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Gaytán Fuentes OF, Barajas Galicia E, Chávez García G, Galván Remigio I, Oviedo RJ, Gaytán Fuentes IA, Ayala Ventura GA, Barba Mendoza JA. Revisional bariatric surgery using robotic-assisted surgery in a national medical center in Mexico. J Robot Surg 2024; 18:247. [PMID: 38850381 DOI: 10.1007/s11701-024-01980-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/11/2024] [Indexed: 06/10/2024]
Abstract
Long-term postoperative complications of metabolic and bariatric surgery (MBS) are more frequent than those of primary surgery. Robotic-assisted procedures offer several advantages over traditional laparoscopy, but there are limited data. A retrospective study of 29 patients who underwent a revisional robotic-assisted Roux-en-Y gastric bypass (RRYGB) in a Tertiary Level Hospital. Variables included were demographics, causes for revision, operative details, complications, and weight loss outcomes up to 54 month post-RRYGB. Causes for conversion were weight loss failure (WLF), weight regain (WR), Gastroesophageal Reflux Disease (GERD), or Joint Pain (JP). We assessed 29 patients. Causes for conversion included WLF (34%), WR (15%), WR with GERD (20%), GERD (24%), and JP (3%). Initial BMI was 53.43 kg/m2 ± 8.75. Mean length of hospital stay (LOS) was 2 days. Total operative time was 126 min. ± 43.45. Excess weight loss at 1 year post-surgery was 82.66% (p < 0.0001), with mean BMI of 30.93 kg/m2 (p < 0.001). At 3 years, mean %EWL was 71.26% and a mean BMI 33.81 kg/m2 (p < 0.0001). At 4.5 years, mean %EWL was 59.29% and mean BMI 37.27 kg/m2 (p < 0.0001). One complication (8%) was found (jejunojejunal stenosis). There was no mortality. The initial experience with RRYGB shows acceptable outcomes, including low morbidity, no mortality, excellent weight loss after the revisional surgery, and promising reduction in operative times, with important implications on reduction of the total cost of the procedure.
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Affiliation(s)
- Omar Felipe Gaytán Fuentes
- Upper Gastrointestinal Robotic Surgery Fellowship, General Surgery Department, "CMN 20 de Noviembre" ISSSTE, Mexico City, México
- Revenant Clinic, Integral Obesity Clinic, Hospital Ángeles Acoxpa, Mexico City, México
| | - Edith Barajas Galicia
- Upper Gastrointestinal Robotic Surgery Fellowship, General Surgery Department, "CMN 20 de Noviembre" ISSSTE, Mexico City, México
| | - Geovany Chávez García
- Upper Gastrointestinal Robotic Surgery Fellowship, General Surgery Department, "CMN 20 de Noviembre" ISSSTE, Mexico City, México.
- Revenant Clinic, Integral Obesity Clinic, Hospital Ángeles Acoxpa, Mexico City, México.
| | - Isabel Galván Remigio
- Upper Gastrointestinal Robotic Surgery Fellowship, General Surgery Department, "CMN 20 de Noviembre" ISSSTE, Mexico City, México
- Revenant Clinic, Integral Obesity Clinic, Hospital Ángeles Acoxpa, Mexico City, México
| | - Rodolfo J Oviedo
- University of Houston Tilman J, Fertitta Family College of Medicine, Houston, TX, USA
- Sam Houston State University College of Osteopathic Medicine, Conroe, TX, USA
- Nacogdoches Center for Metabolic and Weight Loss Surgery, Nacogdoches, TX, USA
| | - Israel Abraham Gaytán Fuentes
- Revenant Clinic, Integral Obesity Clinic, Hospital Ángeles Acoxpa, Mexico City, México
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gustavo Andrés Ayala Ventura
- Upper Gastrointestinal Robotic Surgery Fellowship, General Surgery Department, "CMN 20 de Noviembre" ISSSTE, Mexico City, México
- Revenant Clinic, Integral Obesity Clinic, Hospital Ángeles Acoxpa, Mexico City, México
| | - Jairo Arturo Barba Mendoza
- Upper Gastrointestinal Robotic Surgery Fellowship, General Surgery Department, "CMN 20 de Noviembre" ISSSTE, Mexico City, México
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Scott AW, Amateau SK, Leslie DB, Ikramuddin S, Wise ES. Prediction of 30-Day Morbidity and Mortality After Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Use of an Artificial Neural Network. Am Surg 2024; 90:1202-1210. [PMID: 38197867 DOI: 10.1177/00031348241227182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is indicated primarily for unsatisfactory weight loss or gastroesophageal reflux disease (GERD). This study aimed to use a comprehensive database to define predictors of 30-day reoperation, readmission, reintervention, or mortality. An artificial neural network (ANN) was employed to optimize prediction of the composite endpoint (occurrence of 1+ morbid event). METHODS Areview of 8895 patients who underwent conversion for weight-related or GERD-related indications was performed using the 2021 MBSAQIP national dataset. Demographics, comorbidities, laboratory values, and other factors were assessed for bivariate and subsequent multivariable associations with the composite endpoint (P ≤ .05). Factors considered in the multivariable model were imputed into a three-node ANN with 20% randomly withheld for internal validation, to optimize predictive accuracy. Models were compared using receiver operating characteristic (ROC) curve analysis. RESULTS 39% underwent conversion for weight considerations and 61% for GERD. Rates of 30-day reoperation, readmission, reintervention, mortality, and the composite endpoint were 3.0%, 7.1%, 2.1%, .1%, and 9.1%, respectively. Of the nine factors associated with the composite endpoint on bivariate analysis, only non-white race (P < .001; odds ratio 1.4), lower body-mass index (P < .001; odds ratio .22), and therapeutic anticoagulation (P = .001; odds ratio 2.0) remained significant upon multivariable analysis. Areas under ROC curves for the multivariable regression, ANN training, and validation sets were .587, .601, and .604, respectively. DISCUSSION Identification of risk factors for morbidity after conversion offers critical information to improve patient selection and manage postoperative expectations. ANN models, with appropriate clinical integration, may optimize prediction of morbidity.
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Affiliation(s)
- Adam W Scott
- School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Stuart K Amateau
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Daniel B Leslie
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Eric S Wise
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Chin WL, Tu WL, Yang TH, Chen CY, Chen JH, Hung TT. Impact of Recurrent Weight Gain Thresholds on Comorbid Conditions Progression Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2024:10.1007/s11695-024-07282-6. [PMID: 38771478 DOI: 10.1007/s11695-024-07282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Defining recurrent weight gain after metabolic bariatric surgery poses a significant challenge. Our study aimed to standardize recurrent weight gain measurements in patients undergoing laparoscopic sleeve gastrectomy (LSG) and ascertain its association with comorbidity progression. METHODS We conducted a retrospective data analysis on 122 patients who underwent LSG, tracking their progress over 2-7 years. Data on weight, blood pressure measurements, and laboratory tests were collected, focusing on the postoperative period to identify nadir weight, total weight loss, and recurrent weight gain. RESULTS Significant weight loss and comorbidity remission were noted, with diabetes, hypertension, and dyslipidemia showing substantial remission rates of 85.71%, 68.24%, and 85.37%, respectively. The median recurrent weight gain was 6.30 kg within 12 months of the nadir. Progression proportion of diabetes, hypertension, and dyslipidemia were 8.20%, 44.26%, and 40.98%, respectively. Hypertension progression was strongly associated with a recurrent weight gain ≥ 10 kg and ≥ 20% of maximum weight loss. Dyslipidemia progression was significantly correlated with recurrent weight gain ≥ 10 kg and ≥ 20% of maximum weight loss. Diabetes progression was significantly correlated with recurrent weight gain ≥ 10% of pre-surgery body weight and ≥ 25% of maximum weight loss. A ≥ 10% weight gain of maximum weight loss did not significantly impact the progression of these conditions. CONCLUSION Recurrent weight gain ≥ 20% of maximum weight loss can be treated as a specific threshold indicating comorbidity progression post-LSG. Standardizing the measurement of recurrent weight gain can help healthcare providers to implement targeted management strategies to optimize long-term health outcomes.
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Affiliation(s)
- Wei-Leng Chin
- Department of Chemical Engineering & Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, 84001, Taiwan
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
- Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wan-Ling Tu
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
- Department of Nutrition Therapy, E-Da Hospital, Kaohsiung, Taiwan
| | - Tze-Ho Yang
- Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
- Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chung-Yen Chen
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan
- Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Jian-Han Chen
- Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan.
- Division of General Surgery, E-Da Hospital, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
- Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan.
| | - Tien-Tsan Hung
- Department of Chemical Engineering & Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, 84001, Taiwan.
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Mehlig K, Sliwa P, Blomstrand A, Farhan L, Hällström T, Hange D. Eating Behaviors and Adiposity Indicators - Observations from the 2016/17 Examination of the Population Study of Women in Gothenburg. Int J Gen Med 2024; 17:2101-2111. [PMID: 38766600 PMCID: PMC11100506 DOI: 10.2147/ijgm.s457731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose To determine the cross-sectional association between eating behavior in terms of the three-factor eating questionnaire (TFEQ) and adiposity measures. Methods The TFEQ-R21 was administered to 573 women aged 38 and 50 who participated in the population study of women in Gothenburg 2016/17. Three domains, emotional eating (EE), uncontrolled eating (UE), and cognitive restraint (CR) were examined as outcomes as well as predictors of adiposity outcomes. Multiple linear and logistic regression models were adjusted for age, education, lifestyle factors, and dieting behavior. Results All TFEQ domains were positively associated with dieting. EE and UE were associated with higher consumption of sweets and CR with lower consumption of sweets. Wellbeing was negatively associated with EE and UE. In mutually adjusted models, EE and CR but not UE were positively associated with BMI, waist circumference (WC), waist-to-hip ratio, waist-to-height ratio, and skinfold. One standard deviation higher EE was associated with obesity, BMI ≥ 30 kg/m2, OR = 1.62 (1.26, 2.10), and abdominal fatness, WC > 88 cm, OR = 1.57 (1.26, 1.95). Former and current dieting were positively associated with these outcomes, too, but UE and CR were not associated in mutually adjusted models. Conclusion This study shows that emotional eating behavior is associated with adiposity in a population of middle-aged women, over a large range of values for body fatness, and independent of dieting behavior. The results imply that treatment of obesity should include psychological support to restrict the risk for emotional eating in response to states of negative mood.
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Affiliation(s)
- Kirsten Mehlig
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pawel Sliwa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Blomstrand
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Farhan
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tore Hällström
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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Hany M, Zidan A, Aboelsoud MR, Torensma B. Laparoscopic sleeve gastrectomy vs one-anastomosis gastric bypass 5-year follow-up: a single-blinded randomized controlled trial. J Gastrointest Surg 2024; 28:621-633. [PMID: 38704199 DOI: 10.1016/j.gassur.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/15/2024] [Accepted: 01/27/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide, whereas one-anastomosis gastric bypass (OAGB) is the third most performed procedure. Both procedures have reported good weight loss (WL) and low complications. However, should both have differences in the durability of WL and malnutrition? METHODS A single-blinded, randomized controlled trial of 300 patients was conducted to compare the outcomes of LSG and OAGB over a 5-year follow-up. The primary endpoint was WL in percentages of total WL (%TWL) and excess WL (%EWL). The secondary endpoints were complications, gastroesophageal reflux disease (GERD), associated medical problems, bariatric analysis and reporting outcome system (BAROS) assessment, and weight recurrence (WR). RESULTS Overall, 201 patients (96 in the LSG group and 105 in the OAGB group) completed 5 years of follow-up. OAGB had significantly higher %TWL and %EWL than those of LSG throughout the follow-up. LSG had significantly higher WR and GERD. Both procedures had significant improvement in associated medical problems and BAROS scores compared with baseline, with no significant difference. WR was associated with higher relapse of associated medical conditions after initial remission and with lower BAROS scores regarding WL scores. CONCLUSION OAGB had significantly higher WL, less WR, and less GERD. However, it had a higher incidence of bile reflux. Both procedures had comparable complication rates, excellent remissions in associated medical problems, and improved quality of life. WR was associated with significantly more relapse of associated medical problems and significantly lower BAROS scores.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt; Madina Women Hospital, Alexandria, Egypt.
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Moustafa R Aboelsoud
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Bart Torensma
- Clinical Epidemioloigist, Leiden University Medical Center, Leiden, the Netherlands
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Dréant A, Blanchard C, Jacobi D. Adjuvant Glucose-Like Peptide 1 Receptor Agonist Therapy for Suboptimal Weight Loss After Bariatric Surgery: a Systematic Review. Obes Surg 2024; 34:1846-1854. [PMID: 38436920 DOI: 10.1007/s11695-024-07127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
Addressing suboptimal weight loss post-bariatric surgery poses a challenge. While glucagon-like peptide 1 receptor agonists (GLP1-RA) show promise in managing obesity, their role as an adjuvant treatment after bariatric surgery remains uncertain. We conducted a systematic literature review focused on the efficacy and safety of GLP1-RA in bariatric surgery patients with insufficient weight loss or distant weight regain. Our literature search identified 1167 articles, with 10 (involving 594 patients) meeting inclusion/exclusion criteria for detailed review. GLP1-RA therapy resulted in 5 to 17% weight loss over 6 to 12 months, with 10-50% experiencing non-severe side effects like nausea. Overall, GLP1-RA emerges as an effective adjuvant therapy for patients experiencing inadequate weight loss or regain after bariatric surgery, offering a viable alternative to revision surgery.
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Affiliation(s)
- Alexandre Dréant
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, F-44000, Nantes, France
- Nantes Université, CHU Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), F-44000, Nantes, France
| | - Claire Blanchard
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, F-44000, Nantes, France
- Nantes Université, CHU Nantes, Chirurgie cancérologique, digestive et endocrinienne, F-44000, Nantes, France
| | - David Jacobi
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, F-44000, Nantes, France.
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Abu-Abeid A, Yuval JB, Keidar A, Nizri E, Lahat G, Eldar SM. Technical Considerations in One Anastomosis Gastric Bypass-the Israeli Society of Metabolic and Bariatric Surgery Experience. Obes Surg 2024:10.1007/s11695-024-07223-3. [PMID: 38649670 DOI: 10.1007/s11695-024-07223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is gaining popularity worldwide due to its safety and effectiveness. OAGB is the most commonly performed metabolic bariatric surgery (MBS) in Israel. Israel is the only country where OAGB is the most prevalent MBS. Our aim is to address OAGB technical aspects using a national survey completed by members of the Israeli Society of Metabolic and Bariatric Surgery (ISMBS). MATERIALS AND METHODS An online-survey composed of a 17-item-based questionnaire was sent to ISMBS members. All responses were collected and analyzed. RESULTS A total of 47/64 (73.4%) ISMBS members participated in the survey. Most surgeons (74.5%) had > 10 years of MBS experience, and most (61.7%) performed > 100 MBS/year. The majority (78.7%) perform OAGB as their most common procedure. Most surgeons fashion a 10-15-cm pouch and use a 36-Fr bougie, (57.4% and 38.3%). Regarding bowel length measurement, 70% use visual estimation and 10.6% routinely measure total small bowel length (TSBL). The most common reasons for creating a longer biliopancreatic limb (BPL) were high body mass index (BMI) and revisional surgery (83.3% and 66%, respectively). In a primary procedure of a patient with a BMI = 40, most (76.6%) would create a 150-200-cm BPL. In patients with a BMI > 50 or revisional cases, most (70.2% and 68.0%) would create a 175-225-cm BPL. CONCLUSION OAGB is the most prevalent MBS performed in Israel. This survey showed common preferences and variations among ISMBS members. Further studies are needed in order to standardize and build a consensus on OAGB technique.
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Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.
| | - Jonathan Benjamin Yuval
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Andrei Keidar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Shai Meron Eldar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
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Marek RJ, Ben-Porath YS, Heinberg LJ. Six-year postoperative associations between the Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) and weight recurrence, eating behaviors, adherence, alcohol misuse, and quality of life. Surg Obes Relat Dis 2024; 20:391-398. [PMID: 38216363 DOI: 10.1016/j.soard.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) leads to beneficial and sustained outcomes. However, many patients evidence weight recurrence and psychosocial functioning may be associated with weight recurrence. The Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) is validated for use in presurgical MBS evaluations and likely has clinical utility in understanding weight recurrence and other aspects of postoperative functioning. OBJECTIVE The objective of the current investigation is to understand how postoperative psychosocial functioning relates to weight recurrence and other behaviors and constructs 6 years after MBS. SETTING Cleveland Clinic Bariatric and Metabolic Institute. METHODS A sample of 163 participants consented to take a battery of self-report measures related to psychological functioning, eating behaviors, adherence, alcohol misuse, and quality of life along with their postoperative weight. MMPI-3 scale scores were prorated from the Minnesota Multiphasic Personality Inventory - 2 - Restructured Form (MMPI-2-RF) or scored from the Minnesota Multiphasic Personality Inventory - 2 - Restructured Form - Expanded (MMPI-2-RF-EX). RESULTS Weight recurrence was quite variable in this sample. Postoperative MMPI-3 scales related to emotional/internalizing dysfunction were modestly associated with higher weight recurrence. Postoperative MMPI-3 scale scores also demonstrated associations with other postoperative outcomes including measures of eating behaviors, adherence, alcohol misuse, and quality of life. CONCLUSIONS Postoperative psychosocial functioning as assessed by the MMPI-3 was associated with weight recurrence and a number of other problematic psychological outcomes beyond weight recurrence.
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Affiliation(s)
- Ryan J Marek
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, Texas.
| | | | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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Hu L, Wang L, Li S, Liu Y, Zhang Z, Xiao M, Zhang Z, Wei Z, Cui L, Jiang T. Evaluation study of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy in the treatment of Chinese obese patients based on efficacy and nutrition. Sci Rep 2024; 14:6522. [PMID: 38499796 PMCID: PMC10948890 DOI: 10.1038/s41598-024-57289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/16/2024] [Indexed: 03/20/2024] Open
Abstract
To evaluate the efficacy and nutrition of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in Chinese obese patients in the first postoperative year. Clinical data of 66 obese patients who underwent SADI-S surgery at China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were retrospectively collected. The weight, body mass index (BMI), percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL) were recorded at 3, 6, and 12 months after surgery. Moreover, metabolic disease remission and nutrient deficiencies were assessed at 1 year postoperatively. Overall, 66 patients (38 males and 28 females) were recruited, with a mean age of 35 (18-61) years and an average preoperative BMI of 42.94 kg/m2. Before surgery, 38 patients had type 2 diabetes mellitus (T2DM), 46 patients had hyperuricemia (HUA), 45 patients had hypertension (HTN), 35 patients had hyperlipidemia, 12 patients had hypercholesterolemia, 12 patients had hyper-low-density lipoproteinemia, and 14 patients had gastroesophageal reflux disease symptoms (GERD). All patients had undergone a DaVinci robotic or laparoscopic SADI-S surgery, and none converted to laparotomy or died. Four patients developed postoperative complications and were cured and discharged after conservative treatment or surgical treatment. At 3, 6 and 12 months, the average %EWL was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65%, %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89%, respectively. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), uric acid (UA), triglycerides (TG), blood pressure (BP), and other indexes were significantly lower after one year post-surgery compared with the preoperative period (P < 0.05). The remission rates of T2DM, HUA, HTN, hypertriglyceridemia, hypercholesterolemia, and hyper-low-density lipoproteinemia 1 year after surgery were 100, 65.2, 62.2, 94.3, 100, and100%, respectively. One year after surgery, the remission rate of GERD was 71.4% (10/14), the rate of new occurrence of GERD was 12.1% (8/66), and the overall incidence rate was 18.2% (12/66). Except for vitamin B12(vit B12), the other nutrient indexes were significantly decreased after 1 year of surgery relative to levels before surgery (P < 0.05). The deficiency rates for vitamin A (vit A), vitamin E (vit E), zinc ion (Zn), and folic acid (FA) were higher (45.5, 25.8, 24.2, and 16.7%, respectively); however, there were no related clinical symptoms. SADI-S had significant effects on weight loss and metabolic disease remission. The main nutrient deficiencies after SADI-S were vit A, vit E, Zn, and FA deficiencies. The long-term efficacy and safety of SADI-S warrant further follow-up.
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Affiliation(s)
- Lifu Hu
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Lun Wang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Shixing Li
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Yang Liu
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Zheng Zhang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Minghao Xiao
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Zhenhua Zhang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Zhiqiang Wei
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Liang Cui
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Tao Jiang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China.
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Xie J, Wang Y. Multidisciplinary combined treatment based on bariatric surgery for metabolic syndrome: a review article. Int J Surg 2024; 110:01279778-990000000-01188. [PMID: 38489549 PMCID: PMC11175773 DOI: 10.1097/js9.0000000000001320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
As a chronic, multifactorial disease, obesity is associated with a global social and economic burden. This condition significantly affects normal daily life and healthy social interactions, and shortens the life expectancy of patients. Compared with traditional weight-loss methods, the emergence of bariatric surgery has effectively improved the management of obesity. Further, bariatric surgery can also inhibit the progression of multiple metabolic diseases. Despite its potential advantages, bariatric surgery cannot completely eliminate the possibility of weight regain and inadequate weight loss following the procedure. For super-obese patients, bariatric surgery still remains a surgical risk. In addition, the psychological problems and poor eating habits of obese patients also affect the weight loss effect and daily life. Thus, various adjuvant therapies involving multiple disciplines have attracted people's attention. Recently, it has been recognized that the combination of multiple interventions based on bariatric surgery is more advantageous than a single intervention in alleviating the complex and diverse metabolic diseases associated with obesity. The combined therapy considerably enhances the long-term efficacy of bariatric surgery and plays a positive role in the mental health and social lives of patients. In this article, we review this multidisciplinary combination therapy to enhance the current understanding of the treatment of obesity.
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Affiliation(s)
| | - Yong Wang
- Center of Bariatric and Metabolic Surgery, Fourth Affiliated Hospital of China Medical University, Liaoning, People’s Republic of China
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11
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Hany M, Torensma B, Zidan A, Ibrahim M, Abouelnasr AA, Agayby ASS, Sayed IE. Outcomes of primary versus conversional Roux-En-Y gastric bypass after laparoscopic sleeve gastrectomy: a retrospective propensity score-matched cohort study. BMC Surg 2024; 24:84. [PMID: 38448841 PMCID: PMC10919008 DOI: 10.1186/s12893-024-02374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Conversional surgery is common after laparoscopic sleeve gastrectomy (LSG) because of suboptimal weight loss (SWL) or poor responders and gastroesophageal reflux disease (GERD). Roux-en-Y gastric bypass (RYGB) is the most common conversional procedure after LSG. METHODS A retrospective cohort study analyzed patients who underwent primary RYGB (PRYGB) or conversional RYGB (CRYGB) at three specialized bariatric centers between 2008 and 2019 and tested for weight loss, resolution of GERD, food tolerance (FT), early and late complications, and the resolution of associated medical problems. This was analyzed by propensity score matching (PSM). RESULTS In total, 558 (PRYGB) and 155 (CRYGB) completed at least 2 years of follow-up. After PSM, both cohorts significantly decreased BMI from baseline (p < 0.001). The CRYGB group had an initially more significant mean BMI decrease of 6.095 kg/m2 at 6 months of follow-up (p < 0.001), while the PRYGB group had a more significant mean BMI decrease of 5.890 kg/m2 and 8.626 kg/m2 at 1 and 2 years, respectively (p < 0.001). Food tolerance (FT) improved significantly in the CRYGB group (p < 0.001), while CRYGB had better FT than PRYGB at 2 years (p < 0.001). A GERD resolution rate of 92.6% was recorded in the CRYGB (p < 0.001). Both cohorts had comparable rates of early complications (p = 0.584), late complications (p = 0.495), and reoperations (p = 0.398). Associated medical problems at 2 years significantly improved in both cohorts (p < 0.001). CONCLUSIONS CRYGB is a safe and efficient option in non- or poor responders after LSG, with significant weight loss and improvement in GERD. Moreover, PRYGB and CRYGB had comparable complications, reoperations, and associated medical problem resolution rates.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Alexandria, 21561, Egypt.
- Consultant of bariatric surgery at Madina Women's hospital (IFSO-certified bariatric center), Alexandria, Egypt.
| | - Bart Torensma
- Clinical Epidemiologist, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Alexandria, 21561, Egypt
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Alexandria, 21561, Egypt
| | - Anwar Ashraf Abouelnasr
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Alexandria, 21561, Egypt
| | - Ann Samy Shafiq Agayby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Alexandria, 21561, Egypt
| | - Iman El Sayed
- Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Ganam S, Tang R, Sher T, Worthey A, Docimo S. Quality of Life in Patients Undergoing Revisional Bariatric Surgery: From Sleeve Gastrectomy to Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:997-1003. [PMID: 38308103 DOI: 10.1007/s11695-024-07082-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
Sleeve gastrectomy (SG) is the most performed bariatric surgery worldwide. However, this surgery may be associated with long-term weight regain and severe gastroesophageal reflux disease (GERD), sometimes necessitating conversion to Roux-en-Y gastric bypass (RYGB) to improve quality of life (QoL). We conducted a systematic review on QoL measures following the conversion of SG to RYGB. We searched various databases for studies conducted between January 2005 and September 2023. Four studies, involving 196 participants in total, met the inclusion criteria. Different assessment methods were used to evaluate QoL following the conversion. In the included studies, we observed that GERD symptoms and proton pump inhibitor (PPI) use both decreased following conversion to RYGB. Excess weight loss (EWL) was also observed in all studies.
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Affiliation(s)
- Samer Ganam
- Morsani College of Medicine, University of South Florida, Horatio Street, Tampa, FL, 33609, USA.
- Division of Gastrointestinal Surgery, Tampa General Hospital, Horatio Street, Tampa, FL, 33609, USA.
| | - Ryan Tang
- Morsani College of Medicine, University of South Florida, Horatio Street, Tampa, FL, 33609, USA
| | - Theo Sher
- Morsani College of Medicine, University of South Florida, Horatio Street, Tampa, FL, 33609, USA
| | - Ayana Worthey
- Division of Gastrointestinal Surgery, Tampa General Hospital, Horatio Street, Tampa, FL, 33609, USA
| | - Salvatore Docimo
- Morsani College of Medicine, University of South Florida, Horatio Street, Tampa, FL, 33609, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Horatio Street, Tampa, FL, 33609, USA
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13
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Kanai R, Kinoshita S, Kanbe I, Sameda M, Yamaoka S, Horikawa O, Watanabe Y, Tatsuno I, Shirai K, Oshiro T, Saiki A. Once-weekly semaglutide administered after laparoscopic sleeve gastrectomy: Effects on body weight, glycemic control, and measured nutritional metrics in Japanese patients having both obesity and type 2 diabetes. OBESITY PILLARS (ONLINE) 2024; 9:100098. [PMID: 38230266 PMCID: PMC10789635 DOI: 10.1016/j.obpill.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/31/2023] [Accepted: 12/31/2023] [Indexed: 01/18/2024]
Abstract
Background Glucagon-like peptide (GLP)-1 analogue may be useful for controlling weight recurrence and diabetes relapse after bariatric surgery, but may also adversely affect the measured nutritional metrics. This study aimed to investigate the effect of treatment with once-weekly semaglutide after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes (T2D). We also examined the effects of combined use with a low-energy, high-protein formula diet (FD). Methods This study was a single-center retrospective database analysis. We enrolled 29 Japanese patients with T2D who underwent LSG, and more than 12 months later received semaglutide. The patients were divided retrospectively into a FD group (=6) and a conventional diet (CD) group (n = 23). Results BMI and HbA1c decreased significantly by 10.7 kg/m2 and 1.1 %, respectively, 12 months after LSG, and decreased by an additional 1.6 kg/m2 and 0.6 % after 12-months of treatment with semaglutide. Decreases in serum albumin, vitamin B12 and zinc were observed only after semaglutide administration. A ratio of energy from protein, fat and carbohydrates changed from 13:31:56 before to 19:30:50 after LSG, and from 17:32:51 before to 15:29:56 after semaglutide. Skeletal muscle ratio, which is the ratio of skeletal muscle mass to body weight, increased after LSG, but did not change after semaglutide. FD group showed a significant increase in skeletal muscle mass per 1 % body weight compared to CD group during semaglutide treatment. Conclusion Semaglutide after LSG in patients with obesity and T2D resulted in additional weight reduction and improved glycemic control, but worsened measured nutritional metrics. Administration of a low-energy, high protein formula diet may ameliorate adverse nutritional effects of semaglutide in patients with T2D after LSG. (Ethics Committee of Toho University Sakura Medical Center approval number S18061).
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Affiliation(s)
- Rieko Kanai
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Sachiho Kinoshita
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Izumi Kanbe
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Mariko Sameda
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
| | - Shuhei Yamaoka
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Osamu Horikawa
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yasuhiro Watanabe
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
- Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Kohji Shirai
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
- Department of Internal Medicine, Mihama Hospital, Chiba, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Atsuhito Saiki
- Department of Medical Nutrition, Toho University Sakura Medical Center, Sakura, Japan
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
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14
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Miller-Matero LR, Haley EN, Loree AM, Braciszewski JM, Maye M, Sehgal M, Carlin AM. Post-surgical psychiatric symptoms, maladaptive eating patterns, and lifestyle behaviors associated with weight recurrence after bariatric surgery. Surg Obes Relat Dis 2024; 20:297-303. [PMID: 37923621 DOI: 10.1016/j.soard.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A significant proportion of patients who undergo bariatric surgery experience weight recurrence; however, the most important areas to target to prevent weight recurrence remain unknown. OBJECTIVES The purpose was to examine whether psychiatric symptoms, maladaptive eating behaviors, and lifestyle factors were associated with weight recurrence. SETTING Single healthcare system. METHODS Individuals who underwent bariatric surgery were invited to complete a web-based survey in which they reported their current weight and completed measures of psychiatric symptoms, maladaptive eating behaviors, and lifestyle behaviors. Participants were included if they were at least 2 years postsurgery. Weight recurrence was measured from the 1-year follow-up to the survey date. RESULTS Participants (n = 169) were predominantly female and White or Black, with a mean age of 45 years. The rate of significant weight recurrence was 23.1%. Those who underwent sleeve gastrectomy were more likely to experience weight recurrence (odds ratio [OR] = 12.99; P = .01). In bivariate analyses, anxiety and depressive symptoms, emotional eating, loss of control eating, binge eating, and night eating were associated with weight recurrence (P < .05). Those who did not eat mindfully, take 20 minutes to eat, or get adequate sleep were also more likely to have weight recurrence (P < .05). In a multivariate model, only a lack of mindful eating (OR = 4.84; P = .03) and inadequate sleep (OR = 7.30; P = .02) remained statistically significant predictors. CONCLUSION Engaging in mindful eating and obtaining adequate sleep may protect against weight recurrence following bariatric surgery. Clinicians may want to screen and monitor these behaviors.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Erin N Haley
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Monica Sehgal
- Behavioral Health, Henry Ford Health, Detroit, Michigan
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15
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Kizilkaya MC, Gokay R, Mutlu AU, Sonmez S, Yilmaz S, Kocatas A, Saracoglu C, Aytac E. Posterior fixation of gastric tube with fibrin sealant in laparoscopic sleeve gastrectomy: a promising method to prevent revision surgeries. Langenbecks Arch Surg 2024; 409:60. [PMID: 38353730 PMCID: PMC10867050 DOI: 10.1007/s00423-024-03253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND We aim to assess the effects of gastric posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy in aspects of 12th-month body mass index and gastric volume. METHODS The patients who underwent laparoscopic sleeve gastrectomy between January 2019 and February 2021 were divided into two groups preoperatively. The first 75 patients were appointed to the posterior fixation group, and the second 75 were to the control group. Changes in gastric volume and body mass index were assessed in the postoperative 12th month. RESULTS There were 110 patients in the final analysis. Fifty-four patients had posterior fixation, and 56 had only laparoscopic sleeve gastrectomy. The posterior fixation group was superior in terms of total weight loss rate (39.1% vs. 34.5%, p<0.001) and less gastric volume increase rate (39.8% vs. 164.7%, p<0.001) in the postoperative 12th month. CONCLUSION Our study suggests that posterior fixation with fibrin sealant in laparoscopic sleeve gastrectomy is a promising method for preventing weight regain and creating a need for revision surgery.
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Affiliation(s)
| | | | - Arda Ulaş Mutlu
- Acıbadem University Atakent Hospital, Department of General Surgery, Istanbul, Turkey
| | - Suleyman Sonmez
- University of Health Sciences Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Serhan Yilmaz
- University of Health Sciences Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Ali Kocatas
- University of Health Sciences Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Can Saracoglu
- Acıbadem University Atakent Hospital, Department of General Surgery, Istanbul, Turkey
| | - Erman Aytac
- Acıbadem University Atakent Hospital, Department of General Surgery, Istanbul, Turkey
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16
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Nakanishi H, Mosleh KA, Al-Kordi M, Farsi S, Chaudhry S, Marrero K, Scott Davis S, Kermansaravi M, Parmar C, Clapp B, Ghanem OM. One Anastomosis Gastric Bypass as Revisional Surgery Following Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:429-441. [PMID: 38198098 DOI: 10.1007/s11695-024-07056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Although sleeve gastrectomy (SG) is the most performed metabolic and bariatric surgery (MBS) worldwide, some patients require conversional procedures due to weight recurrence or late complications. Recently, one-anastomosis gastric bypass (OAGB) gained popularity as a viable option to address those problems. The aim of this meta-analysis is to assess the safety and efficacy of conversional OAGB after primary SG in the management of patients with obesity. METHODS Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to February 2023 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42023403528). RESULTS From 1,117 studies screened, twenty studies met the eligibility criteria, with a total of 1,057 patients with obesity undergoing conversional OAGB after primary SG. The mean age ranged from 28.2 to 49.5 years, and 744 patients (75.2%) were women. At one year after revisional OAGB, the pooled mean percent excess weight loss (%EWL) was 65.2% (95%CI: 56.9, 73.4, I2 = 97%). The pooled mean %EWL after conversional OAGB was 71.1% (95%CI: 62.2, 80.0, I2 = 90%) at two years and 71.6% (95%CI: 61.0, 82.2, I2 = 50%) at five years. Additionally, resolution rates of diabetes and hypertension were 65.4% (95%CI: 0.522, 0.785, I2 = 65%) and 58.9% (95%CI: 0.415, 0.762, I2 = 89%), respectively. CONCLUSIONS Our meta-analysis demonstrated OAGB as an effective conversional procedure after primary SG in terms of weight loss and obesity-associated medical problems for selected patients. Despite the promising results, further randomized controlled studies with larger sample sizes and more extended follow-up periods are necessary to determine if the OAGB is the best conversional surgery after SG.
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Affiliation(s)
- Hayato Nakanishi
- St George's University of London, London, SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | | | | | - Soroush Farsi
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Shahrukh Chaudhry
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Katie Marrero
- Carle Foundation Hospital General Surgery Residency, Champaign, IL, USA
| | - S Scott Davis
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital NHS Trust, London, UK
- University College London, London, UK
| | - Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
- Division of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
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Gerges WB, Omar ASM, Shoka AA, Hamed MA, Abdelrahim HS, Makram F. ReSleeve or revisional one anastomosis gastric bypass for failed primary sleeve gastrectomy with dilated gastric tube: a retrospective study. Surg Endosc 2024; 38:787-798. [PMID: 38057540 PMCID: PMC10830658 DOI: 10.1007/s00464-023-10609-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Revisional bariatric surgery (RBS) has been increasingly performed due to weight loss failure (WLF). Many revisional procedures have been proposed after primary laparoscopic sleeve gastrectomy (pLSG) failure, including ReSleeve gastrectomy (ReLSG), and laparoscopic one anastomosis gastric bypass (LOAGB). Choosing the RBS post-pLSG failure represents a challenge. WLF without gastric tube (GT) dilation is undoubtedly converted to a malabsorptive procedure, but the presence of GT dilation makes it more difficult to select a RBS. This study aimed to compare two relatively simple revisional procedures after pLSG failure with dilated GT to help decision making on which procedure better done to which patient. METHODS Data of 52 patients who completed one year follow-up (FU) after their RBS (ReLSG: 27 or LOAGB: 25) for their failed pLSG were collected, assessed, correlated to weight loss (WL) and compared. RESULTS Mean operative time was 97 ± 18.4 min. with revisional LOAGB (RLOAGB) and 62 ± 11 min. with ReLSG. Six patients (11.5%) had seven postoperative procedure-specific complications. Significant hemorrhage occurred in three patients. Two cases of leakage were encountered with each procedure. LOAGB Patients had lower mean final weight (76.2 ± 10.5 vs 85.3 ± 13), lower mean Final BMI (26.4 ± 2.5 vs 29.7 ± 2.9) and higher mean percentage of excess weight loss (EWL%) (83.6 ± 13.5% vs 60.29 ± 14.6%). All RLOAGB patients and 77.8% of ReLSG patients had EWL% > 50%. RLOAGB patients had higher EWL% compared to ReLSG (p < 0.001). Insufficient WL (IWL) patients had higher EWL% compared to weight regain (WR) patients (p = 0.034). CONCLUSION Both procedures (RLOAGB and ReLSG) were relatively safe and effective in terms of WL. RLOAGB led to higher WL compared to ReLSG in all types of patients despite higher Caloric intake. IWL patients had more WL compared to WR patients. WL was not related to GT dilation type. Large-scale longer-FU studies are still needed. TRIAL REGISTRATION PACTR202310644487566 (retrospectively registered).
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Affiliation(s)
- Wadie Boshra Gerges
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Ahmed S M Omar
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Ain Shoka
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Hossam S Abdelrahim
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fady Makram
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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18
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Al-Tai S, Axer S, Szabo E, Ottosson J, Stenberg E. The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy: results from the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2024; 20:139-145. [PMID: 37802662 DOI: 10.1016/j.soard.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/06/2023] [Accepted: 08/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial. OBJECTIVES To evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG. SETTING Nationwide registry-based study. METHODS This study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35-36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30-32 Fr), shorter distances (1-4 cm), and extended distances (6-8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG. RESULTS The study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17-1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed. CONCLUSIONS Using a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.
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Affiliation(s)
- Saif Al-Tai
- Department of Surgery, Torsby Hospital, Torsby, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Stephan Axer
- Department of Surgery, Torsby Hospital, Torsby, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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19
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Çalık Başaran N, Dotan I, Dicker D. Post metabolic bariatric surgery weight regain: the importance of GLP-1 levels. Int J Obes (Lond) 2024:10.1038/s41366-024-01461-2. [PMID: 38225284 DOI: 10.1038/s41366-024-01461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024]
Abstract
Weight regain and insufficient weight loss are essential problems after metabolic bariatric surgery (MBS) in people living with obesity. Changes in the level of glucagon-like peptide-1 (GLP-1) secreted from the gut after bariatric surgery are one of the underlying mechanisms for successful initial weight loss. Studies and meta-analyses have revealed that postprandial GLP-1 levels increase after the Roux-en-Y gastric bypass and sleeve gastrectomy, but fasting GLP-1 levels do not increase significantly. Some observational studies have shown the relationship between higher postprandial GLP-1 levels and successful weight loss after bariatric surgery. There is growing evidence that GLP-1-receptor agonist (GLP-1-RA) use in patients who regained weight after bariatric surgery has resulted in significant weight loss. In this review, we aimed to summarize the changes in endogenous GLP-1 levels and their association with weight loss after MBS, describe the effects of GLP-1-RA use on weight loss after MBS, and emphasize metabolic adaptations in light of the recent literature. We hypothesized that maintaining higher basal-bolus GLP-1-RA levels may be a promising treatment choice in people with obesity who failed to lose weight after bariatric surgery.
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Affiliation(s)
- Nursel Çalık Başaran
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, General Internal Medicine, Ankara, Türkiye.
| | - Idit Dotan
- Rabin Medical Center, Beilinson Hospital, Department of Endocrinology and Obesity Clinic, Petah Tikva, Israel
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
| | - Dror Dicker
- Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel
- Rabin Medical Center, Hasharon Hospital, Department of Internal Medicine and Obesity Clinic, Petah Tikva, Israel
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Al-Juhani A, Sharaf GF, Alyaseen EM, Alkurdi A, Azhari AS, Alshaiban SH, Otaif AA, Abumadian AW, Alshawi AJ, Aldarami YA. Banded Versus Non-banded Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52799. [PMID: 38389592 PMCID: PMC10883259 DOI: 10.7759/cureus.52799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Standard bariatric surgeries include biliopancreatic diversion (BPD), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and adjustable gastric banding (AGB). Laparoscopic sleeve gastrectomy (LSG) is currently favored due to safety, efficacy, and shorter operation time. However, previous literature shows 75.6% weight regain post LSG. Introducing Laparoscopic band sleeve gastrectomy (LBSG) to maintain pouch size is proposed to improve outcomes and reduce weight regain. This study aims to compare the safety and efficacy of LSG vs. LBSG in obese patients. A comprehensive search strategy was executed to identify pertinent literature comparing LBSG and LSG in obese patients. Eligible studies underwent independent screening, and pertinent data were systematically extracted. The analysis employed pooled risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous variables, each accompanied by their respective 95% confidence intervals (CI). Our systematic review and meta-analysis included 15 studies encompassing 3929 patients. Regarding body mass index (BMI), at six, 12, and 24 months, no substantial differences were found between LBSG and LSG groups (p < 0.05). Still, at 36 months, LBSG exhibited significantly lower BMI than LSG (MD = -2.07 [-3.84, -0.29], p = 0.02). Excess Weight Loss (EWL) favored LBSG at 12, 24, and 36 months with MD of 3.30 [0.42, 6.18], 4.13 [1.44, 6.81], and 18.43 [9.44, 27.42], p = 0.02, 0.003, < 0.00001, respectively). Operative time did not significantly differ between the procedures (MD = 2.95, 95%CI [-0.06, 5.95], p = 0.05). Resolution of comorbidities, overall complications, post-operative bleeding, reflux, and early complications did not significantly differ between LBSG and LSG. However, LBSG showed higher post-operative regurgitation than LSG (RR = 2.38, 95%CI [1.25, 4.54], p = 0.008). LBSG showed a substantial decrease in BMI at three-year follow-up and higher EWL at one, two, and three years. However, LBSG procedures exhibited a higher incidence of post-operative regurgitation symptoms than LSG. No substantial differences were noted in BMI at six, 12, or 24 months, EWL at six months, operative time, bleeding, reflux, or overall complications.
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Affiliation(s)
| | | | - Eman M Alyaseen
- Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | | | | | | | | | | | - Alaa J Alshawi
- Medicine, Ibn Sina National College For Medical Studies, Jeddah, SAU
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21
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Mackenzie RM, Ali A, Bruce D, Bruce J, Ford I, Greenlaw N, Grieve E, Lean M, Lindsay RS, O'Donnell J, Sattar N, Stewart S, Logue J. Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study. Health Technol Assess 2024; 28:1-115. [PMID: 38343107 PMCID: PMC11017628 DOI: 10.3310/unaw6331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Bariatric surgery is a common procedure worldwide for the treatment of severe obesity and associated comorbid conditions but there is a lack of evidence as to medium-term safety and effectiveness outcomes in a United Kingdom setting. Objective To establish the clinical outcomes and adverse events of different bariatric surgical procedures, their impact on quality of life and the effect on comorbidities. Design Prospective observational cohort study. Setting National Health Service secondary care and private practice in Scotland, United Kingdom. Participants Adults (age >16 years) undergoing their first bariatric surgery procedure. Main outcome measures Change in weight, hospital length of stay, readmission and reoperation rate, mortality, diabetes outcomes (HbA1c, medications), quality of life, anxiety, depression. Data sources Patient-reported outcome measures, hospital records, national electronic health records (Scottish Morbidity Record 01, Scottish Care Information Diabetes, National Records Scotland, Prescription Information System). Results Between December 2013 and February 2017, 548 eligible patients were approached and 445 participants were enrolled in the study. Of those, 335 had bariatric surgery and 1 withdrew from the study. Mean age was 46.0 (9.2) years, 74.7% were female and the median body mass index was 46.4 (42.4; 52.0) kg/m2. Weight was available for 128 participants at 3 years: mean change was -19.0% (±14.1) from the operation and -24.2% (±12.8) from the start of the preoperative weight-management programme. One hundred and thirty-nine (41.4%) participants were readmitted to hospital in the same or subsequent 35 months post surgery, 18 (5.4% of the operated cohort) had a reoperation or procedure considered to be related to bariatric surgery gastrointestinal complications or revisions. Fewer than five participants (<2%) died during follow-up. HbA1c was available for 93/182 and diabetes medications for 139/182 participants who had type 2 diabetes prior to surgery; HbA1c mean change was -5.72 (±16.71) (p = 0.001) mmol/mol and 65.5% required no diabetes medications (p < 0.001) at 3 years post surgery. Physical quality of life, available for 101/335 participants, improved in the 3 years post surgery, mean change in Rand 12-item Short Form Survey physical component score 8.32 (±8.95) (p < 0.001); however, there was no change in the prevalence of anxiety or depression. Limitations Due to low numbers of bariatric surgery procedures in Scotland, recruitment was stopped before achieving the intended 2000 participants and follow-up was reduced from 10 years to 3 years. Conclusions Bariatric surgery is a safe and effective treatment for obesity. Patients in Scotland, UK, appear to be older and have higher body mass than international comparators, which may be due to the small number of procedures performed. Future work Intervention studies are required to identify the optimal pre- and post surgery pathway to maximise safety and cost-effectiveness. Study registration This study is registered as ISRCTN47072588. Funding details This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/42/02) and is published in full in Health Technology Assessment; Vol. 28, No. 7. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ruth M Mackenzie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Abdulmajid Ali
- University Hospital Ayr, NHS Ayrshire and Arran, Ayr, UK
| | | | - Julie Bruce
- Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mike Lean
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Joanne O'Donnell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sally Stewart
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Jennifer Logue
- Lancaster Medical School, Lancaster University, Lancaster, UK
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22
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Zoumpou T, Fleishman A, Jones DB, Wee CC. Decision regret up to 6 years after sleeve gastrectomy. Surg Endosc 2023; 37:9381-9392. [PMID: 37653161 DOI: 10.1007/s00464-023-10364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/30/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is one of the most popular types of weight loss surgery today but is neither risk-free nor universally effective. We previously demonstrated that 5% of Roux-en-Y gastric bypass (RYGB) patients and up to 20% of gastric banding patients report overall regret 4 years after surgery. This study explores patients' attitudes toward their decision to have SG and decision regret rates up to 6 years postoperatively. METHODS We surveyed 185 patients who were at least 6 months post-SG (response rate 30%). We used a modified version of the Decision Regret Scale developed by Brehaut et al. We converted responses to a 0-100 scale so that higher scores (> 50) reflect greater regret. We characterized patients who expressed having overall decision regret (score > 50) vs. those who did not (≤ 50). Demographic and preoperative clinical information was extracted from the online medical records. RESULTS Of 185 SG patients, only 13 (7%) reported regret scores > 50 (i.e. high decision regret). Mean time from SG to survey completion was 41 months (range 6-76 months). Unadjusted comparisons between the two groups revealed that patients with high regret scores had lower mean weight loss (32.1% vs. 48.9% EBMIL), and reported less improvement in quality-of-life (QoL), such as physical health (46.2% vs. 93.5% "somewhat" or "significantly" improved). The two groups were similar in short-term complications, but those reporting overall regret were more likely to report GI complaints such as bloating (61.5% vs. 30.4%). Finally, patients with regret scores > 50 were more likely to be further out from SG (median time since surgery 61.8 vs. 41.1 months). CONCLUSION In our study, very few patients reported regret (7%) up to 6 years postoperatively, in line with prior reports after RYGB. Those with regret reported poorer QoL.
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Affiliation(s)
- Theofano Zoumpou
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Deaconess 207, 185 Pilgrim Road, Boston, MA, 02215, USA.
| | - Daniel B Jones
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christina C Wee
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- American College of Physicians, Philadelphia, PA, USA
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23
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Mittal T, Ahuja A, Dey A, Malik VK. Surgical Importance of Belseys Fat in Sleeve Gastrectomy-a Less Visited Topic. Obes Surg 2023; 33:4174-4175. [PMID: 37907676 DOI: 10.1007/s11695-023-06892-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/06/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Tarun Mittal
- Department of Laparoscopic, Laser & General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India.
| | - Anmol Ahuja
- Department of Laparoscopic, Laser & General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India
| | - Ashish Dey
- Department of Laparoscopic, Laser & General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India
| | - Vinod K Malik
- Department of Laparoscopic, Laser & General Surgery, Sir Ganga Ram Hospital, New Delhi, 110060, India
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Alenezi MAM, Alkhaldi SIH, Alrumaih YKI, Alzalabani AKM, Alnujaydi MAM, Alanazi SMF, Alotibi FAJ, Alanazi RZA, Alanazi MSM, Alanazi AAA. Single-Anastomosis Sleeve Jejunal Bypass as a Treatment for Morbid Obesity: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e51296. [PMID: 38283494 PMCID: PMC10822685 DOI: 10.7759/cureus.51296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Single-anastomosis sleeve jejunal (SASJ) bypass is a bariatric surgery technique with promising results. However, evidence of its efficacy and safety is still lacking. This study aimed to summarize the evidence regarding the efficacy and safety of SASJ bypass surgery in the treatment of morbid obesity. The literature was searched for English-language studies published from inception till November 26, 2023, on MEDLINE/PubMed, Cochrane Library, Web of Science, ProQuest, Scopus, SCINAPSE, and Google Scholar. The search terms included "morbid obesity," "bariatric surgery," and "single anastomosis sleeve jejunal bypass." Extracted data included the body mass index (BMI) before and after surgery, percent total weight loss (%TWL), percent excess weight loss (%EWL), and improvement in preoperative comorbidities. Pooling of the data was done using random effects or fixed-effect models based on the presence of significant heterogeneity. Nine studies were included in this systematic review and meta-analysis. The change in BMI from baseline at 12 months after SASJ bypass was significant (standardized mean difference (SMD) = -3.576, 95% confidence interval (CI) = -5.423, -1.730; I² = 99.23%). At 12 months after surgery, the pooled %TWL was 42.526 (95% CI = 37.948, 47.105; I² = 97.15%), and the pooled %EWL was 75.258 (95% CI = 67.061, 83.456; I² = 99.26%). The pooled incidence of postoperative improvement in diabetes mellitus was 91% (95% CI = 79.6%, 98%, I² = 82%). The overall rate of complications was 9.9% (95% CI = 2.5%, 21.6%; I² = 92.64%). Regarding the short- and mid-term outcomes, SASJ bypass is a safe and effective procedure for weight loss in patients with morbid obesity, with an acceptable rate of complications. The procedure is also associated with a marked improvement in obesity-related comorbidities.
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Affiliation(s)
- Mohamad Ahmad M Alenezi
- Public Health Department, Maternity and Children Hospital-Arar, Ministry of Health, Arar, SAU
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25
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Boru CE, Marinari GM, Olmi S, Gentileschi P, Morino M, Anselmino M, Foletto M, Bernante P, Piazza L, Perrotta N, Morganti R, Silecchia G. Trends and safety of bariatric revisional surgery in Italy: multicenter, prospective, observational study. Surg Obes Relat Dis 2023; 19:1270-1280. [PMID: 37391349 DOI: 10.1016/j.soard.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking; however, an increased trend in further BS offerings has been reported recently. OBJECTIVE Analyze trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy. SETTING Ten Italian high-volume BS centers (university hospitals and private centers). METHODS Prospective, observational, multicenter study enrolling patients undergoing RBS between October 1, 2021, and March 31, 2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during the same calendar interval in 2016-2020 were considered control patients. RESULTS A total of 220 patients were enrolled and compared with 560 control-group patients. Mortality was .45% versus .35% (n.s), with an overall mortality of .25%, while open surgery or conversion to open surgery was registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%), and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by gastroesophageal reflux disease; Roux-en-Y gastric bypass was the most used revisional procedure (56%). Sleeve gastrectomy was the most revised procedure in the study group, while gastric banding was the most revised in the control group. RBS represents up to 9% of the total BS in the Italian participating centers. CONCLUSIONS Laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift toward sleeve gastrectomy being the most revised procedure and Roux-en-Y gastric bypass being the most frequent revisional procedure.
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Affiliation(s)
- Cristian E Boru
- General Surgery Division, Department of Medical Surgical Sciences and Biotechnologies and Department of Medical Surgical Sciences and Translational Medicine, University "La Sapienza" of Rome, Rome, Italy.
| | - Giuseppe M Marinari
- Bariatric Unit, Humanitas Clinical and Research Hospital, IRCCS Rozzano, Milan, Italy
| | - Stefano Olmi
- General and Oncological Surgery Department, Center of Bariatric Surgery, Policlinico San Marco di Zingonia, Bergamo, Italy
| | - Paolo Gentileschi
- Bariatric and Metabolic Surgery Department, San Carlo of Nancy Hospital and "Tor Vergata" University of Rome, Rome, Italy
| | - Mario Morino
- General Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Mirto Foletto
- Bariatric Surgery Unit, Azienda Ospedaliera of University of Padova, Padova, Italy
| | - Paolo Bernante
- Metabolic and Obesity Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for the Study and Research of Treatment for Morbid Obesity, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luigi Piazza
- General Surgery and Emergency Department, ARNAS Garibaldi Nesima Hospital, Catania, Italy
| | - Nicola Perrotta
- General Surgery Department, Villa d'Agri Hospital, Potenza, Italy
| | | | - Gianfranco Silecchia
- General Surgery Division, Department of Medical Surgical Sciences and Biotechnologies and Department of Medical Surgical Sciences and Translational Medicine, University "La Sapienza" of Rome, Rome, Italy
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26
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Lind R, Hage K, Ghanem M, Shah M, Vierkant RA, Jawad M, Ghanem OM, Teixeira AF. Long-Term Outcomes of Sleeve Gastrectomy: Weight Recurrence and Surgical Non-responders. Obes Surg 2023; 33:3028-3034. [PMID: 37464052 DOI: 10.1007/s11695-023-06730-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is an effective procedure with remarkable weight loss and low complication rates. However, up to 30% of cases require revisional surgery in non-responders or patients who experience weight recurrence. We aim to report the rate of weight recurrence/non-responders (WR/NR) in patients who underwent SG and had more than 5 years of follow-up. METHODS We performed a multicenter retrospective study of patients who underwent initial SG from 2008 to 2017. Patient demographics and weight loss outcomes up to 12 years after SG were collected. Surgical non-responders were defined as 20% weight regain compared to maximum weight loss. A chi-square test for categorical variables and a two-sample t-test for continuous variables were used. Data are summarized as mean ± standard deviation. RESULTS From a total of 1263 patients, we included 339 patients (78% female, age 47.3 ± 11.2 years; baseline weight 125.8 ± 27.6 kg) with at least 5 years of follow-up (mean follow-up of 7.1 ± 1.8 years) (Table 1). Surgical non-response was demonstrated in 15.9% of patients (n=54) and 64.0% (n=217) had weight recurrence after SG (Fig. 1). There was a statistically significant difference in history of hypertension (p=0.046) and diabetes (p=0.032) as well as %TBWL at 1 year (p=0.005) and at longest follow-up (p<0.001) between patients who experienced WR/NR and those who did not. CONCLUSIONS Only 20% of patients who underwent SG and followed up for more than 5 years were able to maintain appropriate weight loss.
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Affiliation(s)
- Romulo Lind
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA.
| | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Ghanem
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
| | - Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Robert A Vierkant
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
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27
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Yıldız E, Karagözoğlu Ş. The Effects of a Web-Based Interactive Nurse Support Program Based on the Health Promotion Model on Healthy Living Behaviors and Self-Efficacy in Patients Who Regained Weight after Bariatric Surgery: A Randomized Controlled Trial. Obes Surg 2023; 33:3212-3222. [PMID: 37620740 DOI: 10.1007/s11695-023-06795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This study was conducted in order to determine the effects of web-based interactive nursing support program prepared in line with Health Promotion Model (HPM) on healthy lifestyle behaviors and self-efficacy of patients who regained weight following metabolic and bariatric surgery. MATERIALS AND METHODS A total of 62 patients with a history of weight regain at least two years after metabolic and bariatric surgery were divided into intervention (n = 31) and control (n = 31) groups by stratified randomization. The intervention group was given a web-based interactive nurse support program based on HPM for 10 weeks and followed up by telephone 12 times (every two weeks) in 6 months. No attempt was made to the control group during the study. The data were collected a total of 3 times before the training, in the 12th week and in the 6th month. RESULTS In the last test after the web-based interactive nurse support program and telephone follow-up, the difference was found to be statistically significant in terms of BMI, healthy lifestyle behaviors, eating behaviors, and general self-efficacy mean scores of the patients in the intervention group (p < 0.05). In addition, after the study, it was determined that the physical activity, nutrition, spiritual development, emotional eating and the Dutch Eating Behavior scales total score averages and Self-Efficacy Scale total score averages of the intervention group changed positively compared to the control group, and this change was statistically significant (p < 0.05). There was no difference between the groups in the mean scores of health responsibility, interpersonal relationships, stress, restrictive eating, external eating and Healthy Lifestyle Behaviors-II Scale (p > 0.05). CONCLUSION It can be stated that the web-based interactive nurse support program based on HPM is applicable in patients who regain weight after metabolic and bariatric surgery, and it contributes positively to the healthy lifestyle behaviors, BMI, eating behaviors, and general self-efficacy of these patients. In order to ensure the continuity of post-operative patient follow-up, it is recommended to increase the importance of telephone counseling and to establish follow-up program based on the HPM.
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Affiliation(s)
- Ezgi Yıldız
- Susehri School of Health Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Şerife Karagözoğlu
- Faculty of Health Sciences Fundamentals of Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey
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28
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Axer S, Szabo E, Näslund I. Non-response After Gastric Bypass and Sleeve Gastrectomy-the Theoretical Need for Revisional Bariatric Surgery: Results from the Scandinavian Obesity Surgery Registry. Obes Surg 2023; 33:2973-2980. [PMID: 37587379 PMCID: PMC10514155 DOI: 10.1007/s11695-023-06783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Revisional surgery is a second-line treatment option after sleeve gastrectomy (SG) and gastric bypass (GBP) in patients with primary or secondary non-response. The aim was to analyze the theoretical need for revisional surgery after SG and GBP when applying four indication benchmarks. METHOD Based on data from the Scandinavian Obesity Surgery Registry, SG and GBP were compared regarding four endpoints: 1. excess weight loss (%EWL) < 50%, 2. weight regain of more than 10 kg after nadir, 3. fulfillment of previous IFSO-guidelines, or 4. ADA criteria for bariatric metabolic surgery 2 years after primary surgery. RESULTS A total of 60,426 individuals were included in the study (SG: n = 7856 and GBP: n = 52,570). Compared to patients in the GBP group, more SG patients failed to achieve a %EWL > 50% (23.0% versus 8.5%, p < .001), regained more than 10 kg after nadir (4.3% versus 2.5%, p < .001), and more often fulfilled the IFSO criteria (8.0% versus 4.5%, p < .001) or the ADA criteria (3.3% versus 1.8%, p < 001) at the 2-year follow-up. CONCLUSION SG is associated with a higher risk for weight non-response compared to GBP. To offer revisional bariatric surgery to all non-responders exceeds the bounds of feasibility and operability. Hence, individual prioritization and intensified evaluation of alternative second-line treatments are necessary.
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Affiliation(s)
- Stephan Axer
- Faculty of Health and Medicine, Örebro University, Campus USÖ, 701 82, Örebro, Sweden.
- Department of Surgery, Torsby Hospital, Box 502, 685 29, Torsby, Sweden.
| | - Eva Szabo
- Department of Surgery, Faculty of Health and Medicine, Örebro University, Campus USÖ, 701 82, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Health and Medicine, Örebro University, Campus USÖ, 701 82, Örebro, Sweden
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Cohen RV, Petry TB. How to address weight regain after bariatric surgery in an individualized way. Rev Endocr Metab Disord 2023; 24:993-1002. [PMID: 37171756 DOI: 10.1007/s11154-023-09806-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
Bariatric surgery is the most effective obesity treatment. As a chronic and progressive disease, weight loss response to surgery will vary individually. Thus, insufficient weight loss or regain can happen after surgery, but they lack a standard definition. There are different mechanisms underlying weight regain and/or insufficient weight loss, such as genetics, maladaptive eating behaviors, and the inadequate choice of index operations, among others. Patients with weight regain or insufficient weight loss should be submitted to an individualized and comprehensive evaluation by a multidisciplinary team. This may help identify the causes and direct the appropriate treatment individually. Options for patients with insufficient weight loss and/or weight regain following bariatric surgery include repair of postoperative complications, conversion into another operation, endoscopic therapies with inconsistent outcomes, and dietary/behavioral counseling. Revision and conversion surgeries have higher complication rates than primary operations. Although there is no standard pharmacological regimen for that indication, the new agents seem efficient and safe to promote the loss of the regained weight and even be adjunctive to selected patients before they reach the plateau. This review aims to summarize the knowledge of the best approach for patients with weight regain/insufficient weight loss and suggests an algorithm to customize the approach and therapeutic options after bariatric surgery.
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Affiliation(s)
- Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, São Paulo, Brazil.
| | - Tarissa Bz Petry
- Center for the Treatment of Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, São Paulo, Brazil
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30
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Zefreh H, Amani-Beni R, Sheikhbahaei E, Farsi F, Ahmadkaraji S, Barzin M, Darouei B, Khalaj A, Shahabi S. What About My Weight? Insufficient Weight Loss or Weight Regain After Bariatric Metabolic Surgery. Int J Endocrinol Metab 2023; 21:e136329. [PMID: 38666043 PMCID: PMC11041817 DOI: 10.5812/ijem-136329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 04/28/2024] Open
Abstract
Context This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Evidence Acquisition Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Results Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. Risk factors: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Conclusions Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.
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Affiliation(s)
- Hamidreza Zefreh
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Farnaz Farsi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ahmadkaraji
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Darouei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khalaj
- Department of Surgery, School of Medicine, Tehran Obesity Treatment Center, Shahed University, Tehran, Iran
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Voorwinde V, Moukadem S, van Stralen MM, Janssen IM, Monpellier VM, Steenhuis IH. How to get back on track? Experiences of patients and healthcare professionals regarding weight recurrence and needs for an intervention after bariatric-metabolic surgery. OBESITY PILLARS (ONLINE) 2023; 7:100074. [PMID: 37990676 PMCID: PMC10662074 DOI: 10.1016/j.obpill.2023.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 11/23/2023]
Abstract
Background Multidisciplinary lifestyle interventions are recommended as a first step in treating weight recurrence after bariatric-metabolic surgery (BMS). However, little is known about the experience of patients and healthcare professionals (HCP) with these interventions and how they should be tailored to the patients' needs. The aim of this study was to gain more insight into the experiences and needs of patients and HCP regarding weight recurrence after BMS and an intervention to get Back on Track. In addition, attitudes towards integrating e-Health into the care program were explored. Methods A qualitative process evaluation of an intervention for weight recurrence, the Back on Track (BoT), was conducted by means of in-depth interviews and focus groups with 19 stakeholders, including patients and HCP involved in BoT. Interviews were transcribed verbatim. Data were analyzed through thematic analysis. Results Patients and HCP reported a wide array of causes of weight recurrence. Patients found it difficult to decide when weight recurrence is problematic and when they should ask for help. Patients reported feeling like the exception and ashamed, therefore experiencing a high threshold to seek help. E-Health was seen as a promising way to improve tailoring, screening, autonomy for the patient, and accessible contact. Conclusion Patients should be adequately counselled on weight recurrence after BMS and the importance of intervening early. It is important to lower the threshold for seeking help. For example by offering more long-term standard care or by adding e-Health to the intervention.
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Affiliation(s)
- Vera Voorwinde
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Sahar Moukadem
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Maartje M. van Stralen
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ignace M.C. Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
| | - Valerie M. Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
| | - Ingrid H.M. Steenhuis
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Maselli DB, Waseem A, Lee D, Wooley C, Donnangelo LL, Coan B, McGowan CE. Performance Characteristics of Endoscopic Sleeve Gastroplasty in Patients with Prior Intragastric Balloon: Results of a Propensity Score Matched Study. Obes Surg 2023; 33:2711-2717. [PMID: 37474866 DOI: 10.1007/s11695-023-06715-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION The performance characteristics of endoscopic sleeve gastroplasty (ESG) for weight recurrence after intragastric balloon (IGB) are unknown. METHODS This is a retrospective propensity score matched study of ESG after IGB (IGB-to-ESG) vs ESG without prior IGB (ESG-only). The primary outcome was total weight loss (TWL) at 12 months. Secondary outcomes included TWL at 3 and 6 months, 12-month excess weight loss (EWL), procedural characteristics, and safety. RESULTS Thirty-nine adults underwent ESG from August 2020 to September 2022 after IGB explantation a median of 24 months (range 2-56 months) prior and a median post-IGB nadir weight increase of 100.0% (range 0 to 3200%). An ESG-only 2:1 age- sex- and BMI- propensity score matched cohort was derived from 649 patients (Pearson's goodness-of-fit: 0.86). TWL for IGB-to-ESG vs. ESG-only was 12.3 ± 13.5% vs. 12.4 ± 3.7% at 3 months (p = 0.97), 10.1 ± 7.1% vs. 15.4 ± 4.6% at 6 months (p < 0.001), and 8.7 ± 7.7% vs. 17.1 ± 5.7% at 12 months (p < 0.001). Twelve-month EWL for IGB-to-ESG vs ESG-only was 27.8 ± 46.9% vs 62.0 ± 21.0% (p < 0.001). There was no difference in mean procedural duration of ESG; however, more sutures were used with IGB-to-ESG vs. ESG-only (7 vs. 6, p < 0.0002). There were no serious adverse events in either cohort. CONCLUSION ESG after IGB produces safe, acceptable weight loss but with an attenuated effect compared to ESG alone. Further study is required to understand the factors driving this discrepancy.
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Affiliation(s)
- Daniel B Maselli
- True You Weight Loss, 5673 Peachtree Dunwoody Road, Ste 470, Atlanta, GA, 30342, USA
| | - Areebah Waseem
- True You Weight Loss, 2001 Weston Parkway, Cary, NC, 27513, USA
| | - Daniel Lee
- True You Weight Loss, 2001 Weston Parkway, Cary, NC, 27513, USA
| | - Chase Wooley
- True You Weight Loss, 2001 Weston Parkway, Cary, NC, 27513, USA
| | - Lauren L Donnangelo
- True You Weight Loss, 5673 Peachtree Dunwoody Road, Ste 470, Atlanta, GA, 30342, USA
| | - Brian Coan
- True You Weight Loss, 2001 Weston Parkway, Cary, NC, 27513, USA
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Giannopoulos S, Kapsampelis P, Pokala B, Nault Connors JD, Hilgendorf W, Timsina L, Clapp B, Ghanem O, Kindel TL, Stefanidis D. Bariatric Surgeon Perspective on Revisional Bariatric Surgery (RBS) for Weight Recurrence. Surg Obes Relat Dis 2023; 19:972-979. [PMID: 37061437 DOI: 10.1016/j.soard.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Weight recurrence (WR) after bariatric surgery occurs in nearly 20% of patients. Revisional bariatric surgery (RBS) may benefit this population but remains controversial among surgeons. OBJECTIVES Explore surgeon perspectives and practices for patients with WR after primary bariatric surgery (PBS). SETTING Web-based survey of bariatric surgeons. METHODS A 21-item survey was piloted and posted on social media closed groups (Facebook) utilized by bariatric surgeons. Survey items included demographic information, questions pertaining to the definition of suboptimal and satisfactory response to bariatric surgery, and general questions related to different WR management options. RESULTS One hundred ten surgeons from 19 countries responded to the survey. Ninety-eight percent responded that WR was multifactorial, including behavioral and biological factors. Failure of PBS was defined as excess weight loss < 50% by 31.4%, as excess weight loss <25% by 12.8%, and as comorbidity recurrence by 17.4%. Surgeon responses differed significantly by gender (P = .036). 29.4% believed RBS was not successful, while 14.1% were unsure. Nevertheless, 73% reported that they would perform RBS if sufficient evidence of benefit existed. Most frequently performed revisional procedures included conversion of sleeve gastrectomy to Roux-en-Y gastric bypass (RYGB), adjustable gastric band to RYGB, and RYGB revision (21.9% versus 18.2% versus 15.3%, respectively). CONCLUSIONS This survey demonstrates significant variability in surgeon perception regarding causes and the effectiveness of RBS. Moreover, they disagree on what constitutes a nonsatisfactory response to PBS and to whom they offer RBS. These findings may relate to limited available clinical evidence on best management options for this patient population. Clinical trials investigating the comparative effectiveness of various treatment options are needed.
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Affiliation(s)
| | | | - Bhavani Pokala
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jill D Nault Connors
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Lava Timsina
- Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin Clapp
- Paul Foster School of Medicine, Texas Tech HSC, El Paso, Texas
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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Tabesh MR, Eghtesadi M, Abolhasani M, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline. Obes Surg 2023; 33:2557-2572. [PMID: 37389806 DOI: 10.1007/s11695-023-06703-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Only in the USA, 315 billion dollars are spent annually on the medical cost of obesity in adult patients. Till now, bariatric surgery is the most effective method for treating obesity and can play an essential role in reducing the direct and indirect costs of obesity treatment. Nonetheless, there are few comprehensive guidelines which include nutrition, physical activity, and supplements, before and after surgery. The purpose of the present narrative review is to provide an updated and comprehensive practical guideline to help multidisciplinary teams. The core keywords include nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic diversion with duodenal switch which were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google Scholar. We answered questions in five important areas: (a) nutritional strategies before bariatric surgery, (b) nutrition after bariatric surgery, (c) physical activity before and after bariatric surgery, (d) weight regain after bariatric surgery, and (e) micronutrient assessments and recommendations before and after bariatric surgery. Some new items were added in this updated guideline including "weight regain" and "pregnancy after bariatric surgery." Other fields were updated based on new evidence and guidelines.
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Affiliation(s)
| | - Maryam Eghtesadi
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran
| | - Maryam Abolhasani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran.
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Shenoy A, Schulman AR. Advances in endobariatrics: past, present, and future. Gastroenterol Rep (Oxf) 2023; 11:goad043. [PMID: 37483864 PMCID: PMC10361810 DOI: 10.1093/gastro/goad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023] Open
Abstract
The obesity epidemic in the USA and worldwide is well documented and continues to grow. Endoscopic metabolic and bariatric therapies may offer a less invasive approach than surgical intervention. This article will review advances in endobariatrics over the last several decades, addressing the past and current state of bariatric and metabolic endoscopy. Food and Drug Administration-cleared devices and interventions currently under investigation are described including gastric devices, gastric remodeling procedures, small-bowel devices, duodenal ablation, as well as procedures to address weight regain after bariatric surgery. Future studies evaluating gastric and duodenal combination therapy, adjunctive pharmacotherapy, as well as individualized precision-health algorithms are underway.
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Affiliation(s)
- Abhishek Shenoy
- Corresponding author. Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48105, USA. Tel: +1-908-3381691; Fax: +1-734-9365458;
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
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36
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Hany M, Ibrahim M, Zidan A, Agayaby ASS, Aboelsoud MR, Gaballah M, Torensma B. Two-Year Results of the Banded Versus Non-banded Re-sleeve Gastrectomy as a Secondary Weight Loss Procedure After the Failure of Primary Sleeve Gastrectomy: a Randomized Controlled Trial. Obes Surg 2023; 33:2049-2063. [PMID: 37156932 PMCID: PMC10166688 DOI: 10.1007/s11695-023-06598-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Insufficient weight loss or weight regain has been reported in up to 30% of patients after laparoscopic sleeve gastrectomy (LSG). Approximately 4.5% of patients who undergo LSG need revisional surgery for a dilated sleeve. METHODS This randomized controlled trial compared the outcomes between banded (BLSG) and non-banded re-LSG (NBLSG) after weight regain. Percentage excess body weight loss (%EWL), percentage total weight loss (%TWL), associated medical problems, gastric volume measurement, and endoscopy were measured preoperatively and 1 and 2 years postoperatively. RESULTS Both groups (25 patients each) achieved similar % EWL and %TWL at six months, one year, and two years postoperatively (%EWL 46.9 vs. 43.6, 83.7 vs. 86.3, and 85.7 vs. 83.9) (p= > 0.151) (%TWL 23.9 vs. 21.8, 43.1 vs .43.3, 44.2 vs. 42.2) (p=>0.342), respectively. However, the body mass index was significantly lower with BLSG (24.9 vs. NBLSG, 26.9). Both groups showed a significant reduction in stomach volume after two years (BLSG -248.4 mL vs. NBLSG -215.8 mL). Food tolerance (FT) scores were significantly reduced in both groups, whereby BSLG had significantly lower FT with an average of -1.1 point. No significant differences were observed regarding improvement of the associated medical problems after the first and two years after revisional LSG or the postoperative complications between both groups. CONCLUSION Laparoscopic re-LSG is feasible and safe with satisfactory outcomes in patients with weight regain after LSG who have gastric dilatation without reflux esophagitis. Both groups had comparable significant weight loss effects and improvement of associated medical problems. The BLSG tends to have a more stable weight loss after two years with a significantly lower BMI, lower stomach volume, and less weight regain. Food tolerance decreased in both groups but reduced more in the BLSG group. After a 2-year follow-up, we may regard both procedures are safe, with no significant differences in the occurrence of complications and nutritional deficits.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
- Madina Women's Hospital, Alexandria, Egypt.
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Ann Samy Shafiq Agayaby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Moustafa R Aboelsoud
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Muhammad Gaballah
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Kamali Z, Tabesh MR, Moslehi N, Estaki S, Barzin M, Khalaj A, Mirmiran P. Dietary Macronutrient Composition and Quality, Diet Quality, and Eating Behaviors at Different Times Since Laparoscopic Sleeve Gastrectomy. Obes Surg 2023; 33:2158-2165. [PMID: 37221431 PMCID: PMC10205028 DOI: 10.1007/s11695-023-06651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE This study aimed to compare energy, macronutrients (quantity and quality), the overall dietary quality, and eating behaviors of patients undergoing laparoscopic sleeve gastrectomy (LSG) at different times since surgery. MATERIALS AND METHODS This cross-sectional study included 184 adults at least 1 year post-LSG. Dietary intakes were assessed by a 147-item food frequency questionnaire. Macronutrient quality was assessed by computing the macronutrient quality index (MQI), carbohydrate quality index, fat quality index, and healthy plate protein quality index (HPPQI). The Healthy Eating Index (HEI)-2015 was used to assess diet quality. The Dutch Eating Behavior Questionnaire was used to assess eating behaviors. Based on the time since LSG, the time at which eating data were also collected, participants were categorized into three groups: 1-2 years (group 1), 2-3 years (group 2), and 3-5 years (group 3). RESULTS Group 3 consumed significantly more energy and absolute carbohydrates than group 1. The MQI and HPPQI scores of group 3 were significantly lower than those of group 1. The HEI score was significantly lower in group 3 compared to group 1, with a mean difference of 8.1 points. Compared to patients with 1-2 years following LSG, those with 2-3 and 3-5 years consumed more refined grains. Eating behavior scores did not differ between groups. CONCLUSION Patients at 3-5 years post-LSG consumed more energy and carbohydrates than those at 1-2 years after the surgery. Protein quality, overall macronutrient quality, and overall diet quality decreased as time passed following surgery.
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Affiliation(s)
- Zahra Kamali
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, 1981619573, Iran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, 1985717413, Iran
| | - Mastaneh Rajabian Tabesh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Moslehi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, 1985717413, Iran.
| | - Saghar Estaki
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, 1985717413, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, 1981619573, Iran.
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, 1985717413, Iran.
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Cho YH, Lee Y, Choi JI, Lee SR, Lee SY. Weight loss maintenance after bariatric surgery. World J Clin Cases 2023; 11:4241-4250. [PMID: 37449236 PMCID: PMC10337010 DOI: 10.12998/wjcc.v11.i18.4241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 06/26/2023] Open
Abstract
Metabolic and bariatric surgery (MBS) is an effective treatment for patients with morbid obesity and its comorbidities. However, many patients experience weight regain (WR) after achieving their nadir weight. Establishing the definition of WR is challenging as postoperative WR has various definitions. Risk factors for WR after MBS include anatomical, racial, hormonal, metabolic, behavioral, and psychological factors, and evaluating such factors preoperatively is necessary. Long-term regular follow-up and timely treatment by a multidisciplinary team are important because WR after surgery is multi-factorial. Although lifestyle interventions that focus on appropriate dietary education, physical activity education or interventions, and behavioral psychological interventions are suggested, more well-designed studies are needed because studies evaluating intervention methods and the effectiveness of WR prevention are lacking. Anti-obesity drugs can be used to prevent and manage patients with WR after MBS; however, more research is needed to determine the timing, duration, and type of anti-obesity drugs used to prevent WR.
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Affiliation(s)
- Young-Hye Cho
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan 50612, South Korea
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Youngin Lee
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Jung In Choi
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Sae Rom Lee
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
| | - Sang Yeoup Lee
- Family Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan 50612, South Korea
- Department of Medical Education, Pusan National University School of Medicine, Yangsan 50612, South Korea
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Reitano E, Riva P, Keller D, Vannucci M, Zappaterra M, Vix M, Mutter D, Marescaux J, Perretta S. Deep sedation versus orotracheal intubation for endoscopic sleeve gastroplasty (ESG): preliminary experience. Surg Endosc 2023:10.1007/s00464-023-10159-x. [PMID: 37277517 DOI: 10.1007/s00464-023-10159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is an emerging bariatric procedure currently performed under general anaesthesia with orotracheal intubation (OTI). Several studies have shown the feasibility of advanced endoscopic procedures under deep sedation (DS) without impacting patient outcomes or adverse event rates. Our goal was to perform an initial comparative analysis of ESG in DS with ESG under OTI. METHODS A prospective institutional registry was reviewed for ESG patients between 12/2016 and 1/2021. Patients were stratified into OTI or DS cohorts, and the 1st 50 cases performed in each cohort were included for comparability. Univariate analysis was performed on demographics, intraoperative, and postoperative outcomes (up to 90 days). Multivariate analyses evaluated the relationship between anesthesia type, preclinical and clinical variables. RESULTS Of the 50 DS patients, 21(42%) underwent primary and 29 (58%) revisional surgery. There was no significant differences in Mallampati score across groups. No DS patient required intubation. DS patients were younger (p = 0.006) and lower BMI (p = 0.002) than OTI. As expected, DS patients overall and in the primary subgroup had shorter operative time (p ≤ 0.001 and p = 0.003, respectively) and higher rates (84% DS vs. 20% OTI, p ≤ 0.001) of ambulatory procedures. There were no significant differences in the sutures used between groups (p = 0.616). DS patients required less postoperative opioids (p ≤ 0.001) and antiemetics (p = 0.006) than OTI. There were no significant differences in 3-month postoperative weight loss across cohorts. There was no rehospitalization in either group. In primary ESG cases, we found DS patients were more likely younger (p = 0.006), female (p = 0.001), and had a lower BMI (p = 0.0027). CONCLUSIONS ESG under DS is safe and feasible in select patients. We found DS safely increased rates of outpatient care, reduced use of opioids and antiemetics, and provided the same results of postoperative weight loss. Patient selection for DS may be more clearer for durable weight loss.
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Affiliation(s)
- Elisa Reitano
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Pietro Riva
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Deborah Keller
- Marks Colorectal Surgical Associates, Lankenau Medical Center, Wynnewood, PA, USA
| | - Maria Vannucci
- Department of General Surgery, University of Turin, Turin, Italy
| | - Mathieu Zappaterra
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Michel Vix
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Didier Mutter
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Silvana Perretta
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France.
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Hany M, Zidan A, Sabry K, Ibrahim M, Agayby ASS, Aboelsoud MR, Torensma B. How Good is Stratification and Prediction Model Analysis Between Primary and Revisional Roux-en-Y Gastric Bypass Surgery? A Multi-center Study and Narrative Review. Obes Surg 2023; 33:1431-1448. [PMID: 36905504 PMCID: PMC10156787 DOI: 10.1007/s11695-023-06532-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTIONS Revision surgery because of weight recurrence is performed in 2.5-33% of primary vertical banded gastroplasty (VBG), laparoscopic sleeve gastrectomy (LSG), and gastric band (GB) cases. These cases qualify for revisional Roux-en-Y gastric bypass (RRYGB). METHODS This retrospective cohort study analyzed data from 2008 to 2019. A stratification analysis and multivariate logistic regression for prediction modeling compared the possibility of sufficient % excess weight loss (%EWL) ≥ 50 or insufficient %EWL < 50 between three different RRYGB procedures, with primary Roux-en-Y gastric bypass (PRYGB) as the control during 2 years of follow-up. A narrative review was conducted to test the presence of prediction models in the literature and their internal and external validity. RESULTS A total of 558 patients underwent PRYGB, and 338 underwent RRYGB after VBG, LSG, and GB, and completed 2 years of follow-up. Overall, 32.2% of patients after RRYGB had a sufficient %EWL ≥ 50 after 2 years, compared to 71.3% after PRYGB (p ≤ 0.001). The total %EWL after the revision surgeries for VBG, LSG, and GB was 68.5%, 74.2%, and 64.1%, respectively (p ≤ 0.001). After correcting for confounding factors, the baseline odds ratio (OR) or sufficient %EWL ≥ 50 after PRYGB, LSG, VBG, and GB was 2.4, 1.45, 0.29, and 0.32, respectively (p ≤ 0.001). Age was the only significant variable in the prediction model (p = 0.0016). It was impossible to develop a validated model after revision surgery because of the differences between stratification and the prediction model. The narrative review showed only 10.2% presence of validation in the prediction models, and 52.5% had external validation. CONCLUSION Overall, 32.2% of all patients after revisional surgery had a sufficient %EWL ≥ 50 after 2 years, compared to PRYGB. LSG had the best outcome in the revisional surgery group in the sufficient %EWL group and the best outcome in the insufficient %EWL group. The skewness between the prediction model and stratification resulted in a partially non-functional prediction model.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
- Bariatric Surgery at Madina Women's Hospital (IFSO-Certified Bariatric Center), Alexandria, Egypt.
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Karim Sabry
- Department of Surgery, Ain Shams University, Cairo, Egypt
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Ann Samy Shafiq Agayby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Moustafa R Aboelsoud
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Kapała J, Maroszczuk T, Lewandowska J, Lech P, Dowgiałło-Gornowicz N. Weight Regain in the Second Year after Sleeve Gastrectomy Could Be a Predictor of Long-Term Outcomes? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040766. [PMID: 37109724 PMCID: PMC10143935 DOI: 10.3390/medicina59040766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Sleeve gastrectomy (SG) is an effective surgical procedure in the treatment of obesity. However, a significant percentage of patients suffer from weight regain over long-term follow-up. The mechanisms responsible for this process are still poorly understood. The aim of the study is to evaluate the predictive effect of weight regain in the second year after SG on long-term bariatric surgery effectiveness. Methods: A retrospective cohort study was performed using the database of routinely collected information about patients undergoing SG in the Department of General, Minimally Invasive and Elderly Surgery in Olsztyn. Patients were divided into two groups according to the change in body weight between the first and second years after the surgery: weight gainers (WG) and weight maintainers (WM). Results: A study group consisting of 206 patients, with follow-up over 5 years, was included in the study. The WG group consisted of 69 patients while the WM group had 137 patients. There were no significant differences between the patient characteristics (p > 0.05). The WM group had a mean %EWL of 7.45% (SD, 15.83%) and %TWL of 3.74 (SD, 8.43). The WG group had a mean %EWL of 22.78% (SD, 17.11%) and %TWL of 11.29% (SD, 8.68). The difference between the groups was statistically significant (p < 0.05). The study showed significantly better results in WM compared to WG (p < 0.05). Conclusion: Weight regain in the second year after SG may be a good factor for long-term bariatric surgery effectiveness prognosis.
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Affiliation(s)
- Jan Kapała
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległosci 44 St., 10-045 Olsztyn, Poland
| | - Tomasz Maroszczuk
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległosci 44 St., 10-045 Olsztyn, Poland
| | - Julia Lewandowska
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległosci 44 St., 10-045 Olsztyn, Poland
| | - Paweł Lech
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległosci 44 St., 10-045 Olsztyn, Poland
| | - Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległosci 44 St., 10-045 Olsztyn, Poland
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Chaouch MA, Yang W, Gouader A, Krimi B, Carneiro da Costa A, Pourcher G, Oweira H. Banded versus non-banded sleeve gastrectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32982. [PMID: 37058050 PMCID: PMC10101294 DOI: 10.1097/md.0000000000032982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/25/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Laparoscopic banded sleeve gastrectomy (LBSG) has been compared to laparoscopic sleeve gastrectomy (LSG) in terms of anthropometric results and postoperative complications, which are controversial. This systematic review and meta-analysis aimed to compare the safety and efficacy of LBSG and LSG. METHODS We performed a systematic review with meta-analysis according to preferred reporting items for systematic review and meta-analysis 2020 and assessing the methodological quality of systematic review 2 guidelines. We included studies that systematically searched electronic databases and compared LBSG with LSG conducted until August 10, 2021. RESULTS The literature search yielded 8 comparative studies. Seven hundred forty-three patients were included: 352 in the LBSG group and 391 in the LSG group. LBSG group allowed greater anthropometric parameters (body mass index [BMI] after 1 year (mean difference [MD] = -3.18; 95% CI [-5.45, -0.92], P = .006), %EWL after 1 year (MD = 8.02; 95% CI [1.22, 14.81], P = .02), and %EWL after 3 years (MD = 10.60; 95% CI [5.60, 15.69], P < .001) and similar results with LSG group in terms of operative time (MD = 1.23; 95% CI [-4.71, 7.17], P = .69), food intolerance (OR = 1.72; 95% CI [0.84, 3.49], P = .14), postoperative vomiting (OR = 2.10; 95% CI [0.69, 6.35], P = .19), and De novo GERD (OR = 0.65; 95% CI [0.34, 1.26], P = .2). Nevertheless, major postoperative complications did not differ between the 2 groups. CONCLUSIONS This systematic review and meta-analysis comparing LBSG and LSG concluded that banding sleeve gastrectomy (SG) may ensure a lower BMI and %EWL after 1 year of follow-up, and a significant reduction in %EWL after 3 years of follow-up. There is no evidence to support LBSG in vomiting, de novo GERD, food intolerance, or operative time.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
- Department of Digestive, Metabolic, and Oncologic Surgery, Institut Mutualiste of Montsouris, Paris, France
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Amine Gouader
- Department of Visceral and Obesity Surgery, Perpignan Hospital Center, Perpignan, France
| | - Bassem Krimi
- Department of Visceral and Obesity Surgery, Perpignan Hospital Center, Perpignan, France
| | - Adriano Carneiro da Costa
- Department of Digestive, Metabolic, and Oncologic Surgery, Institut Mutualiste of Montsouris, Paris, France
| | - Guillaume Pourcher
- Department of Digestive, Metabolic, and Oncologic Surgery, Institut Mutualiste of Montsouris, Paris, France
| | - Hani Oweira
- Department of Surgery, Universitäts medizin Mannheim, Heidelberg University, Mannheim, Germany
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Fehervari M, Banh S, Varma P, Das B, Al-Yaqout K, Al-Sabah S, Khwaja H, Efthimiou E, Ashrafian H. Weight loss specific to indication, remission of diabetes, and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:384-395. [PMID: 36581551 DOI: 10.1016/j.soard.2022.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Long-term complications such as insufficient weight loss (IWL) and gastroesophageal reflux disease (GERD) may necessitate SG conversion to Roux-en-Y gastric bypass (RYGB). The aim of this review was to determine the indication-specific weight loss and diabetes remission after SG conversion to RYGB (STOBY). Our objective was to extract all available published data on indication for conversion, weight loss, remission of diabetes, and short-term complications after STOBY. A systematic literature search was conducted to identify studies reporting outcomes following STOBY. A random effects model was used for meta-analysis. The search identified 44 relevant studies. Overall short-term (12-mo) excess weight loss (EWL) was 54.6% (95% confidence interval [CI], 46%-63%) in 23 studies (n = 712) and total weight loss (TWL) was 19.9% (95% CI, 14%-25%) in 21 studies (n = 740). For IWL, short-term (12-mo) pooled weight loss outcomes were 53.9% EWL (95% CI, 48%-59%) in 14 studies (n = 295) and 22.7% TWL (95% CI, 17%-28%) in 12 studies (n = 219), and medium-term (2-5 yr) outcomes were 45.8% EWL (95% CI, 38%-53%) in 7 studies (n = 154) and 20.6% TWL (95% CI, 15%-26%) in 9 studies (n = 206). Overall diabetes remission was 53% (95% CI, 33%-72%), and the perioperative complication rate was 8.2% (95% CI, 7.6%-8.7%). Revisional SG conversion to RYGB for IWL can achieve good weight loss outcomes and diabetes remission.
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Affiliation(s)
- Matyas Fehervari
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Serena Banh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Piyush Varma
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | | - Haris Khwaja
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Elhag W, Lock M, El Ansari W. When Definitions Differ, are Comparisons Meaningful? Definitions of Weight Regain After Bariatric Surgery and Their Associations with Patient Characteristics and Clinical Outcomes - A Need for a Revisit? Obes Surg 2023; 33:1390-1400. [PMID: 36995562 PMCID: PMC10156838 DOI: 10.1007/s11695-023-06528-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Definitions and prevalence of weight regain (WR) after bariatric surgery remains inconsistent and their clinical significance unclear. OBJECTIVES To assess WR five years after sleeve gastrectomy (LSG), employing six definitions; and appraise their association with patient characteristics/clinical outcomes. METHODS Consecutive patients (N = 589) who underwent LSG were followed up for 5 years. WR prevalence was calculated yearly employing six definitions. Regression analysis assessed associations between WR at 5 years, and patient characteristics (age, sex, preop BMI, number of follow-up visits, number of comorbidities) and remission of comorbidities (type 2 diabetes, hypertension, and dyslipidemia). RESULTS Sample's mean age and BMI were 34 ± 11.6 years and 43.13 ± 5.77 kg/m2, and 64% were females. Percentage of patients with WR at 2, 3, 4, and 5 years fluctuated between 2.53% and 94.18%, subject to definition, and time point. The definition "Any WR" generated the highest prevalence of WR (86-94%) across all time points. At 5 years, for patient characteristics, preoperative BMI was associated with three definitions (P 0.49 to < 0.001), sex was associated with two (P < 0.026-0.032), and number of comorbidities was associated with one definition (P = 0.01). In terms of comorbidities, only hypertension was associated with WR (one definition, P = 0.025). No other definitions of WR were associated with any of the variables under examination. CONCLUSION Weight regain is reasonably expected after BMS. WR definitions were of minor clinical significance due to weak associations with limited comorbidities. Dichotomous definitions might offer some guidance while managing individual patients. However, its utility as a comparator metric across patients/procedures requires refinements.
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Affiliation(s)
- Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Merilyn Lock
- Division of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Walid El Ansari
- Weill Cornell Medicine-Qatar, Doha, Qatar.
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.
- College of Medicine, Qatar University, Doha, Qatar.
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Nduma BN, Mofor KA, Tatang JT, Ekhator C, Ambe S, Fonkem E. Endoscopic Gastric Sleeve: A Review of Literature. Cureus 2023; 15:e36353. [PMID: 37082499 PMCID: PMC10112045 DOI: 10.7759/cureus.36353] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/21/2023] Open
Abstract
For morbid obesity, one of the treatment options that have been deemed the most effective is bariatric surgery. Specifically, endoscopic sleeve gastrectomy (ESG) has emerged as one of the minimally invasive procedures for weight loss to be developed recently. In this procedure, there is the endoscopic placement of sutures in a quest to ensure reductions in the stomach volume. In this review, the main aim was to review the literature concerning ESG's efficacy and safety. Secondary sources of data were used and electronic databases were searched to identify articles focused on assessing the safety or efficacy of ESG. They included several databases such as Clinicaltrials.gov, Embase (Excerpta Medica Database), and MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online) to select relevant articles. Both the titles and abstracts of the articles were used to determine their inclusion or exclusion from the current review. Additionally, some keywords were used to search and obtain relevant articles such as: ESG, obesity, bariatric surgery, and total body weight loss. This review relied on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for the identification of articles, screening, determination of eligibility, and inclusion and exclusion as deemed appropriate. From the findings, the review established that ESG is effective when used as an alternative intervention for obesity. The beneficial effects are felt particularly in terms of the procedure's capacity to ensure that the total body weight loss mean percentage is significant. Apart from the benefit of ensuring weight loss, ESG was also found to impair gastric emptying, pose metabolic effects that are key to controlling obesity-associated metabolic dysregulation, and the ability to increase satiety. However, the procedure was documented to yield a few adverse events in some studies. Some of the notable adverse events include pulmonary embolism, potential pneumoperitoneum, and possible post-procedure leak in the posterior aspect of the gastric fundus as sutures exert tension and also cause thin walls. Emerging as a minimally-invasive procedure, ESG is a cost-effective alternative through which weight loss can be achieved significantly in obese populations. It leads to a slowdown of gastric emptying, causes an increase in satiety, and leads to an improvement in the metabolic profile. Therefore, for obese individuals not undergoing bariatric surgery, ESG can be an ideal treatment option, including individuals in need of a bridge to surgery and also those diagnosed with moderate obesity. Overall, when it comes to the management of obesity, this review established that ESG provides a paradigm shift targeting existing therapeutic gaps.
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Noria SF, Shelby RD, Atkins KD, Nguyen NT, Gadde KM. Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment. Curr Diab Rep 2023; 23:31-42. [PMID: 36752995 PMCID: PMC9906605 DOI: 10.1007/s11892-023-01498-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE OF REVIEW Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain. RECENT FINDINGS Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy. Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.
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Affiliation(s)
- Sabrena F Noria
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University, N718 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA.
| | - Rita D Shelby
- Department of Plastic and Reconstructive Surgery, University of Miami, Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Katelyn D Atkins
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA, 70808, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine, 3800 W Chapman Ave, Orange, CA, 92868, USA
| | - Kishore M Gadde
- Department of Surgery, University of California Irvine, 3800 W Chapman Ave, Orange, CA, 92868, USA
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Association Between Energy and Macronutrient Intakes and Weight Change After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:938-949. [PMID: 36604381 DOI: 10.1007/s11695-022-06443-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to summarize the evidence on the associations of energy and macronutrient intakes (carbohydrates, fats, and proteins) with weight loss in adults after sleeve gastrectomy or gastric bypass and to determine whether these dietary characteristics of patients with suboptimal weight loss (SWL) or weight regain differ from those without these experiences. METHODS PubMed, Scopus, and Web of Science were searched until December 2021. Twenty-three observational studies were included. RESULTS Studies on the association of postoperative energy and macronutrients and weight loss used diverse approaches. Pooled results showed that patients with SWL consumed more energy than those with acceptable weight loss. Weight regainers consumed more energy and carbohydrates and less protein than non-regainers. CONCLUSIONS Higher energy consumption is related to SWL and weight regain after surgery. Associations between macronutrients and weight outcome following bariatric surgery warrant further investigation.
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Bonaldi M, Rubicondo C, Giorgi R, Cesana G, Ciccarese F, Uccelli M, Zanoni A, Villa R, De Carli S, Oldani A, Ismail A, Di Capua F, Olmi S. Re-sleeve gastrectomy: weight loss, comorbidities and gerd evaluation in a large series with 5 years of follow-up. Updates Surg 2023:10.1007/s13304-023-01471-1. [PMID: 36849646 DOI: 10.1007/s13304-023-01471-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (SG) has rapidly become one of the most commonly performed procedures in bariatric surgery. Weight regain and insufficient weight loss are the most common causes for surgical failure. Re-sleeve gastrectomy (ReSG) can represent an option when there is evidence of a dilated gastric tube. OBJECTIVES The aim of the study is to evaluate safety, efficacy and rate of gastro-esophageal reflux disease (GERD) after ReSG in one of the largest series present in literature with long-term follow up. METHODS AND STUDY DESIGN Retrospective study design. From February 2010 to August 2018, 102 patients underwent ReSG at our Centre. We divided patients into two groups, according to the main reason for surgical failure: insufficient weight loss or progressive weight regain. RESULTS One hundred-two patients (78 women, 24 men) with BMI 38 ± 6 kg/m2 underwent ReSG (mean age 44 years). Rate of postoperative complications was 3.9% (4/102). After a mean follow-up of 55 months, mean BMI decreased to 30,4 kg/m2 and the mean percentage of excess weight loss (%EWL) was 51 ± 38.6. Symptoms of GERD were present in 35/102 patients (34.3%) and the need for a new operation occurred in six patients. Forty-five patients were submitted to ReSG for progressive weight regain (group A) and 57 for insufficient weight loss (group B). No differences were found in terms of postoperative BMI and %EWL. CONCLUSION ReSG is a feasible procedure after primary SG failure in selected patients, but its efficacy in reducing the BMI under 30 kg/m2 is still unclear. In addition, over 30% of patients suffer from long-term gastro-esophageal reflux.
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Affiliation(s)
- Marta Bonaldi
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy.
| | - Carolina Rubicondo
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Riccardo Giorgi
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Giovanni Cesana
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Francesca Ciccarese
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Matteo Uccelli
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Adelinda Zanoni
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Roberta Villa
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Stefano De Carli
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Alberto Oldani
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Ayman Ismail
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Francesco Di Capua
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
| | - Stefano Olmi
- Division of General and Oncological Surgery and Obesity Center of Policlinico San Marco, Corso Europa, 7, Zingonia, 24040, Osio Sotto, BG, Italy
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Efficacy of the Glucagon-Like Peptide-1 Receptor Agonists Liraglutide and Semaglutide for the Treatment of Weight Regain After Bariatric surgery: a Retrospective Observational Study. Obes Surg 2023; 33:1017-1025. [PMID: 36765019 PMCID: PMC9918402 DOI: 10.1007/s11695-023-06484-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Weight regain after bariatric surgery occurs in up to a third of patients and reduces treatment-associated health benefits. The efficacy of glucagon-like peptide-1 receptor agonists (GLP1-RA) for treatment of type 2 diabetes mellitus and obesity is well established, but their role in the treatment of weight regain after bariatric surgery remains to be defined. MATERIALS AND METHODS This was a single centre retrospective observational study conducted at a Swiss bariatric reference centre. Patients with 6 months of treatment with GLP1-RA, up until November 2021, due to weight regain after bariatric surgery were identified. Data on body weight and relevant clinical parameters were collected before and after 6 months of treatment with GLP1-RA. Data are presented as median (interquartile range). RESULTS Fifty patients (82% female) were included. Before GLP1-RA treatment (liraglutide, n=29; semaglutide, n=21), weight and BMI were 90.5 kg (83.4, 107.9) and 34.0 kg/m2 (31.7, 38.7), respectively, with a post-bariatric weight regain of 15.1% (10.6, 22.8) of total body weight and 4.6 kg/m2 (3.3, 6.2). After 6 months of GLP1-RA treatment, a reduction in weight and BMI of 8.8% (5.2, 11.4) of total body weight and 2.9 kg/m2 (1.8, 4.0) was observed (P value <0.0001), corresponding to 67.4% (40.4, 92.2) of the weight regain. No serious adverse events were reported. CONCLUSION For patients experiencing weight regain after bariatric surgery, two-thirds of the weight regain can be safely lost with GLP1-RA, providing clinicians with a therapeutic option for this clinical challenge, and highlights the need for a large-scale randomized clinical trial.
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Conversion of gastric sleeve to Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch: safe and viable options. Surg Obes Relat Dis 2023; 19:131-135. [PMID: 36414524 DOI: 10.1016/j.soard.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/19/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) remains the most performed bariatric surgery. As numbers of SG increase, so do the numbers of patients requiring conversion for insufficient weight loss or weight regain. However, the literature has cited complication rates as high as 30% for reoperative bariatric surgery. OBJECTIVE With the recent inclusion of conversion surgery variables in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we compared the safety and efficacy of SG conversion to Roux-en-Y gastric bypass (RYGB) versus biliopancreatic diversion and duodenal switch (BPD/DS). SETTING MBSAQIP database. METHODS Analysis of the 2020 MBSAQIP Participant Use Files revealed 6020 patients who underwent SG conversion to RYGB (5348) and BPD/DS (672). We examined 30-day outcomes including death, anastomotic leak, readmission, any complication, dehydration, and weight loss. RESULTS There was no statistically significant difference in mortality (.12% versus 0%) or; complication rate (6.5% versus 5.1%) with SG conversion to RYGB or BPD/DS. There was a statistically significant difference in anastomotic leak (.5% versus 1.2%, P = .024). Interestingly, BPD/DS was less likely to require dehydration treatments (4.2% versus 2.2%, P = .009) and had fewer readmissions within 30 days (7.3% versus 5.4%, P = .043). CONCLUSIONS Complication rates after conversion of SG to RYGB or BPD/DS may be significantly lower than previously reported and only slightly higher than after primary weight loss surgery. SG conversion to either RYGB or BPD/DS remain safe, viable options for patients who had insufficient weight loss or regain, and BPD/DS may be the better option in the appropriate patient.
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