones were studied. They were randomly divided into two groups: the patients in the first group (n = 48) were insufflated 8.1 liters per minute CO 2 gas by direct trocar port, and the patients in another group (n = 48) were insufflated 2.1 liters per minute CO 2 gas by Veress needle. Pain intensity, nausea, and vomiting were assessed at 20 minutes, 4 hours, and 12 hours after the operations. RESULTS The duration of CO 2 gas insufflation in Veress needle was 88.7 ± 10.7 seconds and indirect trocar was 16.6 ± 1.6 seconds. Visual analog scale (VAS) score significantly reduced in Veress needle compared with direct trocar (0.39 ± 0.98 vs. 1.68 ± 1.48) at 20 min after the operation, while there was no difference at 4 hours and 12 hours after the operation. The requirement and dose of pethidine injection were significantly lower in Veress needle than direct trocar. In addition, nausea and vomiting occurred in Veress needle less than direct trocar at 20 min, 4 hours, and 12 hours after LC. CONCLUSION Pain intensity just in the short term after LC in the group with CO 2 gas insufflation in Veress needle was significantly less than the other group, while nausea and vomiting were significantly less during the whole follow-up periods in the group with CO 2 gas insufflation in Veress needle., Competing Interests: CONFLICT OF INTEREST The authors declare no conflict of interest related to this work., (© 2021 The Author(s).)

Objective: Several trials have examined the effect of Garcinia cambogia supplement on the weight and body composition, but their results are conflicting. This systematic review and dose-response meta-analysis was designed to determine the effect of Garcinia cambogia supplement on the obesity indices in human randomized controlled trials (RCTs)., Methods: PubMed/Medline, Scopus, Cochrane library, and Web of Science databases were searched up to 1 th January, 2020, to screen relevant trials. The mean changes in the weight, body mass index (BMI), percentage of fat mass (PFM), and waist circumference (WC) from the baseline were used to conduct the present dose response meta-analysis., Results: In the current study, eight trials (including 530 subjects) were included. Garcinia cambogia supplement significantly reduced the weight by -1.34 kg (95% CI: -2.62 to -0.07, P = 0.03), BMI by -0.99 kg/m 2 (95% CI: -1.48 to -0.49, P < 0.001), PFM by -0.42% (95% CI: -0.77 to -0.06, P = 0.02), and WC by -4.16 cm (95% CI: -7.83 to -0.49, P = 0.02) compared with the placebo group. Dose-response analysis revealed that there is a nonlinear association between Garcinia cambogia dosage and changes in the body weight (P nonlinearity = 0.04) and BMI (P nonlinearity < 0.001) not PFM (P nonlinearity = 0.68). There was no publication bias among the studies., Conclusion: Our results suggested that Garcinia cambogia supplement had a significant effect on the body weight, BMI, PFA, and WC as compared with the placebo., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

It is well-established that an impaired adipose tissue function and morphology caused by a dysregulated gene expression contribute substantially to obesity. Nowadays, animal model studies and in vitro surveys provide evidence for possible roles of HDACs as emerging epigenetic players in the pathogenesis of obesity. However, the clinical pertinence of HDACs in the field of obesity research in humans is not yet obvious. Here, we investigated mRNA expression of HDAC1, 3 and 9 in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) of obese female participants (n = 20) and normal-weight women (n = 19). We also evaluated the association of the afore-mentioned HDACs gene expression with obesity indices, insulin resistance parameters, and other obesity-related characteristics. Our data revealed the mRNA level of HDAC1 was significantly decreased in both VAT and SAT of obese women, compared to controls. Moreover, the SAT mRNA expression of HDAC3 and VAT mRNA levels of HDAC9 were significantly lower in obese subjects than those found in controls. We observed that HDAC1 and HDAC3 expression in adipose tissue from the whole population is inversely correlated with obesity indices; BMI, waist, hip and waist-to-height ratio (WHtR). Moreover, we found that HDAC3 expression in adipose tissue had an inverse correlation with HOMA-IR, insulin levels, and serum concentration of hs-CRP. Moreover, VAT HDAC9 mRNA level is inversely correlated with obesity indices; BMI, waist, hip and WHtR and with HOMA-IR, insulin levels, and serum concentration of hs-CRP. Hence, it seems that decreased HDAC1,3 and 9 mRNA expression in adipose tissue might be associated with obesity and related abnormalities. However, more studies are needed to establish this concept.

