Læknablaðið - 01.10.2016, Qupperneq 16

432 LÆKNAblaðið 2016/102
R A N N S Ó K N
ENGLISH SUMMARY
Introduction: Laparoscopic roux-en-y gastric bypass (LRYGB) has
been performed at Landspitali University Hospital (LSH) since 2001. The
procedure represents an important treatment option for morbidly obese
patients. The aim of this study is to evaluate the long-term results of
these operations in Iceland.
Material and methods: All 772 consecutive patients undergoing LRYGB
at LSH during 2001-2015 were included. Information was collected from
a prospective database. Successful weight loss was defined as body
mass index (BMI) less than 33 kg/m2 or excess body mass index loss
(EBMIL) more than 50%.
Results: Mean age of patients was 41 years and 83% were females.
Mean pre-operative weight was 127 kg (±20) and mean BMI was 44
(±6). Mean %EBMIL was 80% after 1.5 year, 70% after 5 years and 64%
after 10-13 years. 85% of patients had successful weight loss with a
mean follow-up time of 7.4 years. Pre-operatively patients on average
had 2.8 obesity related comorbid diseases. 71% of patients with type 2
diabetes were in full remission after surgery. One third of patients with
hypertension and one third of patients with hyperlipidemia achieved
full remission after surgery. 37 patients (5%) had an early complication
and 174 (25%) had a late complication that frequently needed surgical
solution. Most patients (78%) needed repeated adjustment of vitamins
and minerals often many years after surgery.
Conclusion: Majority of patients achieved a successful weight loss and
most obesity related comorbidities are still in remission 7.4 years after
surgery. Early complications were rare but one fourth of patients had late
complications. Life long follow-up is of utmost importance after gastric
bypass surgery.
Outcome of gastric bypass surgery in Iceland 2001-2015
Rósamunda Þórarinsdóttir1, Vilhjálmur Pálmason1, Björn Geir Leifsson2, Hjörtur Gíslason2
1Department of Medicine, University of Iceland, 2Surgical department Landspitali University Hospital.
Key words: gastric bypass surgery in Iceland 2001-2015.
Correspondence: Hjörtur Gíslason, hjorturg@landspitali.is
Heimildir
1. Obesity: preventing and managing the global epidem-
ic. Report of a WHO consultation. World Health
Organization technical report series. 2000; 894: i-xii, 1-253.
2. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK,
Paciorek CJ, et al. National, regional, and global trends in
body-mass index since 1980: systematic analysis of health
examination surveys and epidemiological studies with
960 country-years and 9.1 million participants. Lancet
2011; 377: 557-67.
3. Þórsson B, Aspelund T, Harris TB, Launer LJ, Guðnason V.
Þróun holdafars og sykursýki í 40 á Íslandi. Læknablaðið
2009; 95: 259-66.
4. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman
JI, Donato KA, et al. Harmonizing the metabolic
syndrome: a joint interim statement of the International
Diabetes Federation Task Force on Epidemiology and
Prevention; National Heart, Lung, and Blood Institute;
American Heart Association; World Heart Federation;
International Atherosclerosis Society; and International
Association for the Study of Obesity. Circulation 2009;
120: 1640-5.
5. Alberti KG, Zimmet P, Shaw J, Grundy SM. The metabolic
syndrome--a new worldwide definition. Lancet 2005;
366: 1059-62.
6. Sundstrom J, Riserus U, Byberg L, Zethelius B, Lithell H,
Lind L. Clinical value of the metabolic syndrome for long
term prediction of total and cardiovascular mortality:
prospective, population based cohort study. BMJ 2006;
332: 878-82.
7. Batsis JA, Romero-Corral A, Collazo-Clavell ML, Sarr MG,
Somers VK, Lopez-Jimenes F. Effect of bariatric surgery on
the metabolic syndrome: a population-based, long-term
controlled study. Mayo Clin Proc 2008; 83: 897-907.
8. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW,
Jr. Body-mass index and mortality in a prospective cohort
of U.S. adults. N Engl J M 1999; 341: 1097-105.
9. Zoppini G, Verlato G, Leuzinger C, Zamboni C, Brun E,
Bonora E, et al. Body mass index and the risk of mortality
in type II diabetic patients from Verona. Int J Obes Relat
Metab Disord 2003; 27: 281-5.
10. Bianchini F, Kaaks R, Vainio H. Overweight, obesity, and
cancer risk. Lancet Oncology 2002; 3: 565-74.
11. Avenell A, Brown TJ, McGee MA, Campbell MK, Grant
AM, Broom J, et al. What are the long-term benefits of
weight reducing diets in adults? A systematic review of
randomized controlled trials. J Hum Nutr Diet 2004; 17:
317-35.
