The Dutch bariatric weight loss chart: A multicenter tool to assess weight outcome up to 7 years after sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass

Relations between trajectories of weight loss and changes in psychological health over a period of 2 years following bariatric metabolic surgery

PURPOSE

This study aimed to identify trajectories of BMI, obesity-specific health-related quality of life (HR-QoL), and depression trajectories from pre-surgery to 24 months post-bariatric metabolic surgery (BMS), and explore their associations, addressing subgroup differences often hidden in group-level analyses.

METHOD

Patients with severe obesity (n = 529) reported their HR-QoL and depression before undergoing BMS, and at 12 and 24 months post-operation. Latent Class Growth Analysis was used to identify trajectories of BMI, HR-QoL and depression.

RESULTS

BMI and HR-QoL improved significantly for all patients from pre-surgery to 24 months post-operation, though some patients deteriorated in their outcomes after 12 months. Three distinct trajectories of BMI were identified: Low (35.4%), Medium (45.5%), and High (19.2%), and of HR-QoL: High (38.4%), Medium (43.4%), and Poor (18.1%). Three trajectories of depression were extracted: Low/none (32.4%), Medium-low (45.3%), and Worsening (22.3%). The association between the trajectories of BMI and depression was significant, but not between the BMI and HR-QoL trajectories. Specifically, the Low BMI trajectory patients were more likely to follow the Worsening depression trajectory and reported poorer preoperative psychological health than the other two BMI trajectories.

CONCLUSION

Patients following the most favourable weight loss trajectory may not manifest psychologically favourable outcomes (i.e., Worsening depression), and preoperative characteristics do not consistently describe post-surgical BMI trajectories. Clinicians should tend to patients' mental wellbeing besides weight loss post-BMS. The study findings emphasize the significance of incorporating psychological health as an essential component of surgical outcomes.

Fat Mass Index Predicts the Effect of Weight Loss and Quality of Life Early After Laparoscopic Sleeve Gastrectomy

BACKGROUND

Fat mass index (FMI) is a body composition indicator that reflects body fat content. Laparoscopic sleeve gastrectomy (LSG) is widely performed in patients with obesity.

OBJECTIVE

This study aimed to evaluate the value of the FMI in predicting weight loss effect and quality of life early after LSG.

MATERIAL AND METHODS

From January 2014 to July 2022, the clinical data and computed tomography (CT) images of patients who underwent LSG at a tertiary referral teaching hospital were analyzed. Body composition indicators were calculated using the SliceOmatic software. Achieving initial body mass index within 6 months postoperatively was defined as early eligible weight loss (EEWL). The relationship between body composition and EEWL was analyzed.

RESULTS

A total of 243 patients were included. Receiver operating characteristic (ROC) curve analysis showed that the predictive value of the FMI for EEWL in patients after LSG was higher than that of other indicators (all P < 0.05; area under the curve = 0.813). The best FMI cut-off point was 13.662. Accordingly, the patients were divided into the high-FMI group and low-FMI group. The %EWL and BMI of patients in the low-FMI group at 1, 3, 6, 9, 12, and 24 months after surgery were better than those in the high-FMI group (all P < 0.001). Patients in the low-FMI group had higher BAROS (Bariatric Analysis and Reporting Outcome System) scores than those in the high-FMI group (P < 0.001).

CONCLUSION

Compared with other body composition indicators, FMI can effectively predict the early effect of weight loss and quality of life after LSG.

Can Weight of The Resected Stomach Predict Weight Loss Results After Laparoscopic Sleeve Gastrectomy?

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Many factors have been investigated in the literature to predict weight loss outcomes after LSG. However, insufficient data regarding the resected stomach weight (RGW) exists. This retrospective study aimed to investigate the association between RGW and weight loss outcomes 1 year after LSG.

MATERIALS AND METHODS

Fifty-four patients who underwent LSG in a tertiary care center were evaluated retrospectively. The statistical analyses were performed to investigate the correlation between preoperative demographics, RGW, and the excess weight loss percentage (%EWL) and percent total weight loss (%TWL).

RESULTS

The mean RGW was 169.7±40.1, ranging from 101 to 295 grams. The RGW was significantly correlated with preoperative weight (r=0.486; P<0.001), body mass index (r=0.420; P=0.002), and age (r=0.327; P=0.01). However, RGW did not predict postoperative weight loss, as measured by percent total weight loss (%TWL) and percent excess weight loss (%EWL), respectively (r=0.044; P=0.75 and r=-0.216; P=0.11). Multiple linear regression analysis identified age as a negative predictor for both %TWL (β=-0.351, P=0.005) and %EWL (β=-0.265, P=0.03), while preoperative body mass index was a negative predictor for %EWL (β=-0.469, P<0.001).

CONCLUSION

The RGW, although correlated with patient characteristics, does not serve as a reliable predictor of postoperative weight loss in the first year after LSG. Further research is needed to improve predictive models and patient care in bariatric surgery.

Weight Reduction Percentile Charts: 2-Year Follow-up Results of OAGB and RYGB Post Bariatric Surgery

PURPOSE

Using a single percentile chart provides us with high standards for the evaluation and accurate investigation of sufficient weight loss after bariatric surgery, counseling, and treating patients in an evidence-based way. Creating percentile charts of weight loss for gastric bypass is the aim of this study.

