ObjectiveTo systematically review the association between overweight, obesity, abdominal obesity, and cognitive impairment (CI) in the elderly. MethodsThe CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, Embase, and Cochrane Library databases were electronically searched for studies on the relationship between overweight, obesity/abdominal obesity, and CI in the elderly from their inception to July 2024. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed using Stata 15.0 software. ResultsA total of 38 studies involving 1 783 087 subjects were included. Meta-analysis results showed that compared with normal-weight individuals, overweight (OR=0.96, 95%CI 0.91 to 1.02, P=0.201) was not statistically significant in the risk of CI in the elderly. Obesity (OR=1.14, 95%CI 1.02 to 1.28, P=0.03) and abdominal obesity (OR=1.16, 95%CI 1.11 to 1.21, P<0.001) may be risk factors for CI in the elderly. Subgroup analysis was conducted based on study type, BMI standards, cognitive diagnostic standards, national development level, abdominal obesity diagnostic standards, and follow-up time. Among the subgroups analyzing the correlation between overweight and CI in the elderly, follow-up time ≤5 years (OR=0.68, 95%CI 0.58 to 0.80) showed a lower proportion of CI compared to other follow-up periods. In the subgroups analyzing the correlation between obesity and CI in the elderly, follow-up time ≤5 years (OR=0.71, 95%CI 0.50 to 1.01) was not statistically significant compared to other follow-up periods. For abdominal obesity, a significant association with increased CI risk in the elderly was found only in the subgroup with a follow-up time of 5-10 years (OR=1.21, 95%CI 1.15 to 1.27), compared with other follow-up periods. ConclusionCurrent evidence suggests that obesity and abdominal obesity may increase the risk of CI in the elderly. Proper weight management is crucial for preventing and delaying the progression of CI in the elderly.
ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
A lot of evidence-based medical evidence has shown that laparoscopic Roux-en-Y gastric bypass (LRYGB) is a durable and effective method for obesity and diabetes, and can significantly improve a series of obesity-related metabolic complications. This guideline provides a detailed description of the main operating steps and technical points of the symmetric three-port LRYGB, including posture layout, trocar position selection, liver suspension, gauze exposure, production of small gastric sacs, gastrojejunal anastomosis and production of biliary pancreatic branches, entero-enteric side to side anastomosis, closure of gastrointestinal anastomosis and mesenteric hiatus, greater omentum coverage, and closure of incisions. The purpose is to standardize the operating process of the symmetrical three hole method of LRYGB, providing standardized surgical operation references for clinical doctors in the field of obesity metabolic surgery.
ObjectiveTo systematically review the effectiveness of breastfeeding duration and intensity in reducing the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia. MethodsThe PubMed, EMbase, Web of Science, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect observational studies on the associations of breastfeeding with the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia from inception to September 25th, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Stata 16.0 software was used for the meta-analysis. ResultsA total of 12 657 participants from 13 observational studies were included. The results of meta-analysis showed that breastfeeding could reduce the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia (OR=0.67, 95%CI 0.53 to 0.84, P=0.001). Subgroup analysis revealed a protective effect of breastfeeding for both 1-6 months (OR=0.53, 95%CI 0.37 to 0.75, P<0.001) and ≥6 months (OR=0.56, 95%CI 0.46 to 0.69, P<0.001); however, breastfeeding shorter than one month was suggested to increase the risk of overweight or obesity (OR=2.15, 95%CI 1.41 to 3.27, P<0.001). ConclusionAvailable evidence suggests that breastfeeding for more than one month is effective in reducing the risk of overweight or obesity in offspring exposed to intrauterine hyperglycemia, and women with hyperglycemia should be encouraged to breastfeed their offspring for at least 1 month to achieve the effect. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the research progress in the selection of metabolic bariatric procedures, efficacy, safety, complication prevention, and long-term management for elderly patients, so as to provide references for surgical decision-making and perioperative management in future metabolic and bariatric surgery for elderly obese patients. MethodA review of recent domestic and international literature on metabolic and bariatric surgery in elderly patients was conducted. ResultsWith the intensification of societal aging, the incidence of obesity and related metabolic diseases among the elderly population has significantly increased. Metabolic and bariatric surgery has been proven to effectively reduce weight and improve obesity-related metabolic diseases in elderly patients. Current guidelines no longer consider age an absolute contraindication for surgery. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly used procedures internationally. SG is superior to RYGB in terms of surgical safety, while RYGB has greater advantages in improving metabolic diseases. Although the postoperative mortality and complications risks in elderly obese patients are higher than those in younger obese patients, strict preoperative assessment and individualized procedure selection can significantly reduce these risks. ConclusionsMetabolic and bariatric surgery can serve as an effective treatment for elderly obese patients, offering comprehensive benefits in weight loss and metabolic improvement. Procedure selection requires individualized assessment, balancing the patient’s baseline condition and metabolic needs. Postoperative success hinges on systematic long-term follow-up and management to ensure sustained benefits and safety. Future efforts should focus on clarifying the definitions or standards of “elderly” and “obesity,” followed by more large-sample, long-term follow-up randomized controlled studies to validate the safety and efficacy of metabolic and bariatric surgery.
Objective To review recent advancement of the relationship between obesity and gastric cancer. Method We searched PubMed, Medline, EMBASE, Cochrane Library databases, CNKI, and WanFang database for recent clinical trials about the impact of obesity on occurrence, surgery outcomes, and prognosis of gastric cancer. Results Obesity significantly increased the risk of adenocarcinoma of esophagogastric junction (AEG), increased difficulty in radical operation of gastric cancer and complications of perioperative period, but it had no effect on the long-term operative outcomes. The association between obesity and the survival of gastric cancer was not clear. However, the better survival was observed in most researches of gastric cancer patients with excess body weight. Conclusions The relationship between obesity and gastric cancer is very complex, and there is no consistent conclusion. A reasonable body weight by a healthy lifestyle is expected to decline the incidence of AEG.
ObjectiveTo investigate the effects of single anastomosis sleeve ileal (SASI) bypass on weight loss, metabolic improvements, and postoperative safety in patients with obesity and its metabolic comorbidities (such as type 2 diabetes and hyperlipidemia). MethodsA retrospective analysis was conducted. The clinical data of patients with obesity [body mass index (BMI) ≥32.5 kg/m² or BMI ≥27.5 kg/m² with metabolic diseases] who underwent SASI bypass in the Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2023 to December 2023. Weight loss outcomes, including the percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and percentage of excess BMI loss (%EBMIL), were recorded at 6 and 12 months postoperatively. Metabolic disease remission and complications at 12 months postoperatively were also documented. ResultsA total of 82 patients were included in the study. At 12 months postoperatively, the reductions in %TWL, %EWL, and %EBMIL were significantly greater than those observed at 6 months postoperatively [%TWL: (27.1±4.6)% vs. (23.6±3.8)%, t=2.379, P=0.026; %EWL: (72.1±5.8)% vs. (56.6±7.3)%, t=2.593, P<0.001; %EBMIL: (71.6±6.7)% vs. (58.3±4.9)%, t=2.607, P<0.001], remission was observed in 40 out of 48 patients (83.3%) with comorbid hypertension, 49 out of 51 patients (96.1%) with comorbid type 2 diabetes mellitus, and all patients with comorbid hyperlipidemia (33 cases) and obstructive sleep apnea syndrome (29 cases) achieved complete remission. Within 12 months after SASI bypass, 3 patients (3.7%) experienced melena, 2 patients (2.4%) developed incomplete intestinal obstruction, and 10 patients (12.1%) showed malnutrition. ConclusionThe findings of this study indicate that SASI bypass demonstrates significant weight loss and metabolic improvement effects in patients with obesity and metabolic diseases, with a controllable safety profile.
Single-incision laparoscopic sleeve gastrectomy (SILSG) was first described in 2008, which could effectively control excess body weight and treat metabolic diseases relevant to obesity in a long term. Over more than a decade of refinement and technical advancement, precise and standardized surgical techniques have become critical for ensuring treatment efficacy and reducing the rate of postoperative complications. Thus, this review summarizes the evolution of SILSG, further understanding and emphasizing the importance of standardized and precise surgical procedures.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) was recommended as the gold standard procedure for metabolic and bariatric surgery by the National Institutes of Health in the 1990s and then had been adopted till now, which could effectively control excess weight and treat metabolic diseases relevant to obesity in a long term. The current LRYGB procedure had been performed more than half a century of development and update, and is still constantly evolving. Standardized and precise surgical procedures are of great significance in ensuring treatment effect and reducing the incidence of complications. Thus, the author reviewed the development process of LRYGB, further understanding and emphasizing the importance of standardized and precise surgical procedures.
Objective To explore the influencing factors for early complications after laparoscopic sleeve gastrectomy (LSG). Methods A retrospective analysis was conducted for the clinical data of 306 obese patients undergoing LSG at the Weight Reduction and Metabolism Center of Xuzhou Medical University Affiliated Hospital of Lianyungang from January 2020 to September 2022. Early postoperative complications (≤30 d) of LSG were classified according to the Clavien-Dindo classification, and the influencing factors of early postoperative complications were explored. Results There were 27 cases (8.8%) suffered from early complications, including 8 cases of grade Ⅰ (2.6%), 15 cases of grade Ⅱ (4.9%), 4 cases of grade Ⅲ (1.3%), there were no grade Ⅳ and grade Ⅴ complications. The multivariate results showed that BMI≥45 kg/m2 [OR=3.63, 95%CI (1.10, 11.92)], high cholesterol [OR=7.12, 95%CI (2.42, 20.95)], and preoperative GERD [OR=3.69, 95%CI (1.11, 12.23)] were influencing factors for early complications. Conclusions LSG is a safe diagnostic and therapeutic method for treating obesity. Attention should be paid to the impact of BMI, high cholesterol, and preoperative GERD on the occurrence of complications after LSG.