Papers by Emanuela Bianciardi
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
Purpose During the coronavirus disease 19 (COVID-19) outbreak, most public hospitals worldwide ha... more Purpose During the coronavirus disease 19 (COVID-19) outbreak, most public hospitals worldwide have been forced to postpone a major part of bariatric surgery (BS) operations with unfavorable consequences for weight and obesity complications. The aim of this study was to evaluate the effectiveness and safety of laparoscopic BS on subjects with metabolically unhealthy obesity (MUO) during COVID-19 pandemic in a high-volume Italian center. Methods Between March 2020 and January 2021, all patients with MUO submitted to laparoscopic BS (sleeve gastrectomy [SG], one anastomosis gastric bypass [OAGB] and Roux-en-Y gastric bypass [RYGB]) were enrolled according to the ATP III Guidelines, with a minimum follow-up of 3 months. Results In the study period, 210 patients with MUO underwent laparoscopic BS (77 RYGB, 85 SG and 48 OAGB) in our obesity referral center. Postoperative major complications occurred in 4 patients (1.9%) with zero mortality. At 9-month follow-up, a total weight loss (TWL)...
Internal herniation of small bowel through the minimizer ring after banded one anastomosis gastric bypass: Case report with diagnosis and management of a rare complication
Obesity Research & Clinical Practice
Nutrients
Introduction: Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are two e... more Introduction: Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are two effective bariatric surgical procedures with positive outcomes in terms of weight loss, comorbidities remission, and adverse events profiles. OAGB seems to carry a higher risk of malnutrition, but existing data are controversial. The aim of this study is to objectively evaluate and compare malnutrition in patients undergoing RYGB and OAGB. Methods: Retrospective monocentric study of obese patients undergoing RYGB or OAGB between the 15 September 2020 and the 31 May 2021. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score and compared between groups. The primary outcome was the mean CONUT score at 6 months. The secondary outcomes included the incidence of malnutrition, comorbidities, including hypertension, insulin resistance and type II diabetes mellitus, and weight loss. Results: 78 patients were included: 30 underwent RYGB and 48 underwent OAGB. At 6-...
Trauma e Depressione Perinatale
Eterogeneità del quadro clinico e del funzionamento psicosociale negli Ultra High Risk
Journal of Obesity, 2022
Introduction. Laparoscopic one anastomosis gastric bypass (LOAGB) is a relatively new procedure f... more Introduction. Laparoscopic one anastomosis gastric bypass (LOAGB) is a relatively new procedure for the treatment of morbid obesity and related comorbidities. On average, this procedure results in good postoperative weight loss with a low complication rate. Recent publications suggest that dumping syndrome and weight regain might be reduced by placing a silicone ring over the gastric pouch during the procedure, so called laparoscopic banded one anastomosis gastric bypass (LBOAGB). Methods. 86 patients undergoing LBOAGB between 2018 and 2020 were enrolled in this retrospective study. Hospital records were used to assess weight loss, comorbidity resolution, and any complications either in the short or medium term. Results. 54 Female and 32 male patients were included with a mean age of 43 years (25–64), preoperative body mass index of 42 kg/m2 (35–49), and preoperative weight of 114 kg (86–162). Thirty-four patients presented with type 2 diabetes (39.5%), 42 patients (49%) diagnosed w...
Surgery for Obesity and Related Diseases, 2007
Background: The aim of the study was to evaluate the laparoscopic approach to re-operative bariat... more Background: The aim of the study was to evaluate the laparoscopic approach to re-operative bariatric surgery. Methods: From January 2003 to July 2006, 21 obesity surgery patients were referred to our Institution for revision. Fifteen patients previously had a laparoscopic gastric banding (LGB), 3 a laparoscopic vertical banded gastroplasty (LVBG), 2 an open jejuno-ileal bypass (JIB) and 1 a laparoscopic gastric bypass (LRYGB). Indications for re-operation were insufficient weight loss in 8 patients, band slippage in 7, band erosion in 3, severe malabsorption syndrome in 2 and gastric fistula with sepsis in 1 patient. Mean pre-operative BMI was 44.12 kg/m 2. Results: Twenty-one re-operative procedures were performed. Four patients required a third operation. Eight LGB patients underwent band removal (6 by laparoscopy and 2 by open surgery), 6 LGB patients were converted to a RYGB (5 by laparoscopy and 1 by open surgery), 1 band was laparoscopically removed and simultaneously replaced , 2 JIB patients underwent an open intestinal restoration, 2 LVBG patients were converted to a LRYGB, 1 LRYGB patient was converted to a laparoscopic long-limb gastric bypass and 1 LVBG patient with sepsis was drained by open surgery. Further procedures included 1 LGB, 1 LRYGB, 1 open RYGB and 1 laparoscopic biliopancreatic diversion. Laparotomy was needed in 7 patients (7/25, 28%). Early complications include 1 case of pneumothorax and 5 cases of wound infection. Mortality was zero. Mean follow-up was 22.1 months. Mean post-operative BMI was 32.6 kg/m 2. Conclusion: laparoscopic re-operative bariatric surgery is feasible, safe and effective.
Giorgio Di Lorenzo Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Ve... more Giorgio Di Lorenzo Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy • E-mail: [email protected] Summary Hypersexuality is characterized by intrusive fantasies and thoughts regarding sex, excessive sexual behaviours, and the inability to control one’s own sexuality, resulting in an impairment of relational and social life. While several clinical histories and empirical research consider hypersexuality as a disorder, the last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not include hypersexuality as a psychopathological category in se. This has generated controversy among clinicians and researchers and a mismatch with the 11th revision of the International Classification of Diseases (ICD-11). However, different theoretical models are related to hypersexuality, i.e. the compulsivity model, the impulsivity model and the addiction model. This paper addresses the psychopa...
JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2011
Background: Laparoscopic sleeve gastrectomy (LSG) has emerged as an alternative restrictive baria... more Background: Laparoscopic sleeve gastrectomy (LSG) has emerged as an alternative restrictive bariatric procedure to the most popular laparoscopic adjustable gastric banding (LAGB). We analyze and compare the clinical and weight loss outcomes of LSG versus LAGB for the treatment of severe obesity in high-risk patients. Methods: Forty severely obese veterans (20/group) received either LSG or LAGB and were followed prospectively for 2 years. Outcome measures included operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, reoperations, readmission rates, and weight loss over time. Results: The cohort primarily comprised high-risk and older male veterans. Patient's baseline demographics were similar between groups. LSG was associated with prolonged OR time (116Ϯ31 vs. 94Ϯ28min), higher EBL (34Ϯ28 vs. 17Ϯ19mL), and LOS (2Ϯ.9 vs. 1Ϯ.4days) when compared with LAGB. Minor morbidity and readmissions were similar between groups, while no major morbidity, reoperations, or mortality occurred. Total weight and BMI decreased significantly after surgery in both groups (LSG: 302Ϯ52 to 237lbs and 45Ϯ5 to 36Ϯ5kg/m 2 vs. LAGB: 280Ϯ36 to 231Ϯ29lbs and 43Ϯ5 to 36Ϯ5kg/m 2 , respectively). Total weight loss was superior in the LSG vs. LAGB group at 2 years (TWLϭ65Ϯ24 vs. 49Ϯ28 lbs (Pϭ.03); %EWLϭ51Ϯ20 vs. 46Ϯ23%; %EBMI lossϭ48Ϯ22 vs. 45Ϯ23%, and %BWLϭ 21Ϯ8 vs. 17Ϯ9%, respectively). Conclusion: In severely obese and high-risk patients, laparoscopic sleeve gastrectomy provides superior total weight loss at 2 years.
Gastroenterology, 2009
Fifty-one patients were enrolled in the protocol of study. Population of study was homogeneously ... more Fifty-one patients were enrolled in the protocol of study. Population of study was homogeneously distributed in the two groups. Eight patients were excluded from the analysis of primary endpoint: 5 because of findings during initial exploratory surgery and 3 who died within 90 days from surgery. Forty-three patients were followed-up (range 11-104, mean 44 months). Five patients were lost at F.U. Twenty-one patients underwent a laparoscopic gastric surgery (LGS) and 22 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer related survival (44% vs 45%, p 0.9), and 5 years overall survival (39% vs 50%, p 0.9). We found no differences in surgical complications and postoperative mortality in the 2 groups. Operative time was significantly longer for LGS (p<0.001). There was no conversion to open surgery in this series. Healthprofile questionnaires' assessment is still in progress. However preliminary results seems to favor the laparoscopic approach. Conclusions. LGS is as effective as OGS in the treatment of advanced gastric cancer. There was a tendency of higher limitation of patient's day-life in the immediate and late postoperative period in the OGS group. Based on these results, the authors cannot recommend routine use of LGS over OGS for the treatment of advanced gastric cancer.
Gender Influence on Long-Term Weight Loss and Comorbidities After Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: a Prospective Study With a 5-Year Follow-up
Obesity Surgery, 2015
Gender might be important in predicting outcomes after bariatric surgery. The aim of the study wa... more Gender might be important in predicting outcomes after bariatric surgery. The aim of the study was to investigate the influence of gender on long-term weight loss and comorbidity improvement after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). A cohort of 304 consecutive patients underwent surgery in 2006-2009: 162 (98 women, 64 men) underwent LSG and 142 (112 women, 30 men) underwent LRYGB. The mean follow-up time was 75.8 ± 8.4 months (range, 60-96 months). Overall mean (95 % CI) reduction in BMI was 23.5 (24.3-22.7) kg/m(2) after 5 years, with no statistical difference between LSG and LRYGB groups (P = 0.94). The overall means ± standard deviations of %EBMIL after 5 years were 78.8 ± 23.5 and 81.6 ± 21.4 in the LSG and LRYGB groups, respectively. Only for LSG group %EBMIL after 24-36 and 60 months differed significantly between male and female patients (P = 0.003 versus P = 0.06 in LRYGB), and 89 versus 90 % of patients showed improvements in comorbidities in the LSG and LRYGB groups, respectively. Only two patients (women) were lost to follow-up: 1/162 (0.6 %) for LSG at the 4th year and 1/142 (0.7 %) for LRYGB to the 5th year. LSG was more effective in obese male than in female patients in terms of %EBMIL, with no difference in comorbidities. LRYGB elicited similar results in both genders in terms of %EBMIL and comorbidities.
Off-label uses of selective serotonin reuptake inhibitors (SSRIs)
Current neuropharmacology, 2021
Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reupta... more Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reuptake inhibitors (SSRIs) are extremely versatile and, therefore, widely prescribed. Moreover, they are commonly considered as having a better safety profile compared to other antidepressants. For these reasons, when it comes to off-label prescribing, SSRIs rank among the top positions. In this review, we present the state of the art of off-label applications of selective serotonin reuptake inhibitors, ranging from migraine prophylaxis to SARS-CoV-2 antiviral properties. Research on SSRIs provided significant evidence in the treatment of premature ejaculation, both with the on-label dapoxetine 30 mg and the off-label paroxetine 20 mg. However, other than serotoninergic syndrome, serious conditions like increased bleeding rates, hyponatremia, hepatoxicity, and post-SSRIs sexual dysfunctions, are consistently more prominent when using such compounds. These insidious side effects might be frequ...
Introduction. Aim of the study was trying to draw a final flow chart for the management of gastri... more Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years' experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6-34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26-83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stabil...
Trends in Andrology and Sexual Medicine
JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons
Background:With the escalation of surgical treatment of morbid obesity, there is a growing intere... more Background:With the escalation of surgical treatment of morbid obesity, there is a growing interest in the training of bariatric surgeons. Laparoscopic sleeve gastrectomy (LSG) gained popularity both as a first-stage approach and as a stand-alone procedure.Objectives:The aim of this study was to assess detectable differences in LSG with intra-operative resident involvement.Methods:We reviewed obese patients, who had undergone LSG between January 1, 2017 and January 31, 2020. Collected data reported demographic factors, operative time, postoperative complications, and outcomes.Results:Among 313 patients who met the inclusion criteria, 94 were men and 219 were women. The procedures were performed either by an expert bariatric surgeon (group 1), or a general surgery resident (group 2), respectively in 228 and 85 cases. Mean operative time of the first group was 65.3 ± 18.8 minutes, while it was 74.3 ± 17.2 among trainees (p < 0.001). Perioperative complications were diagnosed in 13 patients (10 in group 1 and 3 in group 2). Mean excess body weight loss after 12 months was 87.7 ± 28.2% in the first group and 81.1 ± 31.6% in the residents group. Between the two groups, we found no differences in the incidence of perioperative complications and in surgical outcomes. Trainee involvement was associated with increased operative time, with no correlation with a worse postoperative course.Conclusions:Residents can safely perform LSG in referral centers under the supervision of an expert bariatric surgeon. Trainee involvement is not related to increased leak rate, nor to suboptimal short-term outcome.
Neurocognitive and Psychopathological Predictors of Weight Loss After Bariatric Surgery: A 4-Year Follow-Up Study
Frontiers in Endocrinology
Twenty to thirty percent of patients experience weight regain at mid and long-term follow-up. Imp... more Twenty to thirty percent of patients experience weight regain at mid and long-term follow-up. Impaired cognitive functions are prevalent in people suffering from obesity and in those with binge eating disorder, thereby, affecting the weight-loss outcomes. The aim of our study was to investigate neurocognitive and psychopathological predictors of surgical efficacy in terms of percentage of excess weight loss (%EWL) at follow-up intervals of one year and 4-year. Psychosocial evaluation was completed in a sample of 78 bariatric surgery candidates and included psychometric instruments and a cognitive battery of neuropsychological tests. A schedule of 1-year and 4-year follow-ups was implemented. Wisconsin Sorting Card Test total correct responses, scores on the Raven’s Progressive Matrices Test, and age predicted %EWL at, both, early and long-term periods after surgery while the severity of pre-operative binge eating (BED) symptoms were associated with lower %EWL only four years after t...
Bariatric Surgery Closure During COVID-19 Lockdown in Italy: The Perspective of Waiting List Candidates
Frontiers in Public Health
Background: From the beginning of March 2020, lockdown regimens prevented patients with obesity f... more Background: From the beginning of March 2020, lockdown regimens prevented patients with obesity from receiving bariatric surgery. Surgical emergencies and oncological procedures were the only operations allowed in public hospitals. Consequently, patients with morbid obesity were put in a standby situation. With the aim at exploring the viewpoint of our future bariatric surgery patients, we built a questionnaire concerning obesity and COVID-19. Method: A total of 116 bariatric surgery candidates were approached using a telephonic interview during the Italian lockdown. Results: Of the total sample, 73.8% were favorable to regular bariatric surgery execution. Forty percent were concerned about their own health status due to the COVID-19 emergency, and 61.1% were troubled by the temporary closure of the bariatric unit. The majority of the sample were eating more. Forty-five percent and the 27.5% of patients reported a worsening of the emotional state and physical health, respectively. Most of the patients (52.2%) considered themselves more vulnerable to COVID-19, especially individuals with class III obesity. Patients who reported an increased consumption of food were younger (43.44 ± 12.16 vs. 49.18 ± 12.66; F = 4.28, p = 0.042). No gender difference emerged. Conclusion: The lockdown had a negative result on Italian patients' psychological well-being and eating habits. The majority of patients would have proceeded with the surgery even during the COVID-19 emergency. Effective management and bariatric surgery should be restarted as soon as possible.
Trauma psichico nel periparto, conseguenze ostetriche e metaboliche
JSLS : Journal of the Society of Laparoscopic & Robotic Surgeons, 2021
Background: With the escalation of surgical treatment of morbid obesity, there is a growing inter... more Background: With the escalation of surgical treatment of morbid obesity, there is a growing interest in the training of bariatric surgeons. Laparoscopic sleeve gastrectomy (LSG) gained popularity both as a first-stage approach and as a stand-alone procedure. Objectives: The aim of this study was to assess detectable differences in LSG with intra-operative resident involvement. Methods: We reviewed obese patients, who had undergone LSG between January 1, 2017 and January 31, 2020. Collected data reported demographic factors, operative time, postoperative complications, and outcomes. Results: Among 313 patients who met the inclusion criteria, 94 were men and 219 were women. The procedures were performed either by an expert bariatric surgeon (group 1), or a general surgery resident (group 2), respectively in 228 and 85 cases. Mean operative time of the first group was 65.3 ± 18.8 minutes, while it was 74.3 ± 17.2 among trainees (p < 0.001). Perioperative complications were diagnosed...
Obesity, defi ned as a Body Mass Index ≥30, is a growing global epidemic with adverse short and l... more Obesity, defi ned as a Body Mass Index ≥30, is a growing global epidemic with adverse short and long-term complications impacting subjective well-being, physical health, mental health and sexual function. Sexual disorders have become a feature of growing interest in the obesity fi eld and are critically related to the quality of life. Fat storage and metabolism diff er considerably between men and women. Therefore, the relationship between obesity and sexual functioning may be gender-specifi c. Although there is a link between either obesity and sexual dysfunction or surgical and diet-induced weight loss and improved sexual function, the improvement may not be dependent on the amount of weight loss only. Sexual dysfunction in obese patients may be a consequence of obesity itself, psychiatric and somatic comorbidities, and the use of certain medications such as anti-hypertensive drugs. These issues are also infl uenced by gender diff erences. This paper reviews the most common sexual...
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Papers by Emanuela Bianciardi