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Canadian Journal of Cardiology

How to Choose and Use Bariatric Surgery in 2015

  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Marie-Ève Piché
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada

    Faculty of Medicine, Laval University, Québec, Québec, Canada
    Search for articles by this author
  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Audrey Auclair
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada

    Faculty of Pharmacy, Laval University, Québec, Québec, Canada
    Search for articles by this author
  • Jany Harvey
    Affiliations
    Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada

    Faculty of Pharmacy, Laval University, Québec, Québec, Canada
    Search for articles by this author
  • Simon Marceau
    Affiliations
    Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada

    Faculty of Medicine, Laval University, Québec, Québec, Canada
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  • Paul Poirier
    Correspondence
    Corresponding author: Dr Paul Poirier, Laval University Faculty of Pharmacy, Institut universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec, Québec G1V 4G5, Canada. Tel.: +1-418-656-4767; fax: +1-418-656-4581.
    Affiliations
    Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada

    Faculty of Pharmacy, Laval University, Québec, Québec, Canada
    Search for articles by this author
  • Author Footnotes
    ∗ These authors contributed equally to this work.
Published:December 15, 2014DOI:https://doi.org/10.1016/j.cjca.2014.12.014

      Abstract

      Severe obesity is associated with increased morbidity and mortality and represents a major health care problem with increasing incidence worldwide. Bariatric surgery, through its efficacy and improved safety, is emerging as an important available treatment for patients with severe obesity. Classically, bariatric surgery has been described as either a restrictive or a hybrid surgery, which is a combination of restriction and malabsorption. For most severely obese patients, bariatric surgery results in the remission of major obesity-related comorbidities including type 2 diabetes mellitus, sleep apnea, hypertension, and dyslipidemia. Thus, bariatric surgery reduces cardiovascular risk burden, and overall mortality risk. Early complications (< 30 days) after bariatric surgery were reported to be < 10% and tend to be lower in restrictive surgeries compared with hybrid surgeries. Most common early complications reported are gastric and anastomosis leak (1.6%-5.1%), bleeding (0.5%-3.5%), and pulmonary embolism (0.2%-1%). Long-term complications (> 30 days) might differ depending on the type of bariatric surgery. According to the type of surgery and the type of study, the 30-day operative mortality rates differ from 0.1% to 1.2%. Studies on postoperative outcomes, investigations on weight loss physiology, and mechanism of action after bariatric surgery provide a better understanding of the bariatric surgery metabolic benefits. In this article, we present an overview of bariatric procedures with their effects, including risks and benefits, on the severely obese patients' health. It provides evidence to support surgical treatment of severe obesity to achieve cardiovascular disease risk reduction in severely obese patients.

      Résumé

      L'obésité sévère est un problème de santé majeur, associée à une morbidité et à une mortalité augmentées, dont son incidence mondiale ne cesse d'augmenter. La chirurgie bariatrique est le seul traitement considéré efficace et sécuritaire pour les patients ayant une obésité sévère. Il existe 2 types de chirurgie bariatrique: 1) les chirurgies restrictives impliquant seulement une restriction à l'estomac ou 2) les chirurgies mixtes impliquant une restriction ainsi qu'une malabsorption des aliments. Pour une majorité de patients avec obésité sévère, la chirurgie bariatrique conduit à une rémission des principales comorbidités associées à l'obésité incluant le diabète de type 2, l'apnée du sommeil, l'hypertension artérielle et la dyslipidémie, contribuant ainsi à diminuer le risque cardiovasculaire et la mortalité. En général, le taux de complications à court terme (< 30 jours) est plus faible suite à une chirurgie restrictive comparativement à une chirurgie mixte et a été rapporté comme étant inférieur à 10%. Les complications à court terme (< 30 jours) les plus fréquemment rapportés sont les fuites dans l'anastomose gastrique (1,6 à 5,1%), les saignements (0,5% à 3,5%) et l'embolie pulmonaire (0,2 à 1%). Quant aux taux de complications à long terme (> 30 jours) rapportés dans la littérature, ils varient selon le type de chirurgies ainsi que le type d'étude. Le taux de mortalité post-opératoire à 30 jours varie entre 0,1 à 1,2%. Les études évaluant spécifiquement les mécanismes associés à la perte de poids et à la rémission des comorbidités associées à l'obésité sévère fournissent une meilleure compréhension des effets métaboliques de la chirurgie bariatrique et de ses complications. Cet article présente un aperçu des principales chirurgies bariatriques et résume les principaux risques et avantages de ces chirurgies sur la santé cardiovasculaire chez des patients avec une obésité sévère. Il fournit également des évidences cliniques favorables à effectuer la chirurgie bariatrique pour réduire le risque cardiovasculaire chez ces patients.
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