Background: Recent studies point toward the possible regulatory roles of two lncRNAs; metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and taurine upregulated gene 1 (TUG1) in the pathogenesis of obesity-related disorders and regulation of lipogenesis and adipogenesis. In an attempt to understand the molecules involved in human obesity pathogenesis, we aimed to evaluate the expression of MALAT1 and TUG1 in visceral adipose tissues (VAT) and subcutaneous adipose tissues (SAT) of obese women, as compared to normal-weight women. The mRNA expression of possible target genes including peroxisome proliferator-activated receptor gamma (PPARγ), PPARγ coactivator-1 alpha (PGC1α), sterol regulatory element-binding protein-1c (SREBP-1c), fatty acid synthase (FAS), and acetyl-CoA carboxylase (ACC) which are involved in adipogenesis and lipogenesis were also examined., Methods: This study was conducted on 20 obese [body mass index (BMI) ≥ 30 kg/m 2] female participants and 19 normal-weight (BMI < 25 kg/m 2) female participants. Real-time PCR was performed to investigate the mRNA expression of the above-mentioned genes in VAT and SAT from all participants., Results: The results showed lower mRNA levels of TUG1 in both the VAT and SAT of obese women, compared to normal-weight women. Furthermore, TUG1 expression in SAT positively correlated with BMI, waist circumference (WC), hip circumference, HOMA-IR, and insulin levels, eGFR value, creatinine levels, and hs-CRP in all participants independent of age and HOMA-IR. However, VAT mRNA expression of TUG1 had a positive correlation with obesity indices and HOMA-IR and insulin levels in the whole population. Moreover, SAT mRNA level of TUG1 was positively correlated with SAT gene expression of PGC1α, SREBP-1c, FAS, and ACC independent of age and HOMA-IR. Although mRNA expression of MALAT1 did not differ between two groups for any tissue, it was positively correlated with SAT mRNA levels of SREBP-1c, PPARγ, and their targets; FAS and ACC, as well as with VAT mRNA levels of PGC1α., Conclusions: It seems likely that TUG1 with distinct expression pattern in VAT and SAT are involved in the regulation of lipogenic and adipogenic genes and obesity-related parameters. However, more studies are necessary to establish this concept., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: Obesity, a medical condition with impaired adipokine secretion and function, has a detrimental effect on insulin and glucose metabolism. CTRP3 and CTRP9 are adipokines with possible roles in energy homeostasis regulation. We sought to compare CTRP3, CTRP9, and inflammatory gene expression in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) from obese women who underwent bariatric surgery and non-obese women as controls., Methods: For this study, the investigators recruited 20 morbidly obese women (BMI> 35) who qualified for bariatric surgery and 20 normal-weight women (BMI< 25) who underwent elective surgeries. Real-time PCR was performed to investigate mRNA expression of CTRP3, CTRP9, and the inflammatory genes IL1-β, IL-6, MCP-1, and TNF-α in SAT and VAT from both obese patients and controls., Results: We observed that CTRP3 mRNA levels were significantly greater in VAT from obese patients than from controls (P< 0.0003). Also, patient group had higher levels of CTRP9 that control group (P< 0.0026). Inflammatory cytokines were markedly increased in SAT of obese patients compared to controls (P< 0.05). In addition, our results revealed a positive correlation of CTRP9 with HOMA-IR and waist circumference in VAT and CTRP3 with IL-1β, MCP-1, and TNF-α in SAT., Conclusion: Both CTRP3 and CTRP9 expression were significantly higher in VAT from obese patients than from controls, and CTRP3 expression positively correlated with inflammatory parameters. Our findings indicate that CTRP3 and CTRP9 might be important in regulating glucose metabolism and obesity-related conditions such as inflammation.