MATERIALS AND METHODS

This retrospective study was based on data from patients who underwent RYGB or OAGB from February 2008 to February 2020. The lambda-mu-sigma (LMS) method was used to estimate the reduction in body mass index (BMI) and six other metrics measured throughout post-operative follow-up. Percentile charts for various metrics have been presented for the first 2 years' post-surgery. We applied a bootstrap sampling method to evaluate percentile validity.

RESULTS

We recruited 2579 and 1943 patients who underwent OAGB (75% female) and RYGB (84% female) and were between the ages of 18 and 70 years. The preoperative BMI of patients in the OAGB group was higher than in the RYGB group. Concerning RYGB weight reduction results, the maximum percentage of excess weight loss (%EWL) occurs 18 months after surgery and is steady at 24 months. Far above 50%, EWL is achieved after 6 months. OAGB weight loss follows the same trend as RYGB; at 6 months, the %EWL values are slightly higher than RYGB.

CONCLUSIONS

We present the first bariatric weight loss percentile chart for OAGB. It allows evaluation of sufficient and insufficient weight loss at any post-operative point in a visual aspect. Furthermore, it predicts prospective outcomes and guides patient monitoring.

Pharmacotherapy before and after bariatric surgery

Diabetes is a chronic disease that affects a vast number of individuals globally, and without optimal treatment, can lead to significant health complications. Moreover, obesity is another chronic disease with several complications, which includes type 2 diabetes. Bariatric surgery is a viable long-term choice for managing diseases such as obesity and type 2 diabetes. However, the impact of pharmacotherapy before and after surgery remains unclear. In this review, we assessed the use of pharmacotherapy in patients with obesity with or without diabetes before and after bariatric surgery, focusing on weight loss, glycemic control, and the risk of postoperative complications. We showed that anti-obesity medication has become increasingly important in managing obesity and type 2 diabetes, both before and after bariatric surgery. The use of preoperative pharmacotherapy can optimize patients for surgery and reduce perioperative complications. Meanwhile, postoperative pharmacotherapy can maximize weight loss, improve metabolic outcomes, and lower the risk of weight regain. Medications such as sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and combination therapies, are now very effective for treating obesity and type 2 diabetes mellitus. However, optimal timing, duration, and which combinations of pharmacotherapy to use with bariatric surgery remain unclear. Additionally, the long-term safety and efficacy of these treatments should be assessed. Integrating pharmacotherapy with bariatric surgery is a promising approach to managing obesity and type 2 diabetes, providing patients with additional options for achieving sustainable weight loss and improving their metabolic health.

Study on weight loss outcomes after bariatric surgery to determine a metric least influenced by preoperative BMI

BACKGROUND

Percentage excess weight loss (%EWL) and percentage total weight loss (%TWL) are used for reporting outcomes after bariatric surgery. However, they are not ideal for comparing outcomes on populations of varied initial body mass index (BMI). This study aimed to validate a recently introduced metric - percentage alterable weight loss (%AWL), after laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB).

METHODS

Analysis of weight data of all patients who had undergone LSG and LRYGB until the end of the year 2021. Outcomes for both procedures were analyzed separately. The patients were divided into quartile subgroups Q1 (lowest BMI) to Q4 (highest BMI) and weight loss up to 5 years postoperatively was compared using %EWL, %TWL and %AWL metrics. An intermediary metric was also tested for its effect on the weight loss patterns for both procedures.

RESULTS

The cohort included 1020 LSG and 322 LRYGB patients, with initial mean BMI of 43.5 ± 7.5 and 41.9 ± 8.3 kg/m2, respectively. %EWL significantly favors lower BMI subgroups for both procedures. %TWL is ideal for comparing weight loss during the first 6 months but it then favors higher BMI subgroups beyond 6 months. %AWL with reference BMI of 13 kg/m2 seems the best metric for medium-term comparison of weight loss for LRYGB and an intermediary metric based on BMI 8 kg/m2 provides the best fit for medium-term comparison for LSG.

CONCLUSIONS

%TWL is least influenced by initial BMI during short-term follow-up after LSG and LRYGB. For medium-term comparison, %AWL is best suited for LRYGB while an intermediary metric is found to provide the best fit for LSG.

The Relationship between Depressive Symptoms, Quality of Life and miRNAs 8 Years after Bariatric Surgery

(1) Background: There are conflicting results on whether weight loss after bariatric surgery (BS) might be associated with quality of life (QoL)/depressive symptomatology. We aim to determine whether BS outcomes are associated with QoL/depressive symptomatology in studied patients at the 8-year follow-up after BS, as well as their relationship with different serum proteins and miRNAs. (2) Methods: A total of 53 patients with class III obesity who underwent BS, and then classified into "good responders" and "non-responders" depending on the percentage of excess weight lost (%EWL) 8 years after BS (%EWL ≥ 50% and %EWL < 50%, respectively), were included. Basal serum miRNAs and different proteins were analysed, and patients completed tests to evaluate QoL/depressive symptomatology at 8 years after BS. (3) Results: The good responders group showed higher scores on SF-36 scales of physical functioning, role functioning-physical, role functioning-emotional, body pain and global general health compared with the non-responders. The expression of hsa-miR-101-3p, hsa-miