Publications by authors named "Pierre Y Garneau"

14 Publications

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Successful surgical weight loss with laparoscopic sleeve gastrectomy for morbid obesity prior to kidney transplantation.

Transpl Int 2021 Feb 25. Epub 2021 Feb 25.

General Surgery Service, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada.

Morbid obesity in kidney transplant (KT) candidates is associated with increased complications and graft failure. Multiple series have demonstrated rapid and significant weight loss after laparoscopic sleeve gastrectomy (LSG) in this population. Long-term and post-transplant weight evolutions are still largely unknown. A retrospective review was performed in eighty patients with end-stage kidney disease (ESKD) who underwent LSG in preparation for KT. From a median initial BMI of 43.7 kg/m , the median change at 1-year was -10.0 kg/m . Successful surgical weight loss (achieving a BMI < 35 kg/m or an excess body weight loss >50%) was attained in 76.3% and was associated with male gender, predialysis status, lower obesity class and lack of coronary artery disease. Thirty-one patients subsequently received a KT with a median delay of 16.7 months. Weight regain (increase in BMI of 5 kg/m postnadir) and recurrent obesity (weight regain + BMI > 35) remain a concern, occurring post-KT in 35.7% and 17.9%, respectively. Early LSG should be considered for morbidly obese patients with ESKD for improved weight loss outcomes. Early KT after LSG does not appear to affect short-term surgical weight loss. Candidates with a BMI of up to 45 kg/m can have a reasonable expectation to achieve the limit within 1 year.
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http://dx.doi.org/10.1111/tri.13855DOI Listing
February 2021

Behavioral weight management interventions in metabolic and bariatric surgery: A systematic review and meta-analysis investigating optimal delivery timing.

Obes Rev 2021 04 6;22(4):e13168. Epub 2021 Jan 6.

Montreal Behavioural Medicine Centre, Montreal North Island Integrated Health and Social Services University Centre (CIUSSS-NIM), Montréal, Canada.

Metabolic and bariatric surgery (MBS) yields unprecedented clinical outcomes, though variability is high in weight change and health benefits. Behavioral weight management (BWM) interventions may optimize MBS outcomes. However, there is a lack of an evidence base to inform their use in practice, particularly regarding optimal delivery timing. This paper evaluated the efficacy of BWM conducted pre- versus post- versus pre- and post-MBS. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and included pre- and/or post-operative BWM interventions in adults reporting anthropometric and/or body composition data. Thirty-six studies (2,919 participants) were included. Post-operative BWM yielded greater decreases in weight (standardized mean difference [SMD] = -0.41; 95% confidence interval [CI]: -0.766 to -0.049, p < 0.05; I = 93.5%) and body mass index (SMD = -0.60; 95% CI: -0.913 to -0.289, p < 0.001; I = 87.8%) relative to comparators. There was no effect of BWM delivered pre- or joint pre- and post-operatively. The risk of selection and performance bias was generally high. Delivering BWM after MBS appears to confer the most benefits on weight, though there was high variability in study characteristics and risk of bias across trials. This provides insight into the type of support that should be considered post-operatively.
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http://dx.doi.org/10.1111/obr.13168DOI Listing
April 2021

A reliable, reproducible flow cytometry protocol for immune cell quantification in human adipose tissue.

Anal Biochem 2021 01 11;613:113951. Epub 2020 Sep 11.

Department of Health, Kinesiology, and Applied Physiology, Concordia University, 7141 Sherbrooke St W, Montreal, QC, H4B 1R6, Canada; Metabolism, Obesity, Nutrition Lab, PERFORM Centre, Concordia University, 7200 Sherbrooke St W, Montreal, QC, H4B 1R6, Canada; Centre de Recherche - Axe Maladies Chroniques, Centre Intégré Universitaire de Santé et de Services Sociaux Du Nord-de-l'Ile-de-Montreal, Hôpital Du Sacré-Coeur de Montreal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada. Electronic address:

The ability to accurately identify and quantify immune cell populations within adipose tissue is important in understanding the role of immune cells in metabolic disease risk. Flow cytometry is the gold standard method for immune cell quantification. However, quantification of immune cells from adipose tissue presents a number of challenges because of the complexities of working with an oily substance and the rapid deterioration of immune cell viability before analysis can be performed. Here we present a highly reproducible flow cytometry protocol for the quantification of immune cells in human adipose tissue, which overcomes these issues.
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http://dx.doi.org/10.1016/j.ab.2020.113951DOI Listing
January 2021

Case Report: Endoscopic Removal of an Eroded Gastric Band Causing Small Bowel Obstruction upon Migration into the Proximal Jejunum.

Obes Surg 2020 Dec 11;30(12):5153-5156. Epub 2020 Aug 11.

Department of Minimally Invasive and Bariatric Surgery, Hôpital du Sacré-Coeur, CIUSSS du Nord de l'île de Montréal, 5400 Boulevard Gouin Ouest H4J 1C5, Québec, Montréal, Canada.

Background: Adjustable gastric banding (AGB) is on the decline due to its relatively modest amount of expected weight loss, coupled with high rates of revision and complications such as band erosion. Management of eroded gastric bands can be challenging especially when complete intra-gastric erosion is followed by distal migration causing small bowel obstruction.

Methods: We present an endoscopic option of using a pediatric colonoscope to remove an eroded AGB causing jejunal obstruction.

Result: Endoscopic removal of an eroded ABG causing bowel obstruction was successful.

Conclusion: Endoscopy remains a safe and relatively non-invasive approach to deal with such complications.
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http://dx.doi.org/10.1007/s11695-020-04906-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417257PMC
December 2020

Comment on: Short-term results of long biliopancreatic limb Roux-en-Y gastric bypass: is it superior?

Surg Obes Relat Dis 2020 05 28;16(5):e32-e33. Epub 2020 Jan 28.

Hôpital du Sacré-Cœur, University of Montréal, Montréal, Canada.

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http://dx.doi.org/10.1016/j.soard.2020.01.020DOI Listing
May 2020

Prospective study of the changes in pharmacokinetics of immunosuppressive medications after laparoscopic sleeve gastrectomy.

Am J Transplant 2020 02 13;20(2):582-588. Epub 2019 Oct 13.

Department of Pharmacology, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada.

Laparoscopic sleeve gastrectomy induces weight loss via the creation of a restrictive gastric tube for early satiety and is associated with an accelerated gastric transit time. A prospective, single-dose pharmacokinetic study was performed, prior to and after laparoscopic sleeve gastrectomy, for tacrolimus, extended-release tacrolimus, mycophenolate mofetil, and enteric-coated mycophenolate sodium. The study included 12 morbidly obese patients in chronic renal failure. The median decrease in body mass index was 8.8 kg/m with an excess body weight loss of 54.9%. The AUC of all drugs were increased after laparoscopic sleeve gastrectomy by 46%, 55%, 77%, and 74%, respectively. The maximum concentrations were increased for tacrolimus, extended-release tacrolimus, and mycophenolate mofetil by 43%, 46%, and 65%. The apparent total clearances were decreased for tacrolimus, mycophenolate mofetil, and enteric-coated mycophenolate sodium by 36%, 57%, and 38%. Laparoscopic sleeve gastrectomy can be associated with significant changes in pharmacokinetics of the drugs evaluated. The mechanism is likely decreased apparent drug clearance due to an increased drug exposure (from a more distal site of intestinal absorption with decreased intestinal metabolism), or decreased clearance (liver metabolism). Adapting the monitoring of immunosuppression will be important to avoid overdosing and potential side effects.
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http://dx.doi.org/10.1111/ajt.15602DOI Listing
February 2020

Efficiency of Laparoscopic One-Step Revision of Failed Adjusted Gastric Banding to Gastric Sleeve: a Retrospective Review of 101 Consecutive Patients.

Obes Surg 2019 12;29(12):3868-3873

Division of Bariatric Surgery, Department of Surgery, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, H4J1C5, Canada.

Background: Until recently, laparoscopic adjustable gastric banding (LAGB) was one of the most commonly performed bariatric surgeries worldwide. Today, its high rate of complications and failure rates up to 70% requires revisional surgery. The one-stage conversion from LAGB to laparoscopic sleeve gastrectomy (LSG) has been shown to be safe, although there are some concerns on efficacy and long-term weight loss.

Objectives: To demonstrate that one-step revision of LAGB to another restrictive procedure, such as LSG, might have efficient long-term outcomes.

Methods: The charts from 133 revisional LSGs for failed or complicated LAGB were retrospectively reviewed for the period between January 2010 and August 2017. Thirty-two patients were excluded for loss to follow-up. Demographics, complications, and percentage of excess weight loss (%EWL) were determined.

Results: One hundred one patients were included (85 women and 16 men), with a mean age of 48.5 years, and a mean body mass index of 47.1 kg/m. During the follow-up, 15 patients (15%) underwent a second revisional surgery for weight loss failure (8 Roux-en-Y gastric bypass (RYGBP), 3 biliopancreatic diversion, 3 single anastomosis duodenal-ileal bypass, 1 revisional LSG). Ten patients (10%) had long-term complications (8 severe reflux and 2 stenosis) during this period and underwent a second revisional surgery (10 RYGBP). The remaining 76 had a mean follow-up of 4.3 years and a mean %EWL of 53.2%.

Conclusion: Single-stage conversion to LSG is a safe and appropriate solution for failed or complicated LAGB with good long-term weight loss.
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http://dx.doi.org/10.1007/s11695-019-04061-6DOI Listing
December 2019

Decreasing complication rates for one-stage conversion band to laparoscopic sleeve gastrectomy: A retrospective cohort study.

J Minim Access Surg 2020 Jul-Sep;16(3):264-268

Department of Surgery, Division of Bariatric Surgery, Sacré-Coeur Hospital of Montreal, University of Montreal, Québec H4J 1C5, Canada.

Background: Laparoscopic adjustable gastric banding (LAGB) revision surgery is often necessary because of its high failure rate. The objective of this study was to demonstrate that better patient selection, when converting a failed LAGB to a laparoscopic sleeve gastrectomy (LSG) as a one-stage revision procedure, is safe, feasible and improves the complication rate.

Patients And Methods: A retrospective chart review was performed on patients who underwent a one-stage conversion of failed gastric banding to a LSG. Collected data included age, sex, body mass index (BMI), intraoperative complications, length of stay and post-operative complications. The results were compared to a previous study of 90 cases of LSG as a revision procedure for failed LAGB.

Results: There were 75 patients in the current study, 61 women and 14 men, aged 25-67 (average: 46), with a mean BMI of 45 kg/m (32-66). Seventy patients (93.3%) were operated for insufficient weight loss and 5 patients (6.7%) for intolerance to the band. In our previous study, 35 patients (39%) were operated for slippage, erosion or obstruction and 14 (15.6%) had post-operative complications as opposed to only 4 patients (5.3%) in this series (P = 0.0359). Gastric leak also improved to 1.3% compared to 5.5% previously. Average hospitalisation time was 2.5 days (1-40).

Conclusions: Rigorous patient selection, without band complications such as slippage, erosion or obstruction, allows for a significantly lower rate of operative complications for a one-stage conversion of failed gastric banding to a LSG.
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http://dx.doi.org/10.4103/jmas.JMAS_86_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440019PMC
April 2019

Posttranslational modification of proprotein convertase subtilisin/kexin type 9 is differentially regulated in response to distinct cardiometabolic treatments as revealed by targeted proteomics.

J Clin Lipidol 2018 Jul - Aug;12(4):1027-1038. Epub 2018 Apr 3.

Institut de Recherches Cliniques de Montréal (affiliated to the Université de Montréal), Montréal, Québec, Canada; Department of Biochemistry, Université de Montréal, Montréal, Québec, Canada. Electronic address:

Background: The proprotein convertase subtilisin/kexin type 9 (PCSK9) is a secreted protein that interacts with the low-density lipoprotein (LDL) receptor at the surface of hepatocytes to regulate circulating LDL cholesterol levels. High circulating PCSK9 levels have been associated with elevated LDL cholesterol. Recently, the Food and Drug Administration of the United States approved new LDL cholesterol-lowering drugs that specifically target the inhibition of PCSK9. Similar to most human proteins, PCSK9 exists in multiple forms as it is the target of posttranslational modifications (PTMs) such as proteolytic cleavage, phosphorylation, and others, which can affect its biological activity. However, commercially available assays, such as enzyme-linked immunosorbent assays, do not discriminate between these forms.

Objective: To investigate, in 2 patient cohorts, the relationships between circulating levels of multiple forms of PCSK9 and cardiometabolic interventions or treatments known to reduce LDL cholesterol levels.

Methods: PCSK9 forms were measured in plasma: (1) in 20 patients before and 6 months after bariatric surgery and (2) in 132 patients before and 12 months after daily statin treatment. A series of specific peptides used as surrogates for various PCSK9 forms were quantified by a novel semiautomated proteomic assay termed protein affinity capture coupled to quantitative mass spectrometry.

Results: Bariatric surgery resulted in a decrease in the plasma level of PCSK9 prodomain (P < .05), but did not result in a significant change in other measured PCSK9 forms. Statin treatment resulted in an increase in all measured plasma PCSK9 peptides (P < .001), but a 25% decrease in the phosphorylated state of PCSK9 at S688 (P < .05).

Conclusions: These unexpected findings indicate that measuring the circulating levels of the various domains and PTMs of PCSK9 provides more in depth information than total PCSK9 and that the prodomain and the phosphorylated state of S688 may represent novel biomarkers to explore in cardiometabolic diseases and response to treatment. In addition, our data generated new hypotheses on the function of PCSK9 PTMs in health and disease.
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http://dx.doi.org/10.1016/j.jacl.2018.03.092DOI Listing
October 2019

Extracorporeal membrane oxygenation in pheochromocytoma-induced cardiogenic shock.

Asian Cardiovasc Thorac Ann 2018 May 21;26(4):314-316. Epub 2017 Aug 21.

2 Department of Surgery, Montreal Heart Institute, 25465 Université de Montréal, Montreal, Canada.

Extracorporeal membrane oxygenation has been extensively used for cardiopulmonary support in cardiogenic shock. However, its clinical value in the management of pheochromocytoma crisis remains unclear. We report a rare case of life-threatening cardiogenic shock managed with peripheral venoarterial extracorporeal membrane oxygenation combined with endovascular left ventricular venting, in a 40-year-old female patient, in the setting of unknown adrenal pheochromocytoma. We highlight the life-saving role of extracorporeal membrane oxygenation in undiagnosed endocrine emergencies, allowing cardiac and end-organ recovery, and giving time for accurate diagnosis and specific treatment in such unusual situations.
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http://dx.doi.org/10.1177/0218492317727995DOI Listing
May 2018

Laparoscopic Sleeve Gastrectomy in the Postpartum Period: Increased Risk of Bleeding, a Challenging Situation.

Obes Surg 2016 06;26(6):1360-2

Surgical Department, Bariatric Division, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest, Montréal, Québec, H4J 1C5, Canada.

The female population represents three-fourths of patients undergoing a bariatric procedure and could be scheduled for surgery in their postpartum period. We report a difficult case of a female patient who underwent a laparoscopic sleeve gastrectomy 6 weeks postpartum. The postpartum period is accompanied by pronounced vasodilatation with transient portal hypertension. Most of the hemodynamic alterations occurring during pregnancy return to baseline within 6-8 weeks after delivery. Bariatric surgery in the postpartum period should be avoided in order for the cardiovascular system to regain its normality.
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http://dx.doi.org/10.1007/s11695-016-2154-8DOI Listing
June 2016

Is there a future for Laparoscopic Gastric Greater Curvature Plication (LGGCP)? a review of 44 patients.

Obes Surg 2013 Sep;23(9):1397-403

Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest Montréal, Québec, H4J 1C5, Canada.

Background: Laparoscopic gastric greater curvature plication (LGGCP) is a new restrictive weight loss procedure.

Methods: Between February 2011 and June 2012, 57 patients underwent LGGCP. Thirteen had it associated with a lap band and were excluded from the study. Data was collected through routine follow-up. Demographics, complications, and percentage of excess weight loss (% EWL) were determined.

Results: Forty-four patients underwent LGGCP, 40 women and 4 men with a mean age of 40 years (range, 18-72), a mean body mass index of 38 kg/m(2) (range, 35-46). Comorbidities included 2 diabetes mellitus, 11 hypertension, 8 hyperlipidaemia, and 8 obstructive sleep apnea. The mean operative time was 106 min (range, 60-180) and mean duration of hospital stay was 18 h (range, 12-168). Operative complications included one subphrenic abscess, one gastrogastric hernia, and one acute respiratory distress syndrome. Thirty patients experienced strong restriction with nausea and vomiting for the first 10 days (79.5 %). Eleven patients (25.0 %) came back with intractable nausea and vomiting, and were hospitalized, or had their hospital stay prolonged. Four patients needed early reversal of gastric plication (9 %). There was no postoperative death. The mean postoperative % EWL was 30.6 % (n = 40), 57.0 % (n = 24), 50.7 % (n = 13) at 1, 6, and 12 months, respectively.

Conclusions: LGGCP yields an acceptable weight loss compared to other restrictive procedures, but with a higher readmission rate for postoperative nausea and vomiting, or even reversal of plication. We advocate more studies to evaluate safety and effectiveness.
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http://dx.doi.org/10.1007/s11695-013-0934-yDOI Listing
September 2013

Laparoscopic sleeve gastrectomy (LSG)-a good bariatric option for failed laparoscopic adjustable gastric banding (LAGB): a review of 90 patients.

Obes Surg 2013 Mar;23(3):300-5

Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin ouest, Montreal, Quebec, Canada, H4J 1C5.

Background: Laparoscopic adjustable gastric banding (LAGB) is one of the most frequently performed bariatric surgeries. Even with a high failure rate, revisional procedures such as re-banding or laparoscopic Roux-en-Y gastric bypass (LRYGB) were commonly performed. Recently, conversions of LAGB to laparoscopic sleeve gastrectomy (LSG) were reported. We will review our experience on this conversion.

Methods: Between February 2007 and January 2012, 800 patients underwent LSG, with 90 as a revisional procedure for failed LAGB. A retrospective review of a prospectively collected database was performed. Data were collected through routine follow-up and weight loss data were also obtained through self-reporting via the Internet. Demographics, complications, and percentage of excess weight loss (%EWL) were determined.

Results: A total of 90 patients underwent LSG as a revisional procedure, comprising of 77 women and 13 men with a mean age of 41 years (22 to 67), a mean body mass index of 42 kg/m(2) (26 to 58). Among them, 15.5 % had diabetes mellitus, 35.5 % had hypertension, 20.0 % had hyperlipidemia, and 18.8 % had obstructive sleep apnea. The mean operative time was 112 min (50 to 220) and mean hospital stay was 4.2 days (1 to 180). Operative complications included 5.5 % leak and 4.4 % hemorrhage or gastric hematoma. There was no postoperative mortality. The mean postoperative %EWL was 51.8 % (n = 82), 61.3 % (n = 60), 61.6 % (n = 45), 53.0 % (n = 30), 55.3 % (n = 20), and 54.1 % (n = 10) at 6, 12, 18, 24, 36, and 48 months, respectively.

Conclusions: LSG after LAGB yields a positive outcome with higher complication rates than for primary LSG. We advocate this procedure as a good bariatric option for failed LAGB.
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http://dx.doi.org/10.1007/s11695-012-0825-7DOI Listing
March 2013

Outcome after bariatric surgery in two adolescents with hypothalamic obesity following treatment of craniopharyngioma.

J Pediatr Endocrinol Metab 2009 Sep;22(9):867-72

Department of Pediatrics, Divisions of Endocrinology, CHU Sainte-Justine, Université de Montréal, Montreal, PQ, Canada.

Treatment of craniopharyngioma (CP) in childhood can lead to severe, debilitating obesity with devastating medical and psychological outcomes. Despite sustained nutritional and exercise-oriented interventions, no efficacious medical option is available for hypothalamic obesity. We describe two adolescents who developed morbid obesity and significant comorbidities following diagnosis and treatment of CP, in whom bariatric surgery was achieved, illustrating a novel approach for symptomatic hypothalamic obesity, as well as positive and negative outcomes.
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http://dx.doi.org/10.1515/jpem.2009.22.9.867DOI Listing
September 2009