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Skogar, Martin
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Publications (6 of 6) Show all publications
Löfling Skogar, M. (2019). Bariatric Surgery: Outcomes after Gastric Bypass and Duodenal Switch. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Bariatric Surgery: Outcomes after Gastric Bypass and Duodenal Switch
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obesity is associated with increased morbidity and mortality. A BMI >40 kg/mshortens life expectancy by about 10 years. The obesity related comorbidities diabetes, hypertension, dyslipidemia and sleep apnea contributes to the increased risk of cardiovascular events. There is also an increased risk of some forms of cancer (e.g. colon, breast, and prostate cancer) as well as mental illness (depression and low self-esteem). Bariatric surgery is indicated for those with a BMI >35 kg/m2. Unfortunately, there are an increasing number of patients seeking bariatric surgery who are super obese (BMI >50 kg/m2), a condition more difficult to treat because of insufficient weight loss with standard operations, like the Roux-en-Y Gastric Bypass (RYGB). Therefore some surgeons advocate the Duodenal Switch (DS) in super obese patients, because DS results in greater and more sustained weight loss. However, DS is a technically more challenging operation and is associated with an increased risk of malnutrition and surgical complications. There are also concerns about an excessive loss of fat-free mass during weight loss after RYGB and especially after DS.

This thesis focuses on weight-loss, effect on comorbidities, quality of life and complications after DS and RYGB, respectively, with comparisons between the two procedures in patients with super obesity. 

DS resulted in a superior weight loss compared to RYGB (paper I, II and III) and body composition after weight loss did not differ compared with non-operated controls with the same BMI after surgery, for neither DS nor RYGB (paper I). Both DS and RYGB resulted in an improved metabolic control (paper II and III), but the effect on diabetes and hypertension was greater and maintained in the long-term after DS (paper III). Both DS and RYGB resulted in an improved physical quality of life, with greater improvements after DS (paper III). However, complications and long-term adverse effects were more common after DS (paper II and IV).

In conclusion, the superior weight loss and greater improvements in several obesity-related comorbidities after DS must be weighed against the increased risk of complications and long-term adverse effects compared to RYGB. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 76
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1550
Keywords
Body composition, fat-free mass, resting metabolic rate, bariatric surgery, obesity, Roux-en-Y Gastric Bypass, Duodenal Switch, air-displacement plethysmography, Bod Pod, indirect calorimetry assessment, BAROS, quality of life, weight loss, diabetes, hypertension, dyslipidmia, depression, pain, antidepressants, opioids, complications, healthcare consumption, adverse events
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-377036 (URN)978-91-513-0593-6 (ISBN)
Public defence
2019-05-17, Grönwallsalen, Ingång 70, BV, Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2019-04-18 Created: 2019-02-25 Last updated: 2019-06-18
Skogar, M. & Sundbom, M. (2017). Duodenal Switch Is Superior to Gastric Bypass in Patients with Super Obesity when Evaluated with the Bariatric Analysis and Reporting Outcome System (BAROS). Obesity Surgery, 27(9), 2308-2316
Open this publication in new window or tab >>Duodenal Switch Is Superior to Gastric Bypass in Patients with Super Obesity when Evaluated with the Bariatric Analysis and Reporting Outcome System (BAROS)
2017 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 9, p. 2308-2316Article in journal (Refereed) Published
Abstract [en]

Background

It is not clear which bariatric procedure that gives the best outcome for patients with super obesity (body mass index [BMI] > 50 kg/m2). This study aims to compare outcomes in patients with super obesity after Roux-en-Y gastric bypass (RYGB) and duodenal switch (BPD/DS) using the Bariatric Analysis and Reporting Outcome System (BAROS) and a local questionnaire for gastrointestinal symptoms.

Methods

A retrospective mail survey including 211 patients, 98 RYGB and 113 BPD/DS, with a mean follow-up time of 4 years for both groups. Gender distribution, age, and comorbidities were similar. Weight loss, changes in comorbidities, quality of life (QoL), and adverse events were registered, as well as gastrointestinal symptoms.

Results

Preoperative BMI was higher in the BPD/DS group (56 ± 6.7 vs. 52 ± 4.0 kg/m2, p < 0.01); despite this, the postoperative BMI was lower (31 ± 5.5 vs. 36 ± 7.1 kg/m2, p < 0.01). The effect on diabetes was superior after BPD/DS; otherwise, both groups had a similar reduction in comorbidities. There was no difference in QoL. Adverse events were less common after RYGB (14 vs. 27%). Overall, the BPD/DS group had a superior BAROS score (4.7 ± 2.0 vs. 4.0 ± 2.1, p < 0.05). Dumping was more common after RYGB (p < 0.01), while reflux, diarrhea, fecal incontinence, and problems with malodorous flatus were more common after BPD/DS (all p < 0.05). Frequency of nausea/vomiting and abdominal pain were similar.

Conclusion

Patients with super obesity have a better weight reduction and metabolic control with BPD/DS, at the cost of higher incidence of adverse events, compared to patients operated with RYGB.

Keywords
BAROS, Bariatric surgery, Duodenal switch, Gastric bypass, Quality of life
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-333269 (URN)10.1007/s11695-017-2680-z (DOI)000407971600013 ()28439748 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2019-02-25Bibliographically approved
Skogar, M., Holmbäck, U., Hedberg, J., Risérus, U. & Sundbom, M. (2017). Preserved Fat-Free Mass after Gastric Bypass and Duodenal Switch. Obesity Surgery, 27(7), 1735-1740
Open this publication in new window or tab >>Preserved Fat-Free Mass after Gastric Bypass and Duodenal Switch
Show others...
2017 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 7, p. 1735-1740Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Concerns for the possibility of an excessive loss of fat-free mass (FFM) and resting metabolic rate (RMR) after bariatric surgery, such as Roux-en-Y gastric bypass (RYGB) and duodenal switch (BPD/DS), have been raised.

OBJECTIVES: This study aims to examine body composition and RMR in patients after RYGB and BPD/DS and in non-operated controls.

METHODS: Body composition and RMR were studied with Bod Pod and indirect calorimetry in weight-stable RYGB (n = 15) and BPD/DS patients (n = 12) and compared with non-operated controls (n = 17). All patients were 30-55 years old and weight stable with BMI 28-35 kg/m(2).

RESULTS: FFM% was 58% (RYGB), 61% (BPD/DS), and 58% (controls). Body composition did not differ after RYGB and BPD/DS compared to controls, despite 27 and 40% total body weight loss, respectively. No difference in RMR or RMR/FFM was observed (1539, 1617, and 1490 kcal/24 h; and 28.9, 28.4, and 28.8 kcal/24 h/kg).

CONCLUSION: Weight-stable patients with BMI 28-35 kg/m(2) after RYGB and BPD/DS have a body composition and RMR similar to that of non-operated individuals within the same BMI interval.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-310894 (URN)10.1007/s11695-016-2476-6 (DOI)000404529600016 ()27885535 (PubMedID)
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2019-02-25Bibliographically approved
Skogar, M., Ahlberg, J. & Sundbom, M. (2015). Claims to the patient insurance after bariatric surgery in Sweden 2000-2012. Surgery for Obesity and Related Diseases, 11(1), 201-206
Open this publication in new window or tab >>Claims to the patient insurance after bariatric surgery in Sweden 2000-2012
2015 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 11, no 1, p. 201-206Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Since 2000, the annual number of bariatric procedures has increased more than 10-fold in Sweden, and in 2012, 94% of these procedures were primary laparoscopic gastric bypass.

METHODS:

We studied claims from the national Patient Insurance (Landstingens Ömsesidiga Försäkringsbolag, LÖF) to evaluate if the number of adverse events (AEs) from a patient perspective had increased unproportionally. All claims related to bariatric surgery from January 2000 to March 2012 were identified by ICD-10 codes and divided into 3 main groups: (1) procedure-related AEs (occurring within 30 days), (2) late AEs, and (3) nonsurgical AEs. Logistic regression was used to study the change in claim rate over time. The setting was a university hospital in Sweden.

RESULTS:

In total, 359 claims were included, corresponding to 14 claims per 1,000 bariatric procedures (laparoscopic 59%, open 24%, revision 17%). Numbers correlated with the expansion of bariatric surgery and type of procedure routinely performed. Of the procedure-related claims (74% of all claims), postoperative leaks or bleedings were most common. In this group, patients frequently needed additional surgery (69%) and intensive care (42%). Half of the late AEs (69 in total) were related to abdominal pain or malnutrition, including 5 cases of Wernicke's encephalopathy. In total 2% died. Of 344 settled claims, economical compensation was given to 29%.

