Purpose: Obesity is a frequent cause of insulin resistance and poses a major risk for diabetes. The effects of sleeve gastrectomy on diabetes have not elucidated. This report documents that the sleeve gastrectomy provides control for diabetes, prior to significant body weight losses. Methods: We retrospectively reviewed 14 type 2 diabetic patients who underwent laparoscopic isolated sleeve gastrectomy between May 2003 and October 2004. Fourteen patients had type 2 diabetes treated by oral hypoglycemic agents. Preoperative, 4 weeks and 3 months following surgery, all patients checked weight, body mass index(BMI), waist circumference, hip circumference, blood pressure, HbA1c and fasting glucose. Results: Fourteen patients with a mean preoperative body mass index (BMI) of 39.14.2 kg/ (31.9～47.5 kg/) underwent laparoscopic sleeve gastrectomy. Changes in mean BMI were minimal (preop: 39.14.2 kg/, postop (4 week): 35.53.8 kg/), but there are significant decrease in blood fasting glucose (P＜0.001), HbA1c (P＜0.001), systolic blood pressure (P＜0.001), diastolic blood pressure (P=0.009). Ten patient did not require medications after surgery (4 week), the other 4 patient stop the medications after surgery (3 month). Conclusion: Further evaluation is needed to analyze effect of sleeve gastrectomy in treating type 2 diabetes mellitus. But just with restrictive procedures as isolated sleeve gastrectomy also can control early type 2 diabetes mellitus in morbidly obese patients.
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Abstract Study question What is the effect of electronic cigarettes as a substitute for regular cigarettes on sperm and subsequent embryo development in IVF patients? Summary answer E-cigarettes are just as harmful to male fertility as regular cigarettes, reduce the euploidy rate of the embryo, and have negative effects on pregnancy. What is known already Many harmful substances from smoking are known to negatively affect sperm development and function. It causes high elevations in sperm DNA fragmentation (SDF), which are associated with embryo euploidy rates. Recently, the use of e-cigarettes is increasing as an alternative to regular cigarettes because they are less harmful and safer. However, several animal studies have shown that e-cigarettes are just as harmful as regular cigarettes and can have negative effects on sperm and fertility. Preliminary data showed that SDF increased with e-cigarettes compared to regular cigarettes. Therefore, we would like to find out whether e-cigarettes affect embryo euploidy. Study design, size, duration In this study, from January 2022 to December 2023, 1,725 cycles of PGT-A (PGT for aneuploidy) were analyzed among the patients of IVF. The average ages of men and women were 40.0±4.6 and 38.7±4.0. A total of 4,796 embryos were analyzed (2.8 ± 2.0 per case) for euploidy rates. Participants/materials, setting, methods Blastocyst biopsy and PGT-A were performed, and embryo euploidy rates was confirmed. In male, the number of no smoking IVF cycles was 1061 and the number of embryo biopsies was 2.9 ± 2.1. The number of IVF cycles using regular cigarettes is 370, and the number of embryo biopsies is 2.8 ± 2.1. The number of IVF cycles using e-cigarettes was 294, and the number of embryo biopsies was 2.5 ± 1.6. Main results and the role of chance Based on the total female age, the embryo euploidy rate was nonsmoking (27.3%), regular cigarettes (23.6%), and e-cigarettes (18.8%). Among women under 38 years of age, e-cigarettes (29.9%) had a lower euploidy rate than regular cigarettes (37.4%), and nonsmoking (38.2%) had the highest rate. Among women over 38, the euploidy rate dropped significantly compared to those under 38, including nonsmoking (18.9%), but it was also lower for e-cigarettes (11.6%) than regular cigarettes (17.7%). Based on female age under 38 years old, the embryo euploidy rate among male age under 39 years old was nonsmoking (39.0%), regular cigarettes (38.3%), and e-cigarettes (31.7%). And among men over 40, the group with the lowest embryo euploidy rate was those who used e-cigarettes (no smoking (35.0%), regular cigarettes (32.6%), e-cigarettes (27.7%)). Based on the age of women over 38 years old, the euploidy rate among men under 39 years of age is nonsmoking (23.9%), regular cigarettes (21.6%), and e-cigarettes (12.7%). And the euploidy rate among men over 40 years of age is nonsmoking (16.8%), regular cigarettes (16.5%), and e-cigarettes (11.8%). nonsmoking is essential to maintain a high euploidy rate in embryos, and e-cigarettes may have a more adverse effect on pregnancy than regular cigarettes. Limitations, reasons for caution Because there are various types of e-cigarettes, it is expected that the degree of harmfulness will vary, but the number of patients was not sufficient to conduct research on each type of e-cigarette. Therefore, it is believed that the above problems should be solved through additional research. Wider implications of the findings This study is a study that links the harmful effects of cigarettes and the polyploidy of embryos. Electronic cigarettes, used as an alternative to regular cigarettes, may reduce embryo euploid production and cause recurrent pregnancy failure. Therefore, it is believed that electronic cigarettes should also be managed appropriately. Trial registration number not applicable
