Childhood obesity is a rapidly growing global health issue, linked to significant lifelong morbidity and mortality. Its impact on various organ systems increases perioperative complications. Obesity treatment in children and adolescents involves lifestyle, dietary, and behavioral modifications, as well as pharmacologic interventions that targets hormonal, metabolic, and neurochemical abnormalities. Metabolic and bariatric surgery, proven safe and effective for adults with severe obesity (class 2 or higher), is now being recommended for adolescents. Key anesthetic considerations for these surgeries include preoperative optimization, advanced airway management, targeted ventilation strategies, and opioid-sparing analgesic regimens. Comprehensive presurgical evaluations must address co-morbid conditions such as hypertension, obstructive sleep apnea, asthma, and impaired glycemic control. Preoperative management should also consider the effects of antiobesity medications on gastric emptying and hemodynamic stability. Ventilation strategies should prevent atelectasis while avoiding barotrauma, and drug dosages must be adjusted for altered pharmacokinetics due to increased adipose tissue. Employing enhanced recovery after surgery protocols may reduce perioperative complications, shorten postsurgical stays, and improve outcomes.
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Background: Single anastomosis duodeno-ileal bypass (SADI) has emerged as a safe and effective bariatric procedure. Its simplicity and robust weight loss outcomes have contributed to its increasing popularity. While traditionally performed as an inpatient procedure, recent trends towards ambulatory surgery have prompted interest in outpatient SADI.
View Article and Find Full Text PDFPostoperative Biochemical Outcomes in Metabolic Bariatric Surgery: Results from a High-Adherence Cohort.
J Pers Med
December 2024
Department of General Surgery, Cannizzaro Hospital, 95126 Catania, Italy.
Background/objectives: In metabolic bariatric surgery, structured follow-up protocols may play an essential role in achieving optimal patient outcomes. This study aims to report postoperative biochemical outcomes in a cohort of post-bariatric patients who underwent a structured follow-up protocol.
Methods: This retrospective study included patients who underwent metabolic bariatric surgery and completed a one-year follow-up at Cannizaro Hospital from October 2022 to May 2024.
Comparing International Guidelines for the Remission of Hypertension After Bariatric Surgery.
Clin Pract
January 2025
Escola Superior de Saúde, Universidade do Algarve (ESSUAlg), 8005-139 Faro, Portugal.
Background/objectives: Obesity remains a global health concern and is associated with increased risk of type 2 diabetes, hypertension, and cardiovascular disease overall. Dissimilar hypertension guidelines are available for clinicians, namely those prepared by the American Heart Association (AHA) and the European Society of Cardiology (ESC), which may lead to distinctive appreciation of health outcomes of patients with obesity after bariatric and metabolic surgery, such as hypertension remission. The main goal of this study was to compare the effects of applying stricter (AHA) versus looser (ESC) blood pressure criteria on hypertension diagnosis pre-bariatric surgery and remission assessment one year post-op.
View Article and Find Full Text PDFInterkingdom signaling between gastrointestinal hormones and the gut microbiome.
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Department of Gastroenterology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China.
The interplay between the gut microbiota and gastrointestinal hormones plays a pivotal role in the health of the host and the development of diseases. As a vital component of the intestinal microecosystem, the gut microbiota influences the synthesis and release of many gastrointestinal hormones through mechanisms such as modulating the intestinal environment, producing metabolites, impacting mucosal barriers, generating immune and inflammatory responses, and releasing neurotransmitters. Conversely, gastrointestinal hormones exert feedback regulation on the gut microbiota by modulating the intestinal environment, nutrient absorption and utilization, and the bacterial biological behavior and composition.
View Article and Find Full Text PDFMetabolic Dysfunction-Associated Steatotic Liver Disease and the Cardiovascular System.
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Department of Cardiology, Euroclinic Hospital, Athens, Greece; First Department of Cardiology, Athens University School of Medicine, Athens, Greece. Electronic address:
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed nonalcoholic fatty-liver disease, is an important and rising health issue with a link with atherosclerotic cardiovascular (CV) disease (CVD), affecting ∼25-30% of the adults in the general population; in patients with diabetes, its prevalence culminates to ∼70%; its evolutive form, nonalcoholic steatohepatitis, is estimated to be the main cause of liver transplantation in the future. MASLD is a multisystem disease that affects, besides the liver, extra-hepatic organs and regulatory pathways; it raises the risk of type 2 diabetes mellitus (T2D), CVD, and chronic kidney disease; the disease may also progress to hepatocellular carcinoma. Its diagnosis requires hepatic steatosis and at least one cardiometabolic risk factor and the exclusion of both significant alcohol consumption and other competing causes of chronic liver disease.
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