Background: This study was conducted to evaluate the amount of weight loss and weight regain and also remission rate of obesity-related comorbidities including diabetes mellitus (DM), hypertension (HTN), and dyslipidemia in patients who underwent LRYGB or LSG during 5 years of follow-up., Methods: A total of 120 patients who underwent LRYGB or LSG from 2011 to 2013 were enrolled and followed-up for 5 years. Changes in weight, body mass index (BMI), percent weight loss (%WL), and percentage of excess weight loss (%EWL) were recorded., Result: %WL and %EWL were similar between two procedures at 1 year following operation. In patients who underwent LSG, %WL and %EWL were 24.6 ± 1.3% and 61.9 ± 3.5%, respectively, and in LRYGB were 30.4 ± 1.3% and 79.4 ± 3.6%, respectively, 5 years after surgery. Weight regain was 32.0% in LSG and 9.3% in LRYGB after 5 years. The remission rate of diabetes mellitus, hypertension, and dyslipidemia was 70%, 54%, and 100%, respectively, after 5 years of surgery., Conclusion: Comparing the 5-year success rate of these two techniques, LRYGB seems to be superior to LSG, with lower weight regain and higher weight loss. The short- and long-term effects of two procedures on remission of comorbidities were comparable.

Purpose: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common techniques for treatment of morbid obesity. However, a few studies have compared the energy expenditure and plasma amino acid profile after LRYGB and LSG. The present study was conducted to assess the resting metabolic rate (RMR) and plasma amino acid profile in obese patients who underwent LRYGB and LSG before and 6 months after the surgery in order to compare these changes from baseline between the two procedures., Materials and Methods: Forty-three adult obese patients participated in this study (LRYGB = 22 and LSG = 21) and were followed up for 6 months. RMR was measured by indirect calorimetry. The plasma amino acid profile was determined using high-performance liquid chromatography (HPLC)., Results: Mean percent excess weight loss (%WL) were 22.8 ± 4.5% and 23.3 ± 5.7% in LRYGB and LSG, respectively. RMR reduced significantly from baseline by - 459 ± 202 kcal/day in LRYGB and - 500 ± 262 kcal/day in LSG. RMR reduced beyond the expected decrease in both procedures. A decreasing trend was observed in the plasma concentration of branched-chain amino acids (BCAA), aromatic amino acids (AAA), and amino acid index (AAI) in both techniques. There was no significant difference in weight, RMR analysis, and amino acid change from baseline between LRYGB and LSG., Conclusion: Our results showed that the effects of LRYGB and LSG on RMR and amino acid profile were comparable.

Introduction: Many surgery videos can be found in different social networks and video sharing websites. Watching surgeries performed by different surgical experts of various institutions can be an invaluable supplement to traditional methods of learning surgery. YouTube is a quite popular video sharing website, and many surgeons and trainees refer to it as a source of surgery videos. However, since its content is not peer-reviewed, there is a concern over reliability and educational value of its surgical videos. In this study, we aimed to investigate the reliability and educational value of laparoscopic sleeve gastrectomy (LSG) videos on YouTube., Methods: We searched YouTube for videos of "Laparoscopic sleeve gastrectomy" on 20 July 2018. In order to assess videos, we evaluated ten key steps in laparoscopic sleeve gastrectomy. The videos were reviewed by two experienced surgeons in the field of bariatric surgery to determine their reliability., Results: A total of 74 videos were selected. After reviewing videos, 32 (43%) of them were considered as reliable. There was no relationship between reliability and views, likes, dislikes, resolution, and year of upload and affiliation of videos. Only 6 (8% of all) reliable videos showed operation setup and port placement and included voice commentary., Conclusion: Importance of online media in the education of surgery cannot be overestimated. However, trainees are advised to search for peer-reviewed contents dedicated to education.

Obesity is a well-known chronic low-grade inflammation condition characterized by dysregulated adipokine secretion and function. Both CTRP12 and CTRP13 are adipokines that influence glucose and lipid metabolism. We aimed to investigate CTRP12, CTRP13, and inflammatory gene expressions in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) from obese women who underwent bariatric surgery in comparison with the normal weight women. This case-control study included 20 obese [body mass index (BMI) > 35-40 kg/m 2 ] candidates for bariatric surgery and 20 normal-weight women (BMI <25 kg/m 2 ) as control group, who underwent elective surgeries. Real-time PCR was used to evaluate mRNA expression levels of CTRP12, CTRP13, and inflammatory genes in SAT and VAT from both groups. We observed significantly higher mRNA expression of CTRP12 in SAT (p = 0.048) and VAT (p = 0.046) from obese patients compared to the controls. There was significantly greater expression of IL-6 and MCP-1 inflammatory genes in SAT (p = 0.013 and p = 0.005 respectively) and VAT (p = 0.000 and p = 0.001 respectively) of obese patients compared to the control group. IL-1β (p = 0.015) and TNF-α (p = 0.014) expressions significantly increased in VAT from obese patients compared to the control group. Spearman correlation analysis showed that CTRP12 expression significantly correlated with obesity indices. Our findings showed that CTRP12 significantly increased in both VAT and SAT of obese group. More importantly, we observed a positive correlation between CTRP12 with inflammatory parameters. These results indicated that CTRP12 might be part of an intricate network for glucose metabolism and obesity-related inflammation processes., (Copyright © 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Introduction: Training is the primary route of attaining required skills among residents in general surgery., Objective: This study was conducted to evaluate the minimum number of required sessions for attaining basic skills in laparoscopic surgery in a skill-lab among surgical residents., Method: This cross-sectional study was conducted in Imam-Khomeini Hospital during 2012. A total of 20 surgical residents were enrolled. There were 45-60 mins sessions weekly, which included the following seven elementary skills: first knot tie, second knot tie, peg exchange, peg drop, rope pass, needle pass, and paper cut. These skills were evaluated weekly, and qualitative evaluations were done every 2 weeks., Results: Mean age of the 20 surgical residents was 32.2 ± 4.7 years, and 55.6% of them were males. The median session counts were as follows: six sessions for first knot tie, six sessions for second knot tie, three sessions for peg exchange, eight sessions for needle pass, and five sessions for paper cut., Conclusion: Based on the obtained results, it may be concluded that relatively five sessions are required for acquiring basic skills in laparoscopic surgery by surgical residents.

Purpose: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most popular procedures to treat morbid obesity among bariatric surgeries. However, only few studies have compared the changes in body composition, dietary intake, and substrate oxidation after LRYGB and LSG. Therefore, the present study was conducted to compare the changes in body composition, dietary intake, and substrate oxidation 6 months postoperatively in obese patients who underwent LRYGB and LSG., Materials and Methods: In this prospective study, a total of 43 adult obese patients participated (LRYGB = 22 and LSG = 21). Their body composition was measured by bioelectric impedance analysis. Dietary intake was assessed using 3-day food record. Substrate oxidation was measured by indirect calorimetry. All participants were followed up for 6 months., Results: The percentage of weight loss was 22.8 ± 4.5 and 23.3 ± 5.7% in LRYGB and LSG, respectively. Fat mass (FM), fat-free mass (FFM), and percentage of fat mass (PFM) significantly reduced in LRYGB and LSG, while the percentage of fat-free mass (PFFM) significantly increased in both surgeries. Dietary energy intake significantly reduced by 63.5 ± 30.6% in LRYGB and 66.7 ± 20.1% in LSG. Dietary intake of protein, carbohydrate, fat, and fiber significantly decreased in each group. The percentage of energy from protein, carbohydrate, and fat did not change in each group. Protein oxidation and carbohydrate oxidation significantly reduced in both procedures postoperatively. Changes in body composition, dietary intake, and substrate oxidation from baseline were equal in LRYGB and LSG., Conclusion: Therefore, LRYGB and LSG have similar effect on total and regional FM and FFM, dietary macronutrients intake, and substrate oxidation.

Background: Several studies have been investigated to find the long-term effect of bariatric surgery on weight loss; nevertheless, a meta-analysis can detailedly demonstrate the effect of bariatric surgery on weight in morbidly obese patients. This study aimed to assess the long- and very long-term effects of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) on weight loss in adults., Methods: An electronic search using PubMed, Scopus, and Google scholar databases was performed for all English-language articles up to May 15, 2016 with no publication date restriction. Outcome was long-term (≥5-10 years) and very long-term (≥10 years) weight reduction that reported as the mean %EWL and changes in BMI from baseline., Results: Eighty articles with 87 arms were included in this meta-analysis. The excess weight loss percentage (%EWL) was 47.94% and 47.43% after LAGB at ≥5 and ≥10 years, respectively. After LRYGB the %EWL was 62.58% at ≥5 years and 63.52% at ≥10 years. It was 53.25% at ≥5 years after LSG. Results of subgroup analyses have indicated that LRYGB leads to higher %EWL in America and Asia compared with Europe. Meta-regression analyses have shown that there is no significant association between %EWL and baseline age, BMI and length of follow-up after three procedures. However, there is a positive association between gender and %EWL after LRYGB (β = 1.24). No publication bias was found., Conclusions: These findings suggest that LRYGB is an effective procedure in morbidly obese patients that leads to sustainable weight loss over the long- and very long-term periods in compared with LAGB and LSG.

How the distance of sutures from the edge of tissue and the horizontal distance between stitches affect the mechanical strength of anastomosis is investigated. In this study, 180 bovine intestines were used to investigate the optimum pattern in 18 groups by considering a 4, 6, and 8 mm horizontal distance between stitches, and a 3, 5, and 7 mm distance from the edge of tissue with 3-0 Silk and 3-0 PDS sutures to maximize the strength of anastomosis (10 specimens in each group). Also, 80 specimens were used to investigate the maximum effective distance of sutures from the edge of tissue in eight groups of: 3, 5, 7, and 10 mm distance from the edge, with the same type of sutures. Tensile tests with an elongation rate of 5 mm/min were performed for all the groups. Based on the results, the pattern of 7-6 (distance from the edge-distance between stitches) for both 3-0 Silk and 3-0 PDS, 5-6 and 7-4 for 3-0 Silk, and 5-6 and 7-4 for 3-0 PDS can be considered as the best options among 18 different combinations. It was also found that increasing the distance from the edge from 7 mm to 10 mm does not cause a significant difference in mechanical strength. Results can help surgeons to improve the intestinal anastomosis and employ it as an input for automatic suturing devices.

