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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 = 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. [ABSTRACT FROM AUTHOR]