Although laparoscopic adjustable gastric banding (LAGB) is a popular bariatric procedure, few comprehensive studies have been investigated on the use of non-gastro-gastric sutures (NGGSs) for decreasing postoperative complications. This study aimed to assess and compare the safety and effectiveness of MIDBAND with or without gastro-gastric sutures (GGSs).Between February 2013 and March 2014, 41 severely obese patients underwent primary LAGB using pars flaccid technique at double center in South Korea. Excess weight loss, operative time and postoperative complications were assessed and compared between a GGS group (group 1) and a NGGS group (group 2), and patients were followed monthly for 1 year.Mean body mass indices in groups 1 and 2 were 38.4 ± 4.7 and 38.9 ± 5.0 kg/m2, respectively, and mean percentage excess weight losses (%EWLs) were 59.9% ± 28.4% and 50.9% ± 20.0%, respectively, at 6 months, and 75.8% ± 26.6% and 72.5% ± 27.5%, respectively, at 12 months, and these intergroup differences of %EWL were not significant (P = 0.256 and P = 0.704, respectively). Mean operative time (57.2 minutes) was shorter in group 2 than in group 1 (79.2 minutes) (P < 0.001). In terms of complications, pouch dilatation rates were similar in the 2 groups, and no case of gastric band erosion was encountered.Operative time was shorter in the NGGS group, and pouch dilatation rates and %EWL were similar in the 2 groups. We conclude NGGS using MIDBAND is both straightforward and effective. A long-term prospective comparative study is needed to demonstrate the safety and efficacy of NGGS.
Laparoscopic sleeve gastrectomy (LSG) has established popularity as a bariatric and metabolic surgery. However, the incidence of gastroesophageal reflux disease (GERD) following LSG is controversial. This study aims to describe the prevalence of de novo GERD after LSG.A retrospective chart review was performed for 130 patients who underwent a routine endoscopic surveillance before and after LSG between January 2013 and October 2018. The diagnosis of GERD was determined by presence of symptoms, history of PPI treatment, and endoscopic findings. The esophagogastroduodenoscopy (EGD) was performed annually after LSG and/or when the patients complained of severe reflux symptoms.The prevalence of GERD before surgery was 18.5%. At 1 year after LSG, GERD was present in 70 (53.8%) of the 130 patients. GERD consisted of 55 patients with newly developed GERD, and 15 with preexisting GERD. 9 (37.5%) out of pre-existing GERD patients were free of symptoms and abnormal finding at EGD following LSG. During the LSG, 66 (50.8%) patients with hiatal hernia underwent re-approximation of the diaphragmatic crura. There was no significant relationship between hiatal hernia repair and postoperative GERD (p = 0.39). Number of patients taking PPI medication before and after LSG were 34 (26.2%) and 49 (37.7%). Out of 56 (43.1%) patients with endoscopic lesions, LA grade A was 31 (23.9%), B = 15 (11.5%), C = 4 (3.1%), and D = 6 (4.6%).In this study, 42.3% (n = 55) of total patients developed newly developed GERD, and 7.7% (n = 10) had LA grade C or D esophagitis.
The aim of this study was to show that bariatric surgery (BS) is more effective than medical therapy (MT) in Asian obese patients.In this prospective, multicenter, nonrandomized, controlled trial, obese patients with body mass index of ≥35 kg/m2 or 30.0-34.9 kg/m2 with obesity-related comorbidities were assigned to undergo BS, such as laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass, or MT. Patients who underwent BS were evaluated 4, 12, 24, and 48 weeks after surgery, whereas patients who received MT were monitored at a hospital every 6 weeks for 1 year. At each visit, weight, waist and hip circumference, and blood pressure were measured, and patients underwent physical examination and laboratory testing. Health-related quality of life (HQOL) was investigated using Euro QOL-5 Dimension, Impact of Weight on Quality of Life questionnaire-Lite and Obesity-related Problems scale.The study included 264 patients from 13 institutions; of these, 64 underwent BS and 200 received MT. Of the patients who underwent BS, 6.3% experienced early complications. Relative weight changes from baseline to 48 weeks were significantly greater in the BS than in the MT group (26.9% vs. 2.1%, P < 0.001), as were the rates of remission of diabetes (47.8% vs. 16.7%, P = 0.014), hypertension (60.0% vs. 26.1%, P < 0.001), and dyslipidemia (63.2% vs. 22.0%, P < 0.001). HQOL was better in the BS than in the MT group at 48 weeks.BS was safe and effective in Korean obese patients, with greater weight reduction, remission of comorbidities, and quality of life improvement than MT.
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