Background: Laparoscopic adjustable gastric banding (LAGB) is a common bariatric surgery. Although it is a safe and effective method of weight reduction in short term, it may result in some problems in long term. The purpose of this study was to investigate the consequences of LAGB in long term among morbid obese patients., Methods: In this prospective study, 80 patients underwent LAGB using pars flaccida technique from 2001 to 2006. Long-term postoperative consequences and complications of these patients were recorded., Results: The preoperative mean values of weight and body mass index were 125.5 ± 22.5 kg and 44.5 ± 6.5 kg/m(2), respectively. Over the 13-year follow-up period, 56 patients (84.8%) experienced at least one complication. The most common complications were band erosion (20 patients) and weight regains (13 patients). Fifty-one patients (78.5%) required reoperation. The band of 48 patients (72.7%) was removed; of these, twenty patients (30.3%) underwent other bariatric surgeries. Percent of excess weight loss was 47.1% ± 30.1%, and the success rate was 48.7%., Conclusions: LAGB is a successful method with low complications in short term; however, over long term, it results in various complications., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Obesity as a worldwide health problem is associated with nonalcoholic steatohepatitis (NASH). Since severe liver injury may be present in asymptomatic obese patients and a definite diagnosis of nonalcoholic steatohepatitis can only be made after an invasive procedure of liver biopsy, there is a need for noninvasive methods to predict the probability of NASH., Objectives: To investigate the role of vitamin D endocrine system in predicting the probability of presence of NASH in asymptomatic morbidly obese candidates of bariatric surgery., Patients and Methods: From December 09 to March 11, every patient undergoing bariatric surgery had a liver biopsy. Nonalcoholic steatohepatitis was diagnosed using the Lee's criteria, the baseline labs obtained and the association between laboratory data and presence of NASH assessed., Results: Forty-six patients (34 women, aged 36.5 ± 10.6 years) were analyzed. The mean levels of liver enzymes were significantly higher in the group with NASH (P value < 0.01). In an unadjusted logistic model, PTH was the only variable in vitamin D endocrine system which was significantly associated with NASH (odds ratio (OR): 1.04, 95%CI: 1.01 - 1.07). After adjustment for possible confounding factors, age (OR: 1.22, 95%CI: 1.00 - 1.50) and PTH (OR: 1.08, 95%CI: 1.01 - 1.16) were predictive factors for NASH (P value < 0.05)., Conclusions: Elevated serum PTH level was the predictive factor for NASH in morbidly obese patients. Also, we reported elevated serum liver enzymes, high serum PTH levels and older age as predictors of NASH in patients seeking obesity surgical treatments.

Objective: Middle Eastern and North African countries are undergoing nutrition transition, a transition which is associated with an increased burden of non-communicable diseases. This necessitates the evaluation of dietary patterns in these regions. The present study aimed to assess changes in dietary patterns in Middle Eastern and North African countries between 1961 and 2007., Design: Availability of energy and fifteen main food items during 1961-2007 was examined using FAO food balance sheets from the FAOSTAT database., Setting: Fifteen countries including nine in the Middle East and six in North Africa were selected and the average availability of total energy and different food items in these regions were compared., Results: Over the 47 years studied, energy and food availability (apart from animal fats and alcoholic beverages) has increased in the Middle East and North Africa. In both regions the proportion of energy derived from meat and vegetable oils has increased significantly while that from cereals decreased significantly. In addition, the proportion of energy from milk and dairy products and vegetables has shown an ascending trend in North Africa while the proportion of energy from fruits has shown a descending trend in the Middle East., Conclusions: The study results reveal an unfavourable trend towards a Westernized diet in the Middle East and, to a certain extent, in North Africa. Tailored nutritional education encouraging healthy eating for prevention of the burden of chronic diseases in these countries seems essential.

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is suggested as the gold standard of the surgical techniques for morbid obesity treatment. The aim of this study was to evaluate the weight loss and biomarker parameter changes over a 1-year period following LRYGB in Iranian morbidly obese patients., Methods: Sixty patients who had undergone LRYGB from June 2006 to August 2008 were followed up. Complication rates and changes in anthropometric indices, metabolic parameters, and obesity-related comorbidities were evaluated., Results: During the mean follow-up duration of 27.2 ± 9.4 months, the mean weight reduced from 128.8 ± 20.4 to 86.9 ± 12.7 kg with excess weight loss (%EWL) of 63.8 ± 15.6%. The male young-adolescent patients showed more weight loss than females. Biochemical parameter changes were reduction of fasting blood sugar by 19%, total cholesterol by 17%, triglyceride by 30%, low-density lipoprotein by 19%, aspartate aminotransferase by 44%, alanine aminotransferase by 52%, alkaline phosphatase by 33%, and uric acid by 19%, while high-density lipoprotein (HDL) levels increased by 22%. HDL level change was the only biomarker factor showing correlation with age (P = 0.005, r = -0.353, R(2) = 0.125). Obesity comorbidities were resolved considerably. There were two cases of surgical complications and no case of mortality., Conclusion: LRYGB appears to be a safe and effective procedure with a low complication rate in Iranian morbidly obese patients. It results in weight loss, reduction in obesity comorbidities, increasing HDL, and decreasing other measured plasma biochemical parameters. Based on our results, we suggest that LRYGB would benefit young male morbidly obese patients more than others.