12. Avenell A, Brown TJ, McGee MA, Campbell MK, Grant
AM, Broom J, et al. What interventions should we add to
weight reducing diets in adults with obesity? A systematic
review of randomized controlled trials of adding drug
therapy, exercise, behaviour therapy or combinations of
these interventions. J Hum Nutr Diet 2004; 17: 293-316.
13. Dansinger ML, Gleason JA, Griffith JL, Selker HP,
Schaefer EJ. Comparison of the Atkins, Ornish, Weight
Watchers, and Zone diets for weight loss and heart disease
risk reduction: a randomized trial. JAMA 2005; 293: 43-53.
14. Bravata DM, Sanders L, Huang J, Krumholz HM, Olkin I,
Gardner CD, et al. Efficacy and safety of low carbohydrate
diets: a systemic review. JAMA 2003; 289: 1837-50.
15. Yanovski SZ, Yanovski JA. Long-term drug treatment for
obesity. A systematic and clinical review. JAMA 2014;
311: 74-86.
16. Svetkey LP, Stevens VJ, Brantley PL, Apple
LJ, Hollis JF, Loria CM, et al. Comparison of strategies
for sustaining weight loss: the weight loss maintenance
randomized controlled trial. JAMA 2008; 299: 1139-48.
17. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories
W, Fahrbach K, Schoelles K, et al. Bariatric surgery: a
systematic review and meta-analysis. JAMA 2004 13;
292: 1724-37.
18. Adams TD, Gress RE, Smith SC, Halversen RC, Simper
SC, Rosamond WD, et al. Long-term mortality after gastric
bypass surgery. N Engl J Med 2007; 357: 753–61.
19. Christou NV, Sampalis JS, Liberman M, Look D, Auger S,
McLean AP, et al. Surgery decreases long-term mortality,
morbidity, and health care use in morbidly obese patients.
Ann Surg 2004; 240: 416-23; discussion 23-4.
20. Eliasson B, Liakopoulos V, Franzén S, Näslund I, Svensson
AM, Ottoson J, Gudbjörnsdóttir S. Cardiovascular dise-
ase and mortality in patients with type 2 diabetes after
bariatric surgery in Sweden: a nationwide, matched,
observational cohort study. Lancet Diab Endocrinol 2015;
3: 847-54.
21. Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A,
Weiner R, et al. Interdisciplinary European guidelines
on metabolic and bariatric surgery. Obesity Surg 2014;
24: 42-55.
22. Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S,
Inzucchi SE, Et al. How do we define cure of diabetes?
Diab Care 2009; 32: 2133-5.
23. Birgisson G, Guðmundsson L. Offitumeðferð á
Reykjalundi. Sjúkraþjálfarinn 2005; 32: 22-4.
24. Hannesdóttir SH, Guðmundsson ÁL, Jóhannsson E.
Heilsufarslegar breytingar sjúklinga í atferlismiðaðri
offitumeðferð. Læknablaðið 2011; 97: 597-602.
25. Olbers T, Lönroth H, Fagevik-Olsen M, Lundel L.
Laparoscopic gastric bypass: development of technique,
respiratory function, and long-term outcome. Obes Surg
2003; 13: 364-370.
26. Carlin AM, Zeni TM, English WJ, Hawasli AA, Genaw
JA, Krause KR, et al. The comparative effectiveness of
sleeve gastrectomy, gastric bypass, and adjustable gastric
banding procedures for the treatment of morbid obesity.
Ann Surg 2013; 257: 791-7.
27. Sovik TT, Taha O, Aasheim ET, Engstrom M, Kristinsson
J, Bjorkman S, et al. Randomized clinical trial of
laparoscopic gastric bypass versus laparoscopic duodenal
switch for superobesity. Br J Surg 2010; 97: 160-6.
28. Lujan JA, Frutos MD, Hernandez Q, Liron R, Cuenca JR,
Valero G, et al. Laparoscopic versus open gastric bypass in
the treatment of morbid obesity: a randomized prospecti-
ve study. Ann Surg 2004; 239: 433-7.
29. Nguyen NT, Goldman CD, Ho HS, Gosselin RC, Singh
A, Wolfe BM. Systemic stress response after laparoscopic
and open gastric bypass. J Am Coll Surg 2002; 194: 557-66.
30. Westling A, Gustavsson S. Laparoscopic vs open Roux-
en-Y gastric bypass: a prospective, randomized trial. Obes
Surg 2001; 11: 284-92.
Heimildir 31-57 eru birtar
á heimasíðu blaðsins.