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  • 1.
    Abrahamsson, Niclas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Engström, Britt Edén
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Karlsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Gastric Bypass Surgery Elevates NT-ProBNP Levels2013In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 23, no 9, p. 1421-1426Article in journal (Refereed)
    Abstract [en]

    Background

    Brain natriuretic peptide (BNP) is produced in the heart in response to stretching of the myocardium. BNP levels are negatively correlated to obesity, and in obese subjects, a reduced BNP responsiveness has been described. Diet-induced weight loss has been found to lower or to have no effect on BNP levels, whereas gastric banding and gastric bypass have reported divergent results. We studied obese patients undergoing gastric bypass (GBP) surgery during follow-up of 1 year.

    Methods

    Twenty patients, 18 women, mean 41 (SD 9.5) years old, with a mean preoperative BMI of 44.6 (SD 5.5) kg/m2 were examined. N-terminal pro-brain natriuretic peptide (NT-ProBNP), glucose and insulin were measured preoperatively, at day 6 and months 1, 6 and 12. In 14 of the patients, samples were also taken at days 1, 2 and 4.

    Results

    The NT-ProBNP levels showed a marked increase during the postoperative week (from 54 pg/mL preop to 359 pg/mL on day 2 and fell to 155 on day 6). At 1 year, NT-ProBNP was 122 pg/mL (125 % increase, p = 0.01). Glucose, insulin and HOMA indices decreased shortly after surgery without correlation to NT-ProBNP change. Mean BMI was reduced from 44.6 to 30.5 kg/m2 at 1 year and was not related to NT-ProBNP change.

    Conclusions

    The data indicate that GBP surgery rapidly alters the tone of BNP release, by a mechanism not related to weight loss or to changes in glucometabolic parameters. The GBP-induced conversion of obese subjects, from low to high NT-ProBNP responders, is likely to influence the evaluation of cardiac function in GBP operated individuals.

  • 2.
    Alfonsson, Sven
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Ghaderi, Ata
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Screening of Adult ADHD Among Patients Presenting for Bariatric Surgery2012In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 22, no 6, p. 918-926Article in journal (Refereed)
    Abstract [en]

    In the field of bariatric surgery, research on symptoms of adult attention deficit hyperactivity disorder (ADHD) and their interrelationships with other psychological risk factors such as depression and anxiety is scarce. The symptoms of adult ADHD seem to be common in the obese population, but they are rarely investigated before bariatric surgery. ADHD-related symptoms such as impulsivity have at the same time been identified as potential risk factors for less successful weight loss among bariatric surgery patients. The aims of the current study were to screen for symptoms of adult ADHD and to investigate their relationships with other psychological risk factors. Candidates for bariatric surgery ( = 187) were anonymously screened for symptoms of anxiety, depression, and adult ADHD, in addition to disordered eating patterns, by means of questionnaires. The relations between these symptoms were investigated. In the current sample, 10% of patients screened positively for adult ADHD, and the symptoms of adult ADHD were significantly correlated with those of anxiety, depression, and disordered eating. The results show that adult ADHD is more common in this clinical group than in the general population (4%) and that adult ADHD is associated with disordered eating patterns, depression, and anxiety. Further prospective research, using multivariate analysis, is needed to investigate whether the symptoms of adult ADHD, and their interaction with anxiety, depression, or disordered eating, may possibly constitute a risk factor in terms of difficulties in adhering to the post-surgery regime and its potential unfavorable outcome.

  • 3.
    Alfonsson, Sven
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Weineland-Strandskov, Sandra
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Self-Reported Hedonism Predicts 12-Month Weight Loss After Roux-en-Y Gastric Bypass2017In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 8, p. 2073-2078Article in journal (Refereed)
    Abstract [en]

    Introduction Research regarding psychological risk factors for reduced weight loss after bariatric surgery has yielded mixed results, especially for variables measured prior to surgery. More profound personality factors have shown better promise and one such factor that may be relevant in this context is time perspective, i.e., the tendency to focus on present or future consequences. The aim of this study was to investigate the predictive value of time perspective for 12-month weight loss after Roux-en-Y gastric bypass surgery.

    Methods A total of 158 patients were included and completed self-report instruments prior to surgery. Weight loss was measured after 12 months by medical staff. Background variables as well as self-reported disordered eating, psychological distress, and time perspective were analyzed with regression analysis to identify significant predictors for 12-month weight loss.

    Results The mean BMI loss at 12 months was 14 units, from 45 to 30 kg/m(2). Age, sex, and time perspective could significantly predict weight loss but only male sex and self-reported hedonism were independent risk factors for reduced weight loss in the final regression model.

    Conclusion In this study, self-reported hedonistic time perspective proved to be a better predictor for 12-month weight loss than symptoms of disordered eating and psychological distress. It is possible that a hedonistic tendency of focusing on immediate consequences and rewards is analogous to the impaired delay discounting seen in previous studies of bariatric surgery candidates. Further studies are needed to identify whether these patients may benefit from extended care and support after surgery.

  • 4.
    Almby, Kristina E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Akademiska Sjukhuset.
    Edholm, David
    Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Anastomotic Strictures After Roux-en-Y Gastric Bypass: a Cohort Study from the Scandinavian Obesity Surgery Registry2019In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 1, p. 172-177Article in journal (Refereed)
    Abstract [en]

    Background

    Roux-en-Y gastric bypass (RYGB) is the most common bariatric procedure worldwide. Anastomotic stricture is a known complication of RYGB. The aim was to explore the incidence and outcomes of strictures within the Scandinavian Obesity Surgery Registry (SOReg).

    Method

    SOReg included prospective data from 36,362 patients undergoing bariatric surgery in the years 2007–2013. Outcomes were recorded at 30-day and at 1-year follow-up according to the standard SOReg routine. The medical charts of patients suffering from stricture after RYGB were requested and assessed.

    Setting

    National bariatric surgery registry

    Results

    Anastomotic stricture within 1 year of surgery was confirmed in 101 patients representing an incidence of 0.3%. Risk factors for stricture were patient age above 60 years (odds ratio (OR), 6.2 95% confidence interval (CI) 2.7–14.3), circular stapled gastrojejunostomy (OR 2.7, 95% CI 1.4–5.5), postoperative anastomotic leak (OR 8.9 95%, CI 4.7–17.0), and marginal ulcer (OR 30.0, 95% CI 19.2–47.0). Seventy-five percent of the strictures were diagnosed within 70 days of surgery. Two dilatations or less was sufficient to successfully treat 50% of patients. Ten pecent of patients developed perforation during dilatation, and the risk of perforating at each dilatation was 3.8%. Perforation required surgery in six cases but there was no mortality. Strictures in SOReg may be underreported, which could explain the low incidence in the study.

    Conclusion

    Most strictures present within 2 months and are successfully treated with two dilatations or less. Dilating a strictured gastrojejunostomy entails a risk of perforation (3.8%).

  • 5.
    Bandstein, Marcus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Schultes, Bernd
    eSwiss Med & Surg Ctr, Interdisciplinary Obes Ctr, St Gallen, Switzerland..
    Ernst, Barbara
    eSwiss Med & Surg Ctr, Interdisciplinary Obes Ctr, St Gallen, Switzerland..
    Thurnheer, Martin
    eSwiss Med & Surg Ctr, Interdisciplinary Obes Ctr, St Gallen, Switzerland..
    Schiöth, Helgi B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Benedict, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    The Role of FTO and Vitamin D for the Weight Loss Effect of Roux-en-Y Gastric Bypass Surgery in Obese Patients2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 11, p. 2071-2077Article in journal (Refereed)
    Abstract [en]

    A recent study in children demonstrated that the rs9939609 single-nucleotide polymorphism in the fat mass and obesity (FTO) gene influences prospective weight gain, however, only in those who were vitamin D-deficient. If this might also be the case for Roux-en-Y gastric bypass (RYGB), surgery-induced weight loss is however unknown. The objective of this study is to examine if the magnitude of RYGB surgery-induced weight loss after 2 years depends on patients' FTO rs9939609 genotype (i.e., TT, AT, and AA) and presurgery vitamin D status (< 50 nmol/L equals deficiency). Before and at 24 months after RYGB surgery, BMI was measured in 210 obese patients (mean BMI 45 kg/m(2), 72 % females). Serum 25-hydroxyvitamin D3 levels were also repeatedly measured. Following surgery, vitamin D was supplemented. Possible weight loss differences between genotypes were tested with multiple linear regressions. The per-allele effect of each FTO A-allele on excessive BMI loss (EBMIL) was 3 % (P = 0.02). When split by baseline status, the EBMIL of vitamin D-deficient patients carrying AA exceeded that of vitamin D-deficient patients carrying TT by similar to 14 % (P = 0.03). No such genotypic differences were found in patients without presurgery vitamin D deficiency. Post-surgery serum levels of vitamin D did not differ between groups. Our data suggest that presurgery vitamin D levels influence the size of genotype effects of FTO rs9939609 on RYGB surgery-induced weight loss in obese patients.

  • 6.
    Bandstein, Marcus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Voisin, Sarah
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Nilsson, Emil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Schultes, Bernd
    eSwiss Medical & Surgical Center, Interdisciplinary Obesity Center, St. Gallen, Switzerland.
    Ernst, Barbara
    eSwiss Medical & Surgical Center, Interdisciplinary Obesity Center, St. Gallen, Switzerland.
    Benedict, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Mwinyi, Jessica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Schiöth, Helgi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    A genetic risk score is associated with weight loss following Roux-Y gastric bypass surgery2016In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 26, no 9, p. 2183-2189Article in journal (Refereed)
    Abstract [en]

    Currently, Roux-en Y gastric bypass (RYGB) is the most efficient therapy for severe obesity. Weight loss after surgery is, however, highly variable and genetically influenced. Genome-wide association studies have identified several single nucleotide polymorphisms (SNP) associated with body mass index (BMI) and waist-hip ratio (WHR). We aimed to identify two genetic risk scores (GRS) composed of weighted BMI and WHR-associated SNPs to estimate their impact on excess BMI loss (EBMIL) after RYGB surgery. Two hundred and thirty-eight obese patients (BMI 45.1 +/- 6.2 kg/m(2), 74 % women), who underwent RYGB, were genotyped for 35 BMI and WHR-associated SNPs and were followed up after 2 years. SNPs with high impact on post-surgical weight loss were filtered out using a random forest model. The filtered SNPs were combined into a GRS and analyzed in a linear regression model. An up to 11 % lower EBMIL with higher risk score was estimated for two GRS models (P = 0.026 resp. P = 0.021) composed of seven BMI-associated SNPs (closest genes: MC4R, TMEM160, PTBP2, NUDT3, TFAP2B, ZNF608, MAP2K5, GNPDA2, and MTCH2) and of three WHR-associated SNPs (closest genes: HOXC13, LYPLAL1, and DNM3-PIGC). Patients within the lowest GRS quartile had higher EBMIL compared to patients within the other three quartiles in both models. We identified two GRSs composed of BMI and WHR-associated SNPs with significant impact on weight loss after RYGB surgery using random forest analysis as a SNP selection tool. The GRS may be useful to pre-surgically evaluate the risks for patients undergoing RYGB surgery.

  • 7.
    Bekhali, Zakaria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery. Gävle City Hospital, Sweden..
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Large Buffering Effect of the Duodenal Bulb in Duodenal Switch: a Wireless pH-Metric Study2017In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 7, p. 1867-1871Article in journal (Refereed)
    Abstract [en]

    Bariatric procedures result in massive weight loss, however, not without side effects. Gastric acid is known to cause marginal ulcers, situated in the small bowel just distal to the upper anastomosis. We have used the wireless BRAVO (TM) system to study the buffering effect of the duodenal bulb in duodenal switch (DS), a procedure in which the gastric sleeve produces a substantial amount of acid. We placed a pre- and a postpyloric pH capsule in 15 DS-patients (seven men, 44 years, BMI 33) under endoscopic guidance and verified the correct location by fluoroscopy. Patients were asked to eat and drink at their leisure, and to register their meals for the next 24 h. All capsules but one could be successfully placed, without complications. Total registration time was 17.2 (1.3-24) hours prepyloric and 23.1 (1.2-24) hours postpyloric, with a corresponding pH of 2.66 (1.74-5.81) and 5.79 (4.75-7.58), p < 0.01. The difference in pH between the two locations was reduced from 3.55 before meals to 1.82 during meals, p < 0.01. Percentage of time with pH < 4 was 70.0 (19.9-92.0) and 13.0 (0.0-34.6) pre and postpylorically, demonstrating a large buffering effect. By this wireless pH-metric technique, we could demonstrate that the duodenal bulb had a large buffering effect, thus counteracting the large amount of gastric acid passing into the small bowel after duodenal switch. This physiologic effect could explain the low incidence of stomal ulcers.

  • 8. Berglind, Daniel
    et al.
    Willmer, Mikaela
    Eriksson, Ulf
    Thorell, Anders
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Uddén, Joanna
    Raoof, Mustafa
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Tynelius, Per
    Näslund, Erik
    Rasmussen, Finn
    Longitudinal Assessment of Physical Activity in Women Undergoing Roux-en-Y Gastric Bypass2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 1, p. 119-125Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Patients undergoing bariatric surgery do not seem to increase objectively measured physical activity (PA) after surgery, despite substantial weight loss. The aims of the present study were (i) to objectively characterize 3 months pre-surgery to 9 months postsurgery PA and sedentary behavior changes in women undergoing Roux-en-Y gastric bypass (RYGB) using tri-axial accelerometers and (ii) to examine associations between pre-surgery versus postsurgery PA and sedentary behavior with anthropometric measures taken in home environment.

    METHODS:

    Fifty-six women, with an average pre-surgery body mass index (BMI) of 37.6 (SD 2.6) and of age 39.5 years (SD 5.7), were recruited at five Swedish hospitals. PA was measured for 1 week by the Actigraph GT3X+ accelerometer, and anthropometric measures were taken at home visits 3 months pre-surgery and 9 months postsurgery, thus limiting seasonal effects.

    RESULTS:

    Average BMI loss, 9 months postsurgery, was 11.7 (SD 2.7) BMI units. There were no significant pre- to postsurgery differences in PA or sedentary behavior. However, pre-surgery PA showed negative association with PA change and positive association with postsurgery PA. Adjustments for pre-surgery BMI had no impact on these associations.

    CONCLUSIONS:

    No significant differences were observed in objectively measured changes in PA or time spent sedentary from 3 months pre-surgery to 9 months postsurgery among women undergoing RYGB. However, women with higher pre-surgery PA decreased their PA postsurgery while women with lower pre-surgery PA increased their PA.

  • 9. de Man Lapidoth, Joakim
    et al.
    Ghaderi, Ata
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Norring, Claes
    A comparison of eating disorders among patients receiving surgical vs non-surgical weight-loss treatments2008In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 18, no 6, p. 715-720Article in journal (Refereed)
    Abstract [en]

    Background Little is known about differences between patients in surgical and non-surgical weight-loss treatments (WLT) regarding eating disorders, level of general psychopathology, and health-related quality of life (HRQL). Such differences could indicate different clinical needs in the management of surgical compared to non-surgical WLT patients. Methods Participants were a subset of 100 patients from a Swedish study investigating the long-term effects of eating disorders in WLT. Participants filled out the Eating Disorders in Obesity Questionnaire as well as self-rating questionnaires of general psychopathology and HRQL before initiating surgical (n=54) or non-surgical (n=46) WLT. Results Eating disorders were found to be more common among patients accepted for surgical treatments, whereas binge eating (as a symptom) was found to be equally common in both groups. Surgical patients also indicated higher levels of psychopathology compared to those receiving non-surgical treatment. Conclusion Patients in surgical WLT are younger, more obese, and indicate higher levels of eating disorders and psychopathology than non-surgical WLT patients. Results highlight the importance of surgical WLT units having adequate knowledge, resources, and methods for detecting and addressing issues of eating disorders and psychopathology before and during the WLT. Future longitudinal studies need to ascertain to what extent eating and general psychopathology influence the outcome of WLT in terms of lapses, complications, weight gain, quality of life, etc.

  • 10.
    Edholm, David
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Kullberg, Joel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Hänni, Arvo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Karlsson, Anders F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ahlström, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese2011In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 21, no 3, p. 345-350Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to explore changes in liver volume and intrahepatic fat in morbidly obese patients during 4 weeks of low-calorie diet (LCD) before surgery and to investigate if these changes would facilitate the following laparoscopic gastric bypass.

    METHODS: Fifteen female patients (121.3 kg, BMI 42.9) were treated preoperatively in an open study with LCD (800-1,100 kcal/day) during 4 weeks. Liver volume and fat content were assessed by magnetic resonance imaging and spectroscopy before and after the LCD treatment.

    RESULTS: Liver appearance and the complexity of the surgery were scored at the operation. Eighteen control patients (114.4 kg, BMI 40.8), without LCD were scored similarly. Average weight loss in the LCD group was 7.5 kg, giving a mean weight of 113.9 kg at surgery. Liver volume decreased by 12% (p < 0.001) and intrahepatic fat by 40% (p < 0.001). According to the preoperative scoring, the size of the left liver lobe, sharpness of the liver edge, and exposure of the hiatal region were improved in the LCD group compared to the controls (all p < 0.05).

    CONCLUSIONS: The overall complexity of the surgery was perceived lower in the LCD group (p < 0.05), due to improved exposure and reduced psychological stress (both p < 0.05). Four weeks of preoperative LCD resulted in a significant decrease in liver volume and intrahepatic fat content, and facilitated the subsequent laparoscopic gastric bypass as scored by the surgeon

  • 11.
    Gryth, Karin
    et al.
    Orebro Univ Hosp, Fac Med & Hlth, Dept Surg, SE-70185 Orebro, Sweden.
    Persson, Carina
    Orebro Univ, Fac Med & Hlth, Dept Community Med & Publ Hlth, Orebro, Sweden;Reg Orebro Cty, Dept Sustainable Dev, Orebro, Sweden.
    Näslund, Ingmar
    Orebro Univ Hosp, Fac Med & Hlth, Dept Surg, SE-70185 Orebro, Sweden.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Näslund, Erik
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Div Surg, Stockholm, Sweden.
    Stenberg, Erik
    Orebro Univ Hosp, Fac Med & Hlth, Dept Surg, SE-70185 Orebro, Sweden.
    The Influence of Socioeconomic Factors on Quality-of-Life After Laparoscopic Gastric Bypass Surgery2019In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 11, p. 3569-3576Article in journal (Refereed)
    Abstract [en]

    Introduction: Patients with low socioeconomic status have been reported to experience poorer outcome after several types of surgery. The influence of socioeconomic factors on health-related quality-of-life (HRQoL) after bariatric surgery is unclear.

    Materials and Methods: Patients operated with a primary laparoscopic gastric bypass procedure in Sweden between 2007 and 2015 were identified in the Scandinavian Obesity Surgery Register. Patients with a completed assessment of health-related quality-of-life based on the Obesity-related Problem Scale (OP Scale) were included in the study. Socioeconomic status was based on data from Statistics Sweden.

    Results: A total of 13,723 patients (32% of the 43,096 operated during the same period), with complete OP scores at baseline and two years after surgery, were included in the study. Age, lower preoperative BMI, male gender, higher education, professional status and disposable income as well as not receiving social benefits (not including retirement pension), and not a first- or second-generation immigrant, were associated with a higher postoperative HRQoL. Patients aged 30-60 years, with lower BMI, higher socioeconomic status, women and those born in Sweden by Swedish parents experienced a higher degree of improvement in HRQoL. Postoperative weight-loss was associated with higher HRQoL (unadjusted B 16.3, 95%CI 14.72-17.93, p < 0.0001).

    Conclusion: At 2 years, a strong association between weight loss and improvement in HRQoL was seen, though several factors influenced the degree of improvement. Age, sex, preoperative BMI and socioeconomic status all influence the postoperative HRQoL as well as the improvement in HRQoL after laparoscopic gastric bypass surgery.

  • 12.
    Hedberg, Jakob
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Karlsson, F. Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Edén-Engström, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Gastric Emptying and Postprandial PYY Response After Biliopancreatic Diversion with Duodenal Switch2011In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 21, no 5, p. 609-615Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Super-obesity (BMI > 50) is increasing rapidly. We use the biliopancreatic diversion with duodenal switch (BPD-DS) as one option in this patient category. The aim of the present study was to investigate the emptying of the gastric tube, PYY levels and dumping symptoms after BPD-DS.

    METHODS: Emptying of the gastric tube was investigated with scintigraphy after an overnight fast. Twenty patients (median age 43 years, BMI 31.1 kg/m(2)) having undergone BPD-DS in median 3.5 years previously were included in the scintigraphic study. A technetium-labelled omelette was ingested and scintigraphic evaluation of gastric emptying was undertaken. Ten of the patients also underwent PYY measurements after a standardised meal and were compared to nine non-operated age-matched normal weight controls, both in the fasting state and after the test meal. Frequency of dumping symptoms was evaluated in all patients.

    RESULTS: The half-emptying time was 28 ± 16 min. Lag phase was present in 30% of the patients. PYY levels were significantly higher in BPD-DS patients as compared to controls both in the fasting state (p < 0.001) and after the test meal (p < 0.001). Dumping symptoms were scarce and occurred in 17 of the 20 patients only few times yearly or less.

    CONCLUSIONS: Although the pylorus is preserved in BPD-DS, the stomach emptying is faster than in non-operated subjects. PYY levels are elevated in the fasting state after BPD-DS and a marked response to a test meal is seen, likely due to the rapid stimulation of intraluminal nutrients in the distal ileum. In spite of this, dumping symptoms are uncommon.

  • 13.
    Hedberg, Jakob
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Hänni, Arvo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Increased plasma magnesium concentrations 3 years after biliopancreatic diversion with duodenal switch2012In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 22, no 11, p. 1708-1713Article in journal (Refereed)
    Abstract [en]

    Background Biliopancreatic diversion with duodenal switch, BPD-DS, is a surgical procedure for treatment of super obese patients. It renders very good weight results and it strongly reduces the incidence of type 2 diabetes. One important mechanism of weight reduction after BPD-DS is malabsorption. Hypomagnesemia is an established cardiovascular risk factor. While it is wellknown that magnesium levels decline after jejuno-ileal bypass and increase after gastric bypass surgery, information on how magnesium status is affected by BPDDS is scant. The aim of the present study was to evaluate plasma magnesium concentrations (P-Mg) after BPD-DS. Methods Thirty-one patients, all Caucasians (9 diabetics, 12 men, age 38±8 years, weight 159±22 kg, body mass index (BMI) 53.9±5.2 kg/m 2) underwent BPD-DS. We evaluated weight, glycated hemoglobin levels (HbA1c) and P-Mg preoperatively as well as at 1 and 3 years after surgery. All subjects were treated with vitamin and mineral substitution after surgery, including 100 mg of magnesium salt. P-Mg was analyzed with respect to changes over time, correlation to BMI and HbA1c levels before and 3 years after surgery. Results The plasma magnesium concentrations increased by 15 % from 0.77±0.07 to 0.88±0.09 mmol/l over 3 years (p &lt;0.001). The weight loss was 71±25 kg. No patient had diabetes at follow-up. No correlations between P-Mg and BMI or HbA1c were seen. Conclusions Although exerting much of its weightreducing effect by a malabsorptive mechanism, BPD-DS yields a rise in P-Mg 3 years postoperatively, possibly contributing to the improved metabolic state after this operation.

  • 14.
    Hedberg, Jakob
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Reply to Gastric Emptying After Sleeve Gastrectomy (OBSU-D-11-00201)2011In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 21, no 11, p. 1812-1813Article in journal (Refereed)
  • 15.
    Hedberg, Jakob
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Zacharias, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Janson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Preoperative Slow-Release Morphine Reduces Need of Postoperative Analgesics and Shortens Hospital Stay in Laparoscopic Gastric Bypass2016In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 26, no 4, p. 757-761Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As most bariatric procedures are performed by laparoscopy, hospital stay is exceptionally short, despite the habitus of patients and the rather extensive intra-abdominal surgery. To facilitate postoperative mobilization, most patients are given repeated single doses of morphine, a drug with several side effects. We aimed to evaluate the effect of preoperative treatment with a tablet of slow-release morphine (SRM) on postoperative analgesic consumption and length of stay (LOS) in laparoscopic gastric bypass (LGBP).

    METHODS: The SRM group (244 patients) was retrospectively compared to a control group (197 patients) concerning postoperative pain management and hospital stay by studying medical charts and data from Scandinavian Obesity Surgery Registry (SOReg).

    RESULTS: Patients in the SRM group needed significantly less analgesics during days 0, 1, and 2 postoperatively, morphine 10.7 vs. 13.6 mg, 10.2 vs. 13.9 mg, and 1.1 vs. 3.6 mg, respectively, p < 0.05, as well as acetaminophen, p < 0.05. According to a subgroup analysis, 20 mg of SRM was needed to obtain these effects. In addition, SRM patients had shorter hospital stay (2.3 vs. 3.5 days, p < 0.05) than the control group. No negative side effects were seen.

    CONCLUSIONS: Preoperatively administered slow-release morphine significantly reduced the need for postoperative analgesics and shortened hospital stay, without side effects or other complications. At our department, the studied regime is now routinely used in all bariatric surgery and we have started to use the concept in other groups of surgical patients.

  • 16. Hedenbro, J. L.
    et al.
    Goine, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Ornstein, Petra
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
    Jonsson, E.
    Uppsala University.
    Preoperative Comorbidity does not Increase the Risk for Postoperative Absenteeism after Bariatric Surgery2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, p. S86-S86Article in journal (Other academic)
  • 17.
    Hedenbro, J. L.
    et al.
    Lund Univ, Dept Surg, Lund, Sweden.;Aleris Obes Sweden, Lund, Sweden..
    Naslund, E.
    Danderyd Hosp, Dept Surg, Stockholm, Sweden.;Karolinska Inst, Stockholm, Sweden..
    Boman, L.
    Lycksele Gen Hosp, Dept Surg, Lycksele, Sweden..
    Lundegayenrdh, G.
    Simrishamn Hosp, Dept Surg, Simrishamn, Sweden..
    Bylund, A.
    Ersta Diakoni, Dept Surg, Stockholm, Sweden..
    Ekelund, M.
    Lund Univ, Dept Surg, Lund, Sweden..
    Laurenius, A.
    Sahlgrens Acad, Dept Surg, Gothenburg, Sweden..
    Moller, P.
    Reg Hosp, Kalmar, Sweden..
    Olbers, T.
    Sahlgrens Acad, Dept Surg, Gothenburg, Sweden..
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Ottosson, J.
    Univ Orebro, Fac Med & Hlth, Dept Surg, SE-70182 Orebro, Sweden..
    Naslund, I.
    Univ Orebro, Fac Med & Hlth, Dept Surg, SE-70182 Orebro, Sweden..
    Formation of the Scandinavian Obesity Surgery Registry, SOReg2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 10, p. 1893-1900Article in journal (Refereed)
    Abstract [en]

    Obesity surgery is expanding, the quality of care is ever more important, and learning curve assessment should be established. A large registry cohort can show long-term effects on obesity and its comorbidities, complications, and long-term side effects of surgery, as well as changes in health-related quality of life (QoL). Sweden is ideally suited to the task of data collection and audit, with universal use of personal identification numbers, nation-wide registries permitting cross-matching to analyze causes of death, in-hospital care, and health-related absenteeism. In 2004, the Scandinavian Obesity Surgery Registry (SOReg) was initiated and government financing secured. A project group created a national database covering all public as well as private hospitals. Data entry was to be made online, operative definitions of comorbidity were formed, and complication severity scored. Several forms of audit were devised. After pilot studies, the system has been running in its present form since 2007. Since 15 January 2013, SOReg covers all bariatric surgery centers in Sweden. The number of operations in the database exceeded 40,000 (March 2014), with a median follow-up of 2.94 years. Audit shows that > 98 % of data are correct. All results are publicized annually on the Internet. Using this systematic approach, it has been possible to cover > 99 % of all bariatric surgery, cross-matching our data with nation-wide registries for in-hospital care, cause of death, and permitting regular nation-wide audit. Several scientific studies have used, or are using, what seems to be the most comprehensive database in obesity surgery.

  • 18.
    Hultin, Hella
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Stevens, Katharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Cholecalciferol Injections Are Effective in Hypovitaminosis D After Duodenal Switch: a Randomized Controlled Study2018In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, no 10, p. 3007-3011Article in journal (Refereed)
    Abstract [en]

    Background: By treating obesity, one of the major epidemics of this past century, through bariatric surgery, we may cause complications due to malnourishment in a growing population. At present, vitamin D deficiency is of interest, especially in patients with inferior absorption of fat-soluble nutrients after biliopancreatic diversion with duodenal switch (BPD/DS).

    Methods: Twenty BPD/DS patients, approximately 4 years postoperatively, were randomized to either intramuscular supplementation of vitamin D with a single dose of 600,000 IU cholecalciferol, or a control group. Patients were instructed to limit their supplementation to 1400 IU of vitamin D and to avoid the influence of UV-B radiation; the study was conducted when sunlight is limited (December to May).

    Results: Despite oral supplementation, a pronounced deficiency in vitamin D was seen (injection 19.3; control 23.2 nmol/l) in both groups. The cholecalciferol injection resulted in elevated 25[OH]D levels at 1 month (65.4 nmol/l), which was maintained at 6 months (67.4 nmol/l). This resulted in normalization of intact parathyroid hormone (PTH) levels. No changes in vitamin D or PTH occurred in the control group.

    Conclusions: In BPD/DS patients, having hypovitaminosis D despite full oral supplementation, a single injection of 600,000 IU of cholecalciferol was effective in elevating vitamin D levels and normalizing levels of intact PTH. The treatment is simple and highly effective and thus recommended, especially in cases of reduced UV-B radiation.

  • 19.
    Hänni, Arvo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Magnesium Status After Gastric Bypass Surgery2011In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 21, no 7, p. 951-Article in journal (Refereed)
  • 20.
    Johansson, Hans-Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Haenni, Arvo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Öhrvall, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Alterations in proinsulin and insulin dynamics, HDL Cholesterol and ALT after gastric bypass surgery: A 42-months follow-up study2009In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 19, no 5, p. 601-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Roux-en-Y gastric bypass (RYGBP) powerfully reduces type 2 diabetes (T2DM) incidence. Proinsulin predicts development of T2DM. Adjustable gastric banding is associated with lowered proinsulin but after RYGBP information is scant. METHODS: Twenty-one non-diabetic morbidly obese patients who underwent RYGBP surgery were evaluated before (baseline), at 12 months (first follow-up), and at 42 months, range 36-50 (second follow-up), after surgery and compared to a control group, matched at baseline regarding fasting glucose, insulin, proinsulin, alanine aminotransferase (ALT), high-density lipoprotein (HDL) cholesterol, and body mass index (BMI). RESULTS: In the RYGBP group, fasting serum proinsulin concentrations were markedly lowered from 13.5 to 3.5 pmol/l at first follow-up and to 4.9 pmol/l at second follow-up (p < 0.001, respectively). Fasting insulin concentrations were reduced from 83.4 to 24.6 pmol/l at first follow-up (p < 0.001) and to 36.4 pmol/l at second follow-up (p < 0.01). ALT was lowered from 0.62 to 0.34 mukatal/l at first follow-up and continued to lower to 0.24 mukatal/l at second follow-up (p < 0.001, respectively). The further decrease between first and second follow-up was also significant (p = 0.002). HDL cholesterol increased from 1.16 to 1.45 mmol/l at the first follow-up and continued to increase at second follow-up to 1.58 mmol/l (p < 0.001, respectively). The further increase between first and second follow-up was also significant (p = 0.006). The differences between groups at first follow-up were significant for BMI, proinsulin, insulin, ALT, and HDL cholesterol (p = 0.04-0.001). CONCLUSION: RYGBP surgery in morbidly obese patients is not only characterized by markedly and sustained lowered BMI but also lowered concentrations of proinsulin, insulin, and ALT and increased HDL cholesterol.

  • 21.
    Johansson, Hans-Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Hänni, Arvo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Karlsson, F. Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Edén-Engström, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Öhrvall, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Bileopancreatic Diversion with Duodenal Switch lowers both Early and Late Phases of Glucose, Insulin and Proinsulin responses after Meal2010In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 20, no 5, p. 549-558Article in journal (Refereed)
    Abstract [en]

    Hyperproinsulinemia is associated with obesity and type 2 diabetes. We explored the after-meal dynamics of proinsulin and insulin and postprandial effects on glucose and lipids in patients treated with bileopancreatic diversion with duodenal switch (BPD-DS) surgery compared with normal-weight controls [body mass index (BMI)+/- SD, 23.2 +/- 2.4 kg/m(2)].

    Ten previously morbidly obese (BMI +/- SD, 53.5 +/- 3.8 kg/m(2)) patients free from diabetes who had undergone BPD-DS (BMI +/- SD, 29.0 +/- 5.2 kg/m(2)) 2 years earlier were recruited. A standardised meal (2400 kJ) was ingested, and glucose, proinsulin, insulin, free fatty acids and triglycerides (TGs) were determined during 180 min. Follow-up characteristics yearly on glucose, lipids, creatinine and uric acid over 3 years after BPD-DS are presented.

    Fasting glucose and insulin were lower, 0.4 mmol/L and 4.6 pmol/L, respectively, in the BPD-DS group despite higher BMI. Fasting proinsulin was similar in both groups. Postprandial area under the curve (AUC) for glucose, proinsulin and insulin did not differ between the two groups (p = 0.106-734). Postprandial changes in glucose, proinsulin and insulin were essentially similar but absolute concentrations of proinsulin and insulin were lower in the later phases in the BPD-DS group (p = 0.052-0.001). Postprandial AUC for TGs was lower in the BPD-DS group (p = 0.005). Postprandial changes in TGs were lowered in the intermediate phase (p = 0.07-0.08) and in the late phase (0.002). Follow-up data showed markedly lowered creatinine and uric acid after BPD-DS.

    BPD-DS surgery induces a large weight loss and lowers, close to normal, postprandial responses of glucose, proinsulin and insulin but with marked lowering of TGs.

  • 22.
    Johansson, Hans-Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Östervala Primary Hlth Care Ctr, Abygrand 2, S-74046 Östervala, Sweden; Falu Lasarett, Dept Surg, Uppsala, Sweden.
    Wahlen, Anna
    Östervala Primary Hlth Care Ctr, Abygrand 2, S-74046 Östervala, Sweden.
    Aldenback, Erica
    Uppsala Univ, Fac Med, Uppsala, Sweden.
    Hänni, Arvo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Falu Lasarett, Dept Surg, Uppsala, Sweden.
    Platelet Counts and Liver Enzymes After Gastric Bypass Surgery2018In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, no 6, p. 1526-1531Article in journal (Refereed)
    Abstract [en]

    Obesity is associated with chronic inflammation, liver steatosis and increased liver enzymes such as gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT), markers for non-alcoholic fatty liver disease (NAFLD) and liver fat content. Increased platelet counts (PCs) are a biomarker reflecting inflammation and the degree of fibrosis in NAFLD. We investigated alterations in PCs, GGT, ALT, C-reactive protein (CRP) and ferritin after Roux-en-Y gastric bypass (RYGBP). One hundred twenty-four morbidly obese non-diabetic patients were evaluated before (baseline) and 12 months after (follow-up) RYGBP. Body mass index (BMI) was reduced from 43.5 kg/m(2) (baseline) to 31.1 kg/m(2) (follow-up), and p < 0.001 and weight declined from 126.2 to 89.0 kg. PCs decreased from 303 x 10(9) to 260 x 10(9)/l, p < 0.001. GGT was reduced from 0.63 to 0.38 mu kat/l, p < 0.001. ALT decreased from 0.69 to 0.59 mu kat/l, p = 0.006. CRP was lowered from 7.3 to 5.4 mg/l p < 0.001 and ferritin from 106 to 84 mu g/l p < 0.001. The alterations in PCs correlated with the changes in CRP (r = 0.38, p = 0.001), BMI (r = 0.25, p = 0.012), weight (r = 0.24, p = 0.015) and inversely correlated with ferritin (r = 21, p = 0.036). PCs, GGT and ALT (markers for NAFLD), and CRP and ferritin (markers for inflammation) decreased in morbidly obese after RYGBP. The decrease in PCs correlated with alterations in CRP, BMI, weight and ferritin. The lowering of liver enzymes may reflect a lowered liver fat content and decreased general inflammation.

  • 23.
    Johansson, Hans-Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Öhrvall, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Haenni, Arvo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Serum Magnesium Status After Gastric Bypass Surgery in Obesity2009In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 19, no 9, p. 1250-1255Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Roux-en-Y gastric bypass (RYGBP) has become a common surgical procedure to treat morbid obesity. Furthermore, it strongly reduces the incidence of type 2 diabetes and mortality. However, there is scant information on how magnesium status is affected by RYGBP surgery. Previous bariatric surgery methods, like jejunoileal bypass, are associated with hypomagnesemia. METHODS: Twenty-one non-diabetic morbidly obese patients who underwent RYGBP were evaluated before and 1 year after surgery and compared to a matched morbidly obese control group regarding serum magnesium. Groups were matched regarding weight, BMI, abdominal sagittal diameter and fasting glucose, blood pressure, and serum magnesium concentrations before surgery in the RYGBP group. RESULTS: The serum magnesium concentrations increased by 6% from 0.80 to 0.85 mmol/l (p = 0.019) in the RYGBP group while a decrease by 4% (p = 0.132) was observed in the control group. The increase in magnesium concentration at the 1-year follow-up in the RYGBP group was accompanied by a decreased abdominal sagittal diameter (r (2) = 0.32, p = 0.009), a lowered BMI (r (2) = 0.28, p = 0.0214), a lowered glucose concentration (r (2) = 0.28, p = 0.027) but not by a lowered insulin concentration (p = 0.242), a lowered systolic (p = 0.789) or a lowered diastolic (p = 0.785) blood pressure. CONCLUSION: RYGBP surgery in morbidly obese subjects is characterized by reduced visceral adiposity, lowered plasma glucose, and increased circulating magnesium concentrations. The inverse association between lowered central obesity, lowered plasma glucose and increased magnesium concentrations, needs further detailed studies to identify underlying mechanisms.

  • 24.
    Johansson, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Roos, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Kullberg, Joel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Weis, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Edén Engström, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Karlsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lipid Mobilization Following Roux-en-Y Gastric Bypass Examined by Magnetic Resonance Imaging and Spectroscopy2008In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 18, no 10, p. 1297-1304Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recent developments of magnetic resonance imaging (MRI) and spectroscopy have made it possible to quantify lipid deposited in different tissues. To what extent an improvement of glucose tolerance shortly after Roux-en-Y gastric bypass surgery (RYGBP) is reflected in lipid levels in liver and skeletal muscle, markers of insulin resistance, has not been clarified. METHODS: Whole-body MRI and MR spectroscopy (MRS) of liver and muscle and measurements of biochemical markers of glucose and lipid metabolism were performed at baseline and 1, 6, and 12 months following surgery in seven morbidly obese women. Volumes of adipose tissue depots and liver and muscle lipids were assessed from the MRI/MRS data. RESULTS: At 1 month postoperatively, body mass index and visceral and subcutaneous adipose tissues were reduced by 9%, 26%, and 10%, respectively, whereas no reductions in intrahepatocellular or skeletal intramyocellular lipid concentrations were found. Free fatty acid and beta-hydroxybutyrate levels were elevated two- and sixfold, respectively; glucose and insulin levels were lowered, indicating increased insulin sensitivity. Further weight loss up to 1 year was associated with reductions in all investigated lipid depots investigated, with the exception of the intramyocellular compartment. CONCLUSION: RYGBP causes rapid lipid mobilization from visceral and subcutaneous adipose depots and enhanced free fatty acid flux to the liver. An exceptional disconnection between liver fat and insulin sensitivity occurs in the early dynamic phase after surgery. However, in the late phase, the energy restriction imposed by the surgical procedure also reduces the liver lipids, but not the intramyocellular lipids.

  • 25.
    Jonsson, E.
    et al.
    Swedish Social Insurance Agcy, Stockholm, Sweden..
    Ornstein, P.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics. Swedish Social Insurance Agcy, Stockholm, Sweden.
    Goine, H.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Swedish Social Insurance Agcy, Stockholm, Sweden.
    Hedenbro, J. L.
    Lund Univ, Dept Surg, Clin Sci, Nicolovius 7, SE-22465 Lund, Sweden..
    Diabetes Resolution and Work Absenteeism After Gastric Bypass: a 6-Year Study2017In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 9, p. 2246-2252Article in journal (Refereed)
    Abstract [en]

    Background

    Obesity-related diseases cause costs to society. We studied the cost of work absenteeism before and after gastric bypass and the effects of postoperative diabetes resolution.

    Patients and Methods

    Data were obtained from the Scandinavian Obesity Surgery Registry (SOReg) (national coverage >98%) and cross-matched with data from the Social insurance Agency (coverage 100%) for the period ± 3 years from operation. In 2010, a total of 7454 bariatric surgeries were performed; the study group is 4971 unique individuals with an annual income of >10,750 Euros and complete data sets. A sex-, age-, and income-matched reference population was identified for comparison.

    Results

    Patients with obesity had preoperatively a 3.5-fold higher absenteeism. During follow-up (FU), the ratio relative to the reference population remained constant. An increase of 12-14 net absenteeism days was observed in the first 3 months after surgery. Female sex (OR 1.5, CI 1.13-1.8), preoperative anti-depressant use (OR 1.5, CI 1.3-1.9), low income (OR 1.4, CI 1.2-1.8), and a history of sick leave (OR 1.004, CI 1.003-1.004) were associated with increased absenteeism during FU. Diabetes resolution did not decrease absenteeism from preoperative values.

    Conclusions

    Patients with obesity have higher preoperative absenteeism than the reference population. Operation caused an increase the first 90 days after surgery of 12-13 days. There were no relative increases in absenteeism in the next 3 years; patients did not deviate from preoperative patterns but followed the trend of the reference population. Preoperative diabetes did not elevate that level during FU; diabetes resolution did not lower absenteeism.

  • 26. Karefylakis, Christos
    et al.
    Näslund, Ingmar
    Edholm, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Karlsson, F Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Rask, Eva
    Prevalence of Anemia and Related Deficiencies 10 Years After Gastric Bypass: a Retrospective Study2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 6, p. 1019-1023Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Bariatric surgery has gained wide acceptance as treatment for severe obesity and is associated with decreased overall mortality. The aims of this study were to evaluate the prevalence of anemia long term after Roux-en-Y gastric bypass (RYGB) and to search for factors predicting anemia.

    METHODS:

    All 745 patients who underwent RYGB between 1993 and 2003 at either Örebro or Uppsala University Hospital and who were living in Sweden were invited to participate by providing a fasting blood sample and completing a questionnaire about their health status. Full blood count, serum iron, transferrin, vitamin B12, and folic acid were determined.

    RESULTS:

    Follow-up was completed in 431 patients (58 %) with mean age 51.3 ± 10 years. Of all patients, 27 % had anemia postoperatively and related deficiencies; iron, folic acid, and vitamin B12 were seen in 20, 12, and 2 %, respectively. There was no correlation between anemia and sex, follow-up time, 25-OH vitamin D level, and preoperative or postoperative BMI. An inverse correlation was found between anemia and regular medical checkups concerning gastric bypass surgery.

    CONCLUSION:

    Twenty-seven percent of patients had anemia more than 10 years after RYGB. Anemia does not seem to progress with time and was less common in patients with regular medical checkups. Thus, improved long-term follow-up is needed.

  • 27. Karefylakis, Christos
    et al.
    Näslund, Ingmar
    Edholm, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Karlsson, F Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Rask, Eva
    Vitamin D Status 10 Years After Primary Gastric Bypass: Gravely High Prevalence of Hypovitaminosis D and Raised PTH Levels2014In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 24, no 3, p. 343-348Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    The primary aim of this study was to evaluate the prevalence of vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass. Secondly, we have tried to assess predictors for vitamin D deficiency.

    METHODS

    Five hundred thirty-seven patients who underwent primary Roux-en-Y gastric bypass surgery between 1993 and 2003 at the Örebro University Hospital and Uppsala University Hospital were eligible for the study. Patients were asked to provide a blood sample between November 2009 and June 2010 and to complete a questionnaire about their postoperative health status. Serum values of 25-OH vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP) and calcium were determined.

    RESULTS

    Follow-up was completed in 293 patients, of which 83 % were female, with an age of 49 ± 9.9 years after a median time of 11 ± 2.8 years. Vitamin D, PTH and albumin-corrected calcium values were 42 ± 20.4 nmol/L, 89.1 ± 52.7 ng/L and 2.3 ± 0.1 mmol/L, respectively. Of all patients, 65 % were vitamin D deficient, i.e. 25-OH vitamin D <50 nmol/L, and 69 % had PTH above the upper normal reference range, i.e. >73 ng/L. Vitamin D was inversely correlated with PTH levels (p < 0.001) and positively correlated with calcium (p = 0.016). Vitamin D did not correlate with ALP. The only factor found to predict vitamin D deficiency was high preoperative body mass index (BMI) (p = 0.008), whereas gender, age, time after surgery and BMI at follow-up did not.

    CONCLUSIONS

    Vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass (RYGB) were confirmed in our study because 65 % of patients had vitamin D deficiency, and 69 % had increased PTH levels more than 10 years after surgery. These data are alarming and highlight the need for improved long-term follow-up. Vitamin D deficiency does not seem to progress with time after surgery, possibly due to weight loss. Only preoperative BMI, cutoff point 43 kg/m(2), was a predictor of vitamin D deficiency at follow-up. Improved long-term follow-up of patients that undergo RYGB is needed.

  • 28. Lagerros, Ylva Trolle
    et al.
    Brandt, Lena
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Boden, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Risk of Suicide, Self-Harm and Depression after Gastric Bypass2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, p. S127-S127Article in journal (Other academic)
  • 29.
    Nilsen, Inger
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Abrahamsson, Niclas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Hänni, Arvo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Comparison of Meal Pattern and Postprandial Glucose Response in Duodenal Switch and Gastric Bypass Patients2019In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 7, p. 2210-2216Article in journal (Refereed)
    Abstract [en]

    Background: Bariatric surgery improves glucose homeostasis; however, side effects such as hypoglycemia can occur. We investigated the effects of meals on interstitial glucose (IG) response in biliopancreatic diversion with duodenal switch (BPD-DS) and Roux-en-Y gastric bypass (RYGBP)-operated patients at least 1 year after surgery.

    Methods: Thirty patients treated with BPD-DS or RYGBP were recruited at the outpatient Obesity Unit, Uppsala University Hospital. IG was measured by continuous glucose monitoring (CGM) for 3 consecutive days, and postprandial IG levels from 5 to 120 min were analyzed for 2 of these days. All intake of food and beverages was simultaneously registered in a food diary, which was processed using The Meal Pattern Questionnaire.

    Results: Postprandial IG levels were significantly lower in BPD-DS (n = 14) compared to RYGBP (n = 15)-treated patients, with mean concentrations of 5.0 (+/- 1.0) and 6.3 (+/- 1.8) mmol/L respectively (p < 0.001). The mean postprandial IG increment was lower in BPD-DS than in RYGBP patients, 0.2 (+/- 0.6) vs. 0.4 (+/- 1.4) mmol/L (p < 0.001). Furthermore, the postprandial IG variability was less pronounced in BPD-DS than in RYGBP patients. The mean number of daily meals did not differ between the two groups, 7.8 (+/- 2.6) in BPD-DS and 7.2 (+/- 1.7) in the RYGBP (p = 0.56).

    Conclusion: BPD-DS patients demonstrated lower postprandial IG concentrations, with smaller postprandial IG increments and less pronounced postprandial IG variability compared to RYGBP patients. The two groups had similar meal pattern and the postprandial IG responses is probably associated with differences in postoperative physiology.

  • 30.
    Poelemeijer, Y.
    et al.
    Leiden Univ, Med Ctr, Leiden, Netherlands; Dutch Inst Clin Auditing, Leiden, Netherlands.
    Liem, R.
    Groene Hart Hosp, Gouda, Netherlands.
    Vage, V.
    Scandinavian Obes Surg Registry, Bergen, Norway.
    Mala, T.
    Oslo Univ Hosp, Oslo, Norway.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Ottosson, J.
    Örebro Univ Hosp, Örebro, Sweden.
    Nienhuijs, S.
    Catharina Hosp, Eindhoven, Netherlands.
    PERIOPERATIVE OUTCOMES OF PRIMARY BARIATRIC SURGERY IN NORTH-WESTERN EUROPE: A POOLED MULTINATIONAL REGISTRY ANALYSIS2018In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, no Issue 2 Supplement, p. 92-92Article in journal (Other academic)
  • 31.
    Poelemeijer, Youri Q. M.
    et al.
    Dutch Inst Clin Auditing, Sci Bur, Leiden, Netherlands;Leiden Univ, Dept Surg, Med Ctr, Albinusdreef 2, NL-2333 ZA Leiden, Netherlands.
    Liem, Ronald S. L.
    Groene Hart Hosp, Dept Surg, Gouda, Netherlands;Dutch Obes Clin, The Hague, Netherlands.
    Våge, Villy
    Scandinavian Obes Surg Registry, Bergen, Norway.
    Mala, Tom
    Oslo Univ Hosp, Dept Gastrointestinal Surg, Oslo, Norway.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Ottosson, Johan
    Orebro Univ Hosp, Dept Surg, Orebro, Sweden.
    Nienhuijs, Simon W.
    Catharina Hosp, Dept Surg, Eindhoven, Netherlands.
    Perioperative Outcomes of Primary Bariatric Surgery in North-Western Europe: a Pooled Multinational Registry Analysis2018In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, no 12, p. 3916-3922Article in journal (Refereed)
    Abstract [en]

    Introduction: The global prevalence of obesity has increased in recent decades, and bariatric surgery has become a part of the treatment algorithm of obesity. National high-quality registries enable large-scale evaluations of the use and outcome of bariatric surgery and may allow for improved knowledge. The main objective was to evaluate the rate and type of complications after primary bariatric surgery in three North-Western European countries using nationwide registries.

    Materials and Methods: Data from three registries for bariatric surgery were used (January 2015-December 2016). All registries have nationwide coverage with data on patient characteristics, obesity-related diseases, surgical technique, complications, grading of complications, reinterventions, readmissions, and mortality. Eligibility criteria for bariatric surgery were similar and included body mass index of 40.0 or 35.0kg/m(2), with one or more obesity-associated diseases.

    Results: A total of 35,858 procedures (32,177 primary) were registered. The most common procedure was gastric bypass in the Netherlands (78.9%) and Sweden (67.0%), and sleeve gastrectomy in Norway (58.2%). A total of 904 (2.8%) patients developed major complications after primary surgery and 12 patients (0.04%) died within 30days. Total number of complications between the registries were comparable (p=0.939). However, significant differences were seen for Clavien-Dindo Classification grades IIIb and IV (p<0.001). Pooled readmission rates were 4.3% (n=1386).

    Discussion: Bariatric surgery is safely performed in the three evaluated countries. Standardization of registries and consensus of variables are essential for international comparison and may contribute to improved quality of treatment across nations.

  • 32. Raoof, Mustafa
    et al.
    Naslund, Ingmar
    Rask, Eva
    Karlsson, Jan
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Edholm, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Karlsson, F. Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Svensson, Felicity
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Szabo, Eva
    Health-Related Quality-of-Life (HRQoL) on an Average of 12 Years After Gastric Bypass Surgery2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 7, p. 1119-1127Article in journal (Refereed)
    Abstract [en]

    It is evident that morbidly obese patients have a low health-related quality-of-life (HRQoL), and this low HRQoL has become a common reason for them to seek bariatric surgery. Several HRQoL studies demonstrate a dramatic postoperative improvement, but most of these have had a short follow-up period. An observational, cross-sectional study for HRQoL was conducted to study 486 patients (average age of 50.7 +/- 10.0 years, with 84 % of them being female) operated with gastric bypass (GBP) in the period 1993 to 2003 at the University Hospitals of A-rebro and Uppsala. Mean follow-up after gastric bypass was 11.5 +/- 2.7 years (range 7-17). Two HRQoL instruments were used, SF-36 and the Obesity-related Problems scale (OP). The study group was compared with two control groups, both matched for age and gender, one from the general population and one containing morbidly obese patients evaluated and awaiting bariatric surgery. The study group scored better in the SF-36 domains (all four physical domains and the vitality subscore) and OP scale compared to obese controls, but their HRQoL scores were lower than those of the general population. HRQoL was better among younger patients and in the following subgroups: men, patients with satisfactory weight loss, satisfied with the procedure, free from co-morbidities and gastrointestinal symptoms, employment, good oral status and those not hospitalised or regularly followed up for non-bariatric reasons. Long-term follow-up after GBP for morbid obesity showed better scores in most aspects of HRQoL compared to obese controls but did not achieve the levels of the general population. Patients with better medical outcome after gastric bypass operation had better HRQoL.

  • 33.
    Sima, Eduardo
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Ehrenborg, A
    University Hospital, 75185, Uppsala, Sweden.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Differences in Early Complications between Circular and Linear Stapled Gastrojejunostomy in Laparoscopic Gastric Bypass2014In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, no 4, p. 599-603Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Laparoscopic gastric bypass (LGBP) is the most common bariatric procedure worldwide. The gastrojejunostomy can be stapled with a circular or linear stapler, each with their own specific advantages. We have evaluated differences in postoperative complications between the two techniques.

    METHODS

    We studied operative data and postoperative complications in 560 patients (79.8 % females, median age 42, BMI 42.5) operated with LGBP between 2008 and 2012 at our center. The gastrojejunostomy was initially performed using a circular stapler (CS) in 288 patients and later by linear stapler (LS) in 272. Complications, operative time, and length of stay were retrieved from our database. The risk of developing a port site infection was evaluated with multivariate logistic regression.

    RESULTS

    Port site infections were more common with CS than LS, 5.2 and 0.4 %, respectively (p < 0.01). Multivariate analysis demonstrated CS to be an independent risk factor for port site infections (OR 16.3 (2.09-126), p < 0.01), as well as for stomal ulcers (OR 10.1, 1.15-89, p = 0.04). Major postoperative complications remained unchanged (anastomotic leak 1.0 vs. 1.1 %, abscess 0.7 vs. 0.4 %), while operative time and length of stay were found to be shorter using the LS (122 vs. 83 min, p < 0.001 and 4 vs. 3 days, p < 0.001).

    CONCLUSIONS

    The linear stapled technique yielded lower incidence of port site infections, probably by avoiding the passage of a contaminated circular stapler through the abdominal wall. No difference in major complications was seen, but operative time was shorter using a linear stapler instead of a circular stapler.

  • 34.
    Sima, Eduardo
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Holmbäck, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Energy Expenditure And Carbohydrate Oxidation In Responders And Non-Responders After Gastric Bypass2016In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 26, p. S82-S83Article in journal (Refereed)
  • 35.
    Sima, Eduardo
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Differences In Inflammatory And Complement Proteins Between Responders And Non-Responders After Gastric Bypass2016In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 26, p. S270-S271Article in journal (Refereed)
  • 36.
    Skogar, Martin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Holmbäck, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Preserved Fat-Free Mass after Gastric Bypass and Duodenal Switch2017In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 7, p. 1735-1740Article in journal (Refereed)
    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.

  • 37.
    Skogar, Martin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Duodenal Switch Is Superior to Gastric Bypass in Patients with Super Obesity when Evaluated with the Bariatric Analysis and Reporting Outcome System (BAROS)2017In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 9, p. 2308-2316Article in journal (Refereed)
    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.

  • 38.
    Sundbom, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Berne, Berit
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology.
    Hultin, Hella
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Short-Term UVB Treatment or Intramuscular Cholecalciferol to Prevent Hypovitaminosis D After Gastric Bypass-a Randomized Clinical Trial2016In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 26, no 9, p. 2198-2203Article in journal (Refereed)
    Abstract [en]

    Gastric bypass is increasingly used worldwide to treat morbidly obese patients with good results. However, several studies have reported low levels of vitamin D in spite of supplementation. In this randomized clinical trial, we have evaluated two principally different interventions, short-term UVB treatment or a single cholecalciferol injection, to prevent hypovitaminosis D. Seventy-three patients, randomly treated by UVB (n = 26) or injection (n = 20), and compared to controls (n = 27), were followed for 6 months. Both interventions, 12 treatments of whole-body narrowband UVB and an intramuscular injection of 600,000 IU cholecalciferol, were given in December, when natural sunlight is limited. Blood samples for 25-OH-vitamin D (25[OH]D), intact PTH, calcium, and albumin were obtained at baseline, after 1 and 3 months, and after 6 months for the intervention groups. 25[OH]D was analyzed using a HPLC method. At baseline, 77.2 % of the patients had 25[OH]D < 75 nmol/L. At 3 months, both UVB and cholecalciferol injection resulted in significantly higher 25[OH]D levels than controls (71.6 and 77.9 vs. 48.6 nmol/L, p < 0.05). The levels remained rather constant at 6 months (69.0 and 76.7 nmol/L, respectively); however, only injection therapy resulted in improved levels compared to baseline (55.7 nmol/L, p < 0.001). No toxic effects, nor significant changes in PTH or albumin-adjusted calcium, were seen. In this randomized trial, both interventions, UVB and cholecalciferol, given as an adjunct to oral supplementation in gastric bypass patients, increased the levels of 25[OH]D. Simplicity makes injection therapy suitable for maintaining vitamin D levels during the Nordic winter.

  • 39.
    Sundbom, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Edholm, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sima, Eduardo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Superior Weight Loss and Improvement in Comorbidities After Duodenal Switch Compared to Gastric Bypass in Patients with BMI > 482013In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 23, no 8, p. 1155-1155Article in journal (Other academic)
  • 40.
    Sundbom, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Holdstock, Camilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Edén Engström, Britt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Karlsson, F. Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Early Changes in Ghrelin following Roux-en-Y Gastric Bypass: Influence of Vagal Nerve Functionality?2007In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 17, no 3, p. 304-310Article in journal (Refereed)
    Abstract [en]

    Background  Roux-en-Y gastric bypass (RYGBP) effectively produces massive weight reduction, improving health in morbidly obese patients. The mechanisms for the weight loss, and the fate of the excluded gastric mucosa, are not fully clarified. To what extent the appetite-stimulating gastric peptide ghrelin is affected remains controversial. Methods  Circulating concentrations of ghrelin, pancreatic polypeptide (PP), pepsinogen I (PGI) and gastrin were examined in 15 morbidly obese patients (median BMI 45 kg/m2) preoperatively, and on days 1, 2, 4, 6 and at months 1, 6 and 12 after RYGBP. Results  Ghrelin levels fell on postoperative day 1 and increased after 1 month to preoperative levels, and rose further at 6 and 12 months. PP concentrations decreased on day 1 and subsequently returned to preoperative levels. PGI levels peaked transiently the first days after surgery and subsequently declined to lower than preoperative levels. Gastrin levels were gradually reduced postoperatively. Conclusion  Ghrelin and PP fall transiently after surgery, possibly due to vagal dysfunction, and ultimately, as weight loss ensues, ghrelin secretion increases to higher than preoperative levels. The RYBGP procedure affects the gastric mucosa, as reflected by a transient increase in circulating PGI, and subsequently, the mucosa in the excluded stomach is at rest, as shown by low levels of PGI and gastrin.

  • 41.
    Sundbom, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Karlson, Britt-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Low mortality in bariatric surgery 1995 through 2005 in sweden, in spite of a shift to more complex procedures2009In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 19, no 12, p. 1697-1701Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Bariatric surgery is expanding worldwide. In a previous study, we found a threefold increase in the annual incidence in Sweden between 1987 and 1996. The aim of the present study was to describe the nationwide practice of bariatric surgery until 2005 and determine the perioperative mortality. METHODS: All bariatric procedures were identified through linkage to the Swedish Inpatient Registry, kept by the National Board of Health and Welfare. Mortality data were obtained from the Swedish National Death Registry RESULTS: A total of 8,129 bariatric procedures were identified. Seventy-eight percent of the patients were women and the mean age was 40.3 years. Hospital stay averaged 6 days. There was a 27% increase in the number of procedures performed in 2005 compared to 1995. After a decline in the beginning of the century, an increase of 119% is noted from 2001 to 2005. In the beginning of the study period, simple gastric restrictive procedures dominated (79%), but these procedures declined gradually. Gastric bypass has had the opposite development and reached 79% of all performed bariatric procedures in 2005. Laparoscopy has been introduced under the study period and in 2005, 42% of all gastric bypasses were performed by laparoscopy. The 30-day mortality was 0.16%. CONCLUSION: In spite of the shift to more complex procedures, the operative mortality was low.

  • 42.
    Sundbom, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Ottosson, Johan
    Örebro Univ Hosp, Dept Surg, Orebro, Sweden..
    Trocar Injuries in 17,446 Laparoscopic Gastric Bypass-a Nationwide Survey from the Scandinavian Obesity Surgery Registry2016In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 26, no 9, p. 2127-2130Article in journal (Refereed)
    Abstract [en]

    Although, the vast majority of bariatric procedures worldwide are performed laparoscopically, there is no consensus on the best technique to enter the first trocar, a potentially dangerous maneuver. Three principally different techniques exist: initial pneumoperitoneum by Verres needle, open Hasson technique, and direct placement of an optical trocar. In this nationwide survey, we have studied the presently used technique to place the first trocar and identified any intraabdominal injuries in 2012-2014. A questionnaire concerning techniques for placing the first trocar and identified intraabdominal injuries was sent to all 41 centers performing laparoscopic Roux en-Y gastric bypass (LRYGB) in Sweden. Total number of procedures were collected from the national quality registry, Scandinavian Obesity Surgery Registry (SOReg), also searched for reports on intraabdominal injuries. During the present study period, 17,446 LRYGBs were performed. Twelve intraabdominal injuries (0.07 %) were found: bleedings from the omentum, small bowel mesentery and liver (n = 8), and gastric or small bowel perforation (n = 4). The injuries were evenly distributed between the Veress technique and direct placement of an optical trocar, while no injuries occurred with the Hasson technique. Concerning placement of the first trocar, initial pneumoperitoneum with Veress needle was most common (59 %), followed by direct placement of an optical trocar (30 %). This indicates a switch from 2009-2010 (Veress 45 % and optical trocar 45 %, p < 0.001). Twelve intraabdominal injuries (0.07 %) were found in this nationwide survey. The most common technique for placing the first trocar had switched from directly placing an optical trocar to prior establishment of pneumoperitoneum.

  • 43.
    Vidarsson, Bjarni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Edholm, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    LEAK AT GASTROJEJUNOSTOMY AFTER ROUX-EN-Y GASTRIC BYPASS-40,844 PATIENTS FROM THE SCANDINAVIAN OBESITY SURGERY REGISTRY (SOREG)2018In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, no Issue 2 Supplement, p. 215-215Article in journal (Other academic)
  • 44.
    Westling, Agneta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Bjurling, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Öhrvall, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Gustavsson, Sven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Silicone-adjustable gastric banding: disappointing results1998In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 8, no 4, p. 467-474Article in journal (Refereed)
    Abstract [en]

    Background:

    Silicone-adjustable Gastric banding (SAGB) has been popularized as a minimally invasive, completely reversible surgical treatment for morbid obesity. We report here out 3-year experience of SAGB with special reference to complications and side-effects.

    Methods:

    There were 90 patients in total, of whom 72 were women. Median age was 42 (range, 20-68) years and median body mass index (BMI) was 43 (range, 34-57) kg/m2. Laparoscopy was attempted to position the band in 63 cases but had to be converted to laparotomy in 16 (25%). Twenty-seven patients were laparotomized. We used the Swedish band (AB Obtech) throughout the series. In addition to regular clinic visits, patients were followed-up with upper gastrointestinal series 6 months postoperatively and gastroscopy after 2 years or earlier when symptomatic.

    Results:

    Median BMI decreased to 32 kg/m2 after 12 months and to 31 kg/m2 after 24 months. With a median follow-up time of 35 months (range, 22-48), 32 patients (35%) have been re-operated usually with removal of the balloon system and conversion into a Roux-en-Y gastric bypass. The most common reasons for re-operation were band erosion (n = 10) and erosive esophagitis (n = 14). Additional indications for re-operation included pouch dilatation, invagination of distal gastric wall through the band, leakage from the balloon, patient dissatisfaction, and severe allergic reaction. When questioned 2 years postoperatively more than half of the patients reported vomiting, heartburn and regurgitation but 78% still pronounced themselves satisfied with the operation. Esophagitis was found in 56% of the patients at gastroscopy after 2 years.

    Conclusion:

    SAGB could be positioned with laparoscopy in 75% of the cases but the incidence of complications and side-effects postoperatively has been high.

  • 45.
    Westling, Agneta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Gustavsson, Sven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Laparoscopic vs open Roux-en-Y gastric bypass: a prospective randomized trial2001In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 11, no 3, p. 284-292Article in journal (Refereed)
    Abstract [en]

    Background:

    The feasibility of laparoscopic Roux-en-Y gastric bypass (Lap-RYGBP) for morbid obesity is well documented. In a prospective randomized trial, we compared laparoscopic and open surgery.

    Methods:

    51 patients (48 females, mean (± SD) age 36 ± 9 years and BMI 42 ± 4 kg/m2) were randomly allocated to either laparoscopy (n=30) or open surgery (n=21). All patients were followed for a minimum of 1 year.

    Results:

    In the laparoscopy group, 7 patients (23%) were converted to open surgery due to various procedural difficulties. In an analysis, with the converted patients excluded, the morphine doses used postoperatively were significantly (p< 0.005) lower in the laparoscopic group compared to the open group. Likewise, postoperative hospital stay was shorter (4 vs 6 days, p<0.025). Six patients in the laparoscopy group had to be re-operated due to Roux-limb obstruction in the mesocolic tunnel within 5 weeks. The weight loss expressed in decrease in mean BMI units after year was 14 and 13 after 1 ± 3 ± 3 laparoscopy and open surgery,respectively (not significant).

    Conclusions:

    Both laparoscopic and open RYGBP are effective and well received surgical procedures in morbid obesity. Reduced postoperative pain, shorter hospital stay and shorter sick-leave are obvious benefits of laparoscopy but conversions and/or reoperations in 1/4 of the patients indicate that Lap-RYGBP at present must be considered an investigational procedure.

  • 46. Willmer, Mikaela
    et al.
    Berglind, Daniel
    Thorell, Anders
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Uddén, Joanna
    Raoof, Mustafa
    Hedberg, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Tynelius, Per
    Ghaderi, Ata
    Näslund, Erik
    Rasmussen, Finn
    Changes in BMI and Psychosocial Functioning in Partners of Women Who Undergo Gastric Bypass Surgery for Obesity2015In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 2, p. 319-324Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    There is very little research exploring the effects of Roux-en-Y gastric bypass surgery (RYGB) on the patient's partner. The aim of the present study was to investigate longitudinally whether male partners of female RYGB patients were affected in terms of BMI, sleep quality, body dissatisfaction, depression, and anxiety.

    METHODS:

    Thirty-seven women, with partners who were willing to participate, were recruited from RYGB waiting lists at five Swedish hospitals. Data collection took place during two home visits, 3 months before and 9 months after RYGB surgery. Anthropometrical data were documented, and both women and men completed the Hospital Anxiety and Depression Scale (HADS) and the Karolinska Sleep Questionnaire (KSQ). The men also completed the Male Body Dissatisfaction Scale (MBDS).

    RESULTS:

    The men's BMI changes between the two time points that were analysed using general estimating equation (GEE) regression. Their BMI decreased significantly (β = -0.9, p = 0.004). The change was more pronounced in the 26 men who had a baseline BMI of ≥25 (β = -1.4, p < 0.001). Fixed-effects regression showed a statistically significant association between the men's weight loss and that of the women (β = 0.3, p = 0.004). There were no significant changes in the men's HADS, KSQ, or MBDS scores.

    CONCLUSIONS:

    Overweight/obese male partners of RYGB patients also lose weight during the first 9 months post-operatively. However, symptoms of body dissatisfaction, anxiety, and depression remain unchanged, as does self-reported sleep quality.

1 - 46 of 46
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