Background: Minimal access mediastinal surgery (MAMS) is usually performed under general anaesthesia with double lumen tubes (DLT). The aim of this study is to evaluate two lung ventilation through single lumen tubes (SLT) during thoracoscopic sympathectomy for hyperhidrosis and thoracoscopic thymectomy for myasthenia gravis., Methods: In this prospective non-randomized study, MAMS was performed in 58 patients with hyperhidrosis and 42 patients with myasthenia gravis, from January 2002 to December 2008. Patients were intubated with a DLT or SLT, 50 patients in each group. In the DLT group, endobronchial tubes were placed using the traditional blind approach and one lung ventilation was confirmed clinically. In the SLT group, the hemithorax was insufflated with CO2 in conjunction with two-lung anaesthesia. All the patients were evaluated for haemodynamic stability, oxygen saturation of haemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for intubation and surgery, satisfaction of surgeon with regard to exposure and postoperative complications., Results: In the SLT group, all the patients had stable haemodynamic and ventilation parameters. In the DLT group, haemodynamic instability occurred in two, decrease in Spo2 in four and increase in ETPco2 in three patients. One patient in the DLT group developed vocal cord granuloma two months later. Time required for surgery and the surgeon's opinion with regard to exposure were similar for both groups., Conclusion: Thoracoscopic surgery when used in cases where a well-collapsed lung may not be essential, since surgery is not performed on the lung itself, does not require DLT. SLT is safe in MAMS. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT.

Context: Video-assisted thoracic surgery (VATS) has been proposed as a less invasive technique for treatment of myasthenia gravis., Materials and Methods: A total of 31 patients underwent a right-sided VATS to remove all anterior mediastinal fat and thymic tissue during a 4-year period in our institution. None of the patients had associated thymoma., Results: All procedures were performed successfully with no conversion to sternotomy. The mean operating time was 190 minutes. The median intubation time and assisted ventilation were 24 and 18 hours, respectively. The median ICU and hospital stays were 3 and 7 days, respectively. The median time for post-operative chest drainage was 48 hours. There was no perioperative mortality. Eight significant complications occurred. One patient had atelectasis, 1 patient had aspiration pneumonia, and 3 patients had postoperative myasthenic crisis and required prolonged mechanical ventilation. Other complications were granuloma of the vocal cord, right recurrent laryngeal nerve palsy, and temporary brachial plexus injury due to poor intraoperative positioning. The mean length of follow-up was 20 months (range: 3-42 months). Overall, 27 patients (87%) had improved clinically and 11 patients (35%) had complete remission. The resulting scars were cosmetically acceptable for all patients., Conclusion: VATS provides an effective alternative approach to thymectomy and has several advantages over open techniques. VATS causes minimal postoperative complications, shortens hospital stay, and gives better cosmetic results.

Background: Video assisted thoracoscopic surgery (VATS) has been successfully used for thymectomy in myasthenia gravis (MG). Thoracoscopic thymectomy (TT) is usually done under general anesthesia with double lumen tubes (DLT). The aim of this study is evaluation of two lung ventilation through single lumen tubes (SLT) during TT., Methods: In this prospective randomized study, TT was done in 30 patients with MG from January 2004 to December 2007. Patients were randomly intubated with either a DLT or SLT, 15 patients in each group. All patients were evaluated for hemodynamic stability, oxygen saturation of hemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for intubation and surgery, satisfaction of surgeon about exposure and postoperative complications., Results: In the SLT group, all patients had stable hemodynamic, Spo2 and ETPco2. In the DLT group, hemodynamic instability occurred in one, decrease in Spo2 in one and increase in ETPco2 in another patient. One patient in DLT group developed vocal cord granuloma two months later. Time required for surgery and surgeon's opinion about exposure were similar in the two groups., Conclusion: SLT is safe in TT. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT.