Gintautas Brimas

Long-term results after sleeve gastrectomy: A systematic review.

Sleeve gastrectomy (SG) has become one of the most commonly used bariatric procedures worldwide. However, data regarding long-term results remain insufficient. The aim of this study was to review the long-term results after SG. We conducted a comprehensive literature search of Medline and the Cochrane Library for articles published until May 2016 on the long-term results (>5 yr) after SG. Studies representing outcomes of SG were included if they reported≥5-year results that contained at least one outcome of interest-weight loss, co-morbidities, long-term complications, or quality of life-and SG was performed as a primary procedure. Of the 297 initially identified articles, 277 studies met the exclusion criteria, and 20 met the inclusion criteria. SG was performed on 2713 patients and 1626 patients reached the≥5-year follow-up point. Among the patients, 71.3% were women and 28.7% were men. The mean preoperative body mass index was 46.9 kg/m2. The duration of follow-up ranged 5 to 11 years. The mean 5-year follow-up rate was 66% (range, 57%-100%). The mean percentage excess weight loss was 58.4%, 59.5%, 56.6%, 56.4%, and 62.5% at 5, 6, 7, 8, and 11 years, respectively. Five years after SG, the resolution or improvement of type 2 diabetes was observed in 77.8% of patients, and arterial hypertension, dyslipidemia, obstructive sleep apnea, gastroesophageal reflux disease, and degenerative joint diseases had improved or resolved in 68.0%, 65.9%, 75.8%, 30.6%, and 55.7% of patients, respectively. This systematic review suggests that SG can lead to substantial and lasting excess weight loss and significant improvement in obesity-related co-morbidities. However, the lack of randomized clinical trials, low follow-up rates, and poorly reported data regarding co-morbidities and quality of life in many of the studies indicate that these findings should be interpreted with caution.

Metabolic changes one year after laparoscopic adjustable gastric banding operation in morbidly obese subjects

Introduction Laparoscopic adjustable gastric banding (LAGB) is effective for weight reduction in severely obese patients. However, the data about its effect on metabolic syndrome (MS) are limited. Aim To assess weight loss and changes of metabolic parameters 1 year after LAGB in a prospective, nonrandomized single center cohort study in morbidly obese subjects. Material and methods Physical examination, body weight (BW) parameters and metabolic profile were assessed at baseline and 1 year after LAGB in morbidly obese subjects. The incidence of MS was evaluated according to National Cholesterol Education Program Adult Treatment Panel III criteria. Results One year after the operation data from 90 patients out of 103 were available. Mean excess weight (EW) loss of 33.1% was associated with a significant improvement in all metabolic parameters: decrease of hypertension by 15.8%, hypertriglyceridemia by 42.6%, and hyperglycemia by 46.3%; and increase in high density lipoprotein cholesterol by 48.3%. This resulted in the resolution of MS in 44.2% of subjects. The significant change in the distribution of MS components was observed with the highest frequency of 4 components before and 2 components after surgery. Patients with MS at baseline lost 29.9% of EW compared to 44.3% in those without MS (p = 0.009). Conclusions The LAGB resulted in effective reduction of BW parameters in morbidly obese subjects 1 year after the operation. Along with the weight loss, resolution of MS and a significant shift towards decrease in the number of MS components was observed. Patients with MS were more resistant to the weight loss.

Laparoscopic adjustable gastric banding. A prospective randomized study comparing the Swedish Adjustable Gastric Band and the MiniMizer Extra: one-year results

Introduction A number of different adjustable gastric bands are available for laparoscopic adjustable gastric banding (LAGB). Few attempts have been made to compare the influence of band design differences for efficiency and complication rate and conflicting results have emerged from comparative studies. Aim To compare SAGB (Swedish Adjustable Gastric Band) and MiniMizer Extra adjustable gastric bands. Material and methods One hundred and three patients were included in the prospective randomized study. All patients underwent LAGB. The SAGB was used in 49 and MiniMizer Extra in 54 patients. The primary endpoint was weight loss, and secondary endpoints were complication rate, correction of co-morbidities and improvement of quality of life. Results There were no early complications. A significant difference in the proportion of patients who have reached good or excellent weight loss results (≥ 50% of initial excess body mass index loss) was found in favour of the MiniMizer Extra group (29.6% vs. 8.2%, p = 0.006). No difference was found in other weight loss parameters, resolution of co-morbidities and improvement of quality of life. One oesophageal dilatation and one leakage were diagnosed in the MiniMizer Extra group. Five band penetrations (9.3%) were diagnosed in the MiniMizer Extra group and no penetrations in the SAGB group (p = 0.069). Conclusions No major significant differences were found between the compared bands. Further results need to be confirmed by longer follow-up.

Determination of Trace Elements in Adipose Tissue of Obese People by Microwave-Assisted Digestion and Inductively Coupled Plasma Optical Emission Spectrometry

In the present work, analytical method for the determination of trace elements in adipose tissue by means of inductively coupled plasma optical emission spectrometry (ICP-OES) was developed. Adipose tissue from two groups of the patients with obesity (with and without metabolic syndrome) was investigated. The main aim of this study was to reveal some differences and regularities in concentrations of trace elements in adipose tissue between these two groups of the individuals. Moreover, different types of adipose tissue (subcutaneous, preperitoneal, and visceral) were analyzed separately in order to investigate distribution of metals between these types in different groups of obese people. Al, Ba, Ca, Co, Cu, Cr, Fe, K, Li, Mg, Mn, Na, Ni, Sr, and Zn were selected for the quantitative determination. However, only 6 elements (Na, K, Ca, Fe, Mg, and Zn) were determined in all analyzed samples independently of the type of adipose tissue and presence of metabolic disorder of the patient. Concentrations of Ca, Fe, K, and Na were found to be strongly dependent on the type of adipose tissue. Other elements in terms of detection frequency in adipose tissue samples can be arranged in the following sequence Sr (94.7%), Cr (86.2%), Cu (24.6%), Li (18%), Ba (1.8%), Co (0.05%). The concentrations of Al, Mn, and Ni were found to be lower than limit of detection (LOD) in all analyzed samples. Comparison of metal distribution depending on the type of adipose tissue of people with and without metabolic syndrome is discussed in this work.

Transcatheter arterial embolization for upper gastrointestinal tract bleeding

Introduction Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment. Aim To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality. Material and methods A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization. Results The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01). Conclusions In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

A prospective 4-year study of insulin resistance and adipokines in morbidly obese diabetic and non-diabetic patients after gastric banding

Introduction There are insufficient data regarding the changes in adipokine levels after laparoscopic adjustable gastric banding (LAGB) in diabetic and non-diabetic patients and their effects on insulin resistance and type 2 diabetes remission. Aim To assess leptin, adiponectin, and insulin resistance changes after LAGB in diabetic and non-diabetic morbidly obese patients. Material and methods One hundred and three patients (37 with and 66 without type 2 diabetes) underwent LAGB from January 2009 to January 2010. Glycated hemoglobin, insulin, adipokine levels and insulin resistance were evaluated preoperatively, and 1 and 4 years after LAGB. Results The mean patient age was 45.9 ±11.7 years and mean preoperative body mass index was 47.5 ±7.3 kg/m2. A total of 80 of 103 patients (77.6%) completed the 4-year follow-up. After 4 years the mean excess weight loss was 38.8% and 39.5% in diabetic and non-diabetic patients respectively. Leptin levels decreased significantly in both groups at 1 year, but after 4 years this was noted only in non-diabetic patients. After 1 year adiponectin levels increased significantly only in non-diabetic patients (p = 0.003) and remained almost the same at 4 years. A significant decrease in insulin resistance was noted in both groups 1 year after LAGB and diabetes remission was observed in 23 (62.1%) patients. There was a negative correlation between preoperative insulin resistance and adiponectin levels throughout the follow-up period. Leptin levels positively correlated with BMI throughout the study period (baseline r = 0.45; p < 0.001; after 1 year r = 0.71; p < 0.001; after 4 years r = 0.68; p < 0.001). There was no significant correlation between leptin and adiponectin concentrations preoperatively or after 1 year; however, at 4 years it was significant (r = 0.27; p < 0.02). Conclusions The most significant metabolic changes occurred within 1 year after LAGB. The 4-year follow-up revealed stabilization in metabolic indices rather than significant improvement.

Reguliuojamos skrandžio apjuosimo juostos: lyginamųjų studijų apžvalga

Tomas Abaliksta, Gintautas Brimas, Kestutis Strupas Vilniaus universiteto Medicinos fakultetas, M. K. Ciurlionio g. 21, LT-03101 Vilnius Vilniaus universiteto ligoninės Santariskių klinikų Pilvo chirurgijos centras, Santariskių g. 2, LT-08661 Vilnius El. pastas: aee703@hotmail.com Darbo tikslas: Remiantis literatūros duomenimis palyginti skirtingas skrandžio apjuosimo reguliuojamas juostas, naudojamas chirurginiam nutukimo gydymui. Tyriamoji medžiaga ir metodai: Publikacijų paieska atlikta elektroninėse MEDLINE, Current Contents ir Cochrane Library duomenų bazėse. Apžvelgtos visos skrandį apjuosiancių reguliuojamų juostų lyginamųjų studijų publikacijos, paskelbtos iki 2010 m. sausio 1 d. Rezultatai: Atlikus literatūros saltinių paieską rasta 10 publikacijų, lyginancių skirtingas skrandį apjuosiancias reguliuojamas juostas. Issamiai atlikta viena studija: perspektyvi, atsitiktinių imcių, jos tiriamųjų skaicius didelis ir stebėjimo laikotarpis ilgas, įvertinti visi gydymo rezultatai. Statistiskai reiksmingo skirtumo tarp SAGB ir LAP-BAND juostų sioje studijoje nerasta. Kitos lyginamosios juostų studijos turi trūkumų: keturios buvo ne atsitiktinių imcių (dvi is jų retrospektyvios), trijose tiriamųjų imtis maža, visų stebėjimo laikas trumpas. Vienoje is sių studijų nustatytas kūno masės kritimo skirtumas tarp grupių: LAP-BAND grupėje pradinė virsnorminė kūno masė sumažėjo 41,7 %, Heliogast – 28,3 %. Mechaninių juostų komplikacijų dažnis skyrėsi vienoje studijoje: LAP-BAND – 7 %, SAGB – 1 %. Skirtumas tarp „mažo skrandžio“ issiplėtimo arba juostos nuslinkimo dažnio rastas trijose studijose (MiniMizer Extra – 0 % ir LAP-BAND – 10,8 %; SAGB – 2,4 % ir LAP-BAND – 27,6 %; SAGB – 2 % ir LAP-BAND – 23 %). Skirtumo tarp gretutinių ligų ir gyvenimo kokybės pokycio, hospitalizacijos trukmės, juostos reguliavimų skaiciaus/dažnio, juostos penetracijos/migracijos į skrandį bei infekcinių komplikacijų dažnio nerasta. Isvados: Tik viena studija atlikta laikantis siuolaikinių įrodymais pagrįstos medicinos keliamų reikalavimų, skirtumo tarp lygintų juostų nerasta. Reikalingos perspektyvios, atsitiktinių imcių ilgalaikės (>5 metų) lyginamosios studijos, vertinancios juostų konstrukcijos ar formos skirtumų įtaką gydymo efektyvumui ar komplikacijoms. Reiksminiai žodžiai: nutukimas, bariatrinė chirurgija, skrandžio apjuosimo reguliuojama juosta operacija. Adjustable gastric bands: review of comparative studies Tomas Abaliksta, Gintautas Brimas, Kestutis Strupas Vilnius University Medical Faculty, M. K. Ciurlionio Str. 21, LT-03101 Vilnius, Lithuania Vilnius University Hospital Santariskių Klinikos Centre of Abdominal Surgery, Santariskių Str. 2, LT-08661 Vilnius, Lithuania El. pastas: aee703@hotmail.com Objective: The objective of this review is to compare different adjustable gastric bands according to the data of comparative studies. Materials and Methods: A search of articles published in any language before January 2010 was carried out through the MEDLINE, Current Contents and Cochrane Library electronic databases. All articles about comparative studies of different adjustable gastric bands were eligible for review. All possible data were extracted from accepted studies and reviewed. Results: Ten comparative studies of different adjustable gastric bands were accepted. Only one comparative study of the bands was accomplished properly. It was a prospective randomised study type with a large number of patients and a long follow-up period with all possible results evaluated. No statistically significant difference between SAGB and LAP-BAND gastric bands was found in this study. The other band studies had shortcomings: four studies were non-randomised (two of them retrospective), a small number of patients in three studies, and a too short follow-up period in all studies. The difference in weight loss was stated in one of these studies: 41.7% of initial excess weight loss in the LAP-BAND group and 28.3% in the Heliogast group. Band leakage frequency was different in one study: LAP-BAND – 7%, SAGB – 1%. A difference between pouch dilatation or band slippage frequency was found in three studies (MiniMizer Extra – 0% and LAP-BAND – 10.8%; SAGB – 2.4% and LAP-BAND – 27.6%; SAGB – 2% and LAP-BAND – 23%). There was no difference between the resolution of comorbidities, improvement of the quality of life, hospital stay, band adjustment frequency, band migration or band infection rate. Conclusion: Only one accepted study was accomplished properly. There was no difference between compared adjustable gastric bands in this study. Prospective randomised long-term (more than 5 years) comparative studies are needed for a proper evaluation of band construction or shape influence on weight loss and complications. Keywords: obesity, bariatric surgery, adjustable gastric banding.

Prevalence of Obesity and the First Experience of Laparoscopic Adjustable Gastric Banding in Lithuania

Background: The increasing weight of Lithuanians represents one of the greatest challenges confronting the medical society. The most effective treatment for morbid obesity is bariatric surgery, showing low major morbidity and mortality. Modern bariatric surgery was started in Lithuania with laparoscopic adjustable gastric banding (LAGB) in 2004. However, there is no published data concerning its results in the case of this particular ethnic population thus far. Patients and Methods: From April 2004 to June 2006, 100 patients underwent LAGB. Mean age was 45.8 years, preoperative body weight 136.2 kg and body mass index (BMI) 48.4 kg/m2. Data of clinical status, complications, initial excess weight loss (%IEWL), BMI and Bariatric Analysis and Reporting Outcome System (BAROS) were used for postoperative evaluation. Results: 15.1% of Lithuanian adults are obese, 20.3% of these have BMI > 35 kg/m2 and 7% BMI > 40 kg/m2. 100 consecutive patients treated with LAGB were evaluated postoperatively. The postoperative average %IEWL amounted to 38, 57, 72 and 84% after 6, 12, 18 and 24 months, respectively. There were complications in 3 patients but no postoperative deaths. Conclusions: The prevalence of obesity in Lithuanian adults is 15.1%. In a 1-year follow-up period LAGB proved to be effective for treatment of morbid obesity, with low complications rate and improved quality of life according to BAROS. LAGB results need to be verified in long-term follow-up.

Hepatoceliulinės karcinomos prognostinės sistemos

Jonas Pivoriūnas 1 , Jonas Jurgaitis 2, 3 , Marius Paskonis 2, 3 , Agnius Juska 1 , Janina Didžiapetrienė 3 , Eugenijus Stratilovas 3 , Narimantas Evaldas Samalavicius 3 , Vitalijus Sokolovas 3 , Gintautas Brimas 2 , Kestutis Strupas 2 1 Vilniaus universiteto Medicinos fakultetas, M. K. Ciurlionio g. 21, LT-03101 Vilnius 2 Gastroenterologijos, urologijos ir abdominalinės chirurgijos klinika, Vilniaus universiteto ligoninės Santariskių klinikos, Santariskių g. 2, LT-08661 Vilnius 3 Vilniaus universiteto Onkologijos institutas Santariskių g. 1, LT-08660 Vilnius El pastas: jonas.jurgaitis@santa.lt Įvadas / tikslas Hepatoceliulinė karcinoma – tai penktas tarp dažniausių navikų pasaulyje ir trecias pagal mirstamumą. Per pastaruosius desimtmecius sergamumas siuo naviku didėja Jungtinėse Amerikos Valstijose ir Europoje. Lietuvoje hepatoceliulinės karcinomos atvejų taip pat daugėja. Manoma, kad kepenų navikų per kitus du desimtmecius dar padaugės. Hepatoceliulinė karcinoma yra sunkiai įvertinama, heterogoniska liga, dėl to pasaulyje kuriamos prognostinės sistemos, kurios turi padėti gydytojui parinkti tinkamą gydymą ir įvertinti ligos prognoze. Sio straipsnio tikslas – isrinkti ir apibūdinti labiausiai pasaulyje paplitusias hepatoceliulinės karcinomos prognostines sistemas, palyginti jų taikymo rezultatus, parinkti Lietuvai tinkamiausias sistemas. Metodai Pasinaudojus „PubMed“ duomenų baze ir įvedus reiksminius žodžius hepatocellular carcinoma, prognostic scores ir staging system buvo rasti 205 straipsniai, publikuoti nuo 1984 iki 2007 metų. Atrinkti 54 straipsniai, kuriuose minimos 24-ios hepatoceliulinės karcinomos prognostinės sistemos. Rezultatai Isanalizavus sistemas buvo nuspresta atmesti tas, kurių pritaikyti Lietuvoje nėra galimybių dėl to, kad salyje neatliekami tyrimai. Placiau aprasytos devynios sistemos. Isvados Isrinke placiausiai pasaulyje naudojamas hepatoceliulinės karcinomos prognostines sistemas ir palygine jų taikymo rezultatus, manome, kad būtų vertinga atlikti retrospektyvųjį lyginamąjį tyrimą, kad issiaiskintume, kokia prognostinė sistema geriausiai tinka hepatoceliuline karcinoma sergantiems Lietuvos populiacijos pacientams diferencijuoti pagal isgyvenamumą. Reiksminiai žodžiai: hepatoceliulinė karcinoma, prognostinė sistema, prognostiniai kriterijai, pacientų isgyvenamumas Prognostic scores of hepatocellular carcinoma Jonas Pivoriūnas 1 , Jonas Jurgaitis 2, 3 , Marius Paskonis 2, 3 , Agnius Juska 1 , Janina Didžiapetrienė 3 , Eugenijus Stratilovas 3 , Narimantas Evaldas Samalavicius 3 , Vitalijus Sokolovas 3 , Gintautas Brimas 2 , Kestutis Strupas 2 1 Vilnius University Faculty of Medicine, M. K. Ciurlionio str. 21, LT-03101 Vilnius, Lithuania 2 Clinic of Gastroenterology, Urology and Abdominal Surgery, Vilnius University Hospital Santariskių Clinic, Santariskių str. 2, LT-08661 Vilnius, Lithuania 3 Institute of Oncology, Vilnius University, Santariskių str. 1, LT-08660 Vilnius, Lithuania E-mail: jonas.jurgaitis@santa.lt Background / objective Hepatocellular carcinoma is the most common primary liver cancer. It is the fifth most common neoplasm and the third most common cause of cancer-related death in the world. Over the last decade the incidence of this cancer has been rising in the United States of America and in Europe as well as in Lithuania. The incidence of this cancer in the next two decades is expected to rise. Hepatocelullar carcinoma is a difficult and heterogenic disease. Therefore, prognostic scores are being created to help clinicians to choose the best treatment for the patient. The aim of this review is to select and describe the most widely used prognostic systems of hepatocellular carcinoma, to compare results of their usage, applicability and to choose the most suitable scoring systems for the further use in Lithuania. Methods The PubMed data base was used to search for the keywords: “hepatocellular carcinoma”, “prognostic scores” and “staging systems”. 205 published articles were found from the year 1984 though 2007; 54 articles with 24 prognostic systems were selected. Results Upon analysing the prognostic systems, it was decided to reject the scoring systems that are impossible to use in Lithuania because of the absence of related tests. In total, nine prognostic systems were overviewed. Conclusions A retrospective cohort study is advisable to ascertain which prognostic system of hepatocellular carcinoma is most suitable for Lithuanian population. Key words: hepatocellular carcinoma, prognostic score, prognostic factors, survival of the patient