CONCLUSION:

In this cohort of patients with insurance claims after bariatric surgery (1.4% of all procedures), procedure-related AEs were severe, with a large amount of patients requiring reoperation and intensive care. No change in claim rate was seen, in spite of the 10-fold increase of bariatric surgery.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-248669 (URN)10.1016/j.soard.2014.06.006 (DOI)000350534300033 ()25443067 (PubMedID)
Available from: 2015-04-07 Created: 2015-04-07 Last updated: 2017-12-04Bibliographically approved
Löfling Skogar, M. & Sundbom, M.Complications, Adverse Events and Healthcare Consumption the First Ten Years after Duodenal Switch and Gastric Bypass in a Matched National Cohort.
Open this publication in new window or tab >>Complications, Adverse Events and Healthcare Consumption the First Ten Years after Duodenal Switch and Gastric Bypass in a Matched National Cohort
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background:Roux-en-Y Gastric Bypass (RYGB), risk unsatisfactory weight loss in super obese patients. Duodenal switch (DS) is more effective, however, considered to have an increased complication rate. 

 

Objectives:To compare early complications, healthcare consumption, long-term adverse events and mortality up until 10 years after primary DS and RYGB, respectively.

 

Setting:Nationwide study in Sweden

 

Methods:In this nationwide population-based cohort study, propensity-score matching (1DS:4RYGB) was used. Five national registers were cross-matched; the Scandinavian Obesity Surgery Register (perioperative data), the Prescribed Drug Register (comorbidities, i.e. medication for the specific conditions), Statistics Sweden (socioeconomic data), the National Patient Register (subsequent healthcare) and the Death Register (mortality). 

 

Results:The study population consisted of 333 DS and 1332 RYGB, operated 2007-2017 (BMI of 55 kg/m2, 38.5 years and 60.7% females). Early complications (≤30 days) were more common after DS (15.3% vs. 8.1%, p<0.01). Hospital admissions and in-hospital days over the 10-year period were similar (1.3 vs. 1.1 admission, p=0.30 and 6.6 vs. 7.2 in-hospital days, p=0.81), while DS had more visits to specialized outpatient clinics (7.1 vs. 4.2, p<0.01). DS were associated with an increased risk of protein-malnutrition/malabsorption (OR 11.7 [3.1-43.5]) and having an additional abdominal operation (any type) (OR 1.9 [1.4-2.6]). Overall mortality did not differ between groups. 

 

Conclusion:DS was associated with more early complications and an increased risk for protein-malnutrition/malabsorption and more additional abdominal surgeries, however, the overall mortality and long-term requirement of in-hospital care were similar to RYGB.

Keywords
bariatric surgery, duodenal switch, gastric bypass, complications, adverse event
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-377035 (URN)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-03-19
Löfling Skogar, M. & Sundbom, M.Weight loss, Effect on Comorbidities and Quality of Life in the Long Term after Duodenal Switch and Gastric Bypass: A population-based cohort study.
Open this publication in new window or tab >>Weight loss, Effect on Comorbidities and Quality of Life in the Long Term after Duodenal Switch and Gastric Bypass: A population-based cohort study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective:To compare long-term weight-loss, effect on comorbidities and quality of life after duodenal switch (DS) and gastric bypass (RYGB) in super obese patients.

 

Background:Unsatisfactory weight loss is common after bariatric surgery in patients with super obesity (Body Mass Index [BMI]≥50 kg/m2). Unfortunately, this group of patients is increasing worldwide.

 

Methods:Population-based cohort-study of primary DS and RYGB (BMI≥48 kg/m2), in Sweden 2007-2017, with cross-matching of four national registers. Baseline characteristics were used for propensity score matching (1DS:4RYGB). Weight loss and quality of life were analyzed up until 5 years after surgery. Medication for obesity-related conditions (diabetes, hypertension, dyslipidemia, depression, pain) and gastrointestinal symptoms were analyzed up until 10 years.

 

Results:The study population consisted of 333 DS and 1332 RYGB, with 60.7% females, 38.5 years old and BMI 55.0 kg/m2at baseline. DS resulted in a lower BMI at 5 years compared to RYGB, 32.2±5.5 and 37.8±7.3, respectively, (p<0.01). DS reduced prevalence of diabetes and hypertension more than RYGB, while reduction in dyslipidemia was similar for both groups, during the 10-year follow-up. Both groups increased their use of anti-depressants and a maintained a high use of opioids. Reflux and diarrhea were more common after DS. Improvement in physical quality of life was seen for both groups, with superior improvement after DS. Mental quality of life remained unchanged at 5 years. 

 

Conclusion:This study indicates that super obese patients have a more favorable outcome after DS compared to RYGB, regarding weight loss, effect on diabetes and hypertension, and physical quality of life.

National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-377032 (URN)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-02-25
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