Bariatric Surgery For Obese Patients With Body Mass Index 27.5-32.5 Kg/m~2 And?32.5 Kg/m~2:One-year Outcomes And Diagnosis And Treatment Of Anemia

Chapter 1 Bariatric Surgery for Obese Patients with Body Mass Index 27.5-32.5 kg/m2 and ?32.5 kg/m2:One-year outcomesObjective:To compare the effect and safety of bariatric surgery in obese patients with body mass index(BMI)27.5-32.5 kg/m2 versus BMI? 32.5 kg/m2.Methods:One hundred and nine obese patients including 49 patients with type 2 diabetes mellitus(T2DM)underwent bariatric surgery and completed one year follow-up in our hospital were divided into two groups based on baseline BMI 27.5-32.5 kg/m2 or ?32.5 kg/m2.The weight,BMI,waist and hip circumference,blood pressure,medications,biochemical index,nutritional status,and adverse events were measured.Weight loss,metabolic improvement,complications and adverse events were compared at 1-year after surgery between these two groups.Results:(1)At 1 year after surgery,similar to group of BMI ? 32.5 kg/m2,26.09%of patients in group of BMI 27.5-32.5kg/m2 achieved the composite end points including excess weight loss(EWL)>50%,glycated hemoglobin A1c(HbA1c)<5.7%,LDL-C<2.6mmol/L,and systolic blood pressure(SBP)<130 mmHg.(2)Significant weight loss and reduction in BMI,waist circumference,low density lipoprotein cholesterol(LDL-C),HbAlc,SBP and diastolic blood pressure(DBP)were found in group of BMI 27.5-32.5kg/m2 at 1 year after surgery,and not different from group of BMI? 32.5 kg/m2 after adjusting both baseline characteristics.(3)At 12 months after surgery,similar to group of BMI? 32.5 kg/m2,31.25%T2DM patients in group of BMI 27.5-32.5kg/m2 achieved the composite end points including EWL>50%,HbAlc<6.5%,LDL-C<2.6mmol/L,and SBP<130 mmHg.All T2DM patients in group of BMI 27.5-32.5kg/m2 had LDL-C<2.6mmol/L,more than group of BMI? 32.5 kg/m2.(4)There were low incidence of postoperative complications,and no serious adverse events in both groups.Conclusion:Same as group of BMI 32.5kg/m2,bariatric surgery resulted in effective weight loss,and alleviation of hyperglycemia,hyperlipidemia,hypertension in patients in group of BMI 27.5-32.5 kg/m2,accompanied with low incidence of postoperative complications at 1-year follow-up.Chapter 2 Diagnosis and treatment of anemia 1-year after laparoscopic Roux-en-Y gastric bypass in obese patientsObjective:To analyze the incidence and treatment of anemia in obese patients after laparoscopic Roux-en-Y gastric bypass(LRYGB).Methods:This retrospective study was conducted to analyze the incidence and treatment of anemia in obese patients underwent LRYGB at 1-year follow-up in our hospital.Results:(1)The incidence of new-onset anemia was 1.12%,3.37%and 8.99%respectively at 3,6 and 12 months follow-up after surgery.(2)Iron deficiency is the main pathogenic factor for anemia after LRYGB.(3)Iron deficiency anemia improved through oral iron supplement,combined with intravenous component blood transfusion when necessary.Conclusion:The incidence of new-onset iron deficiency anemia increased rapidly at 1 year in after LRYGB surgery,and it could be effectively alleviated by proper treatment.Postoperative anemia is not a contraindication for metabolic surgery.Periodic detect serum hemoglobin and serum ferritin help to find out mild iron deficiency anemia and prevent the development of severe anemia.Postoperative follow-up involving endocrinologists efficiently prevents the incidence of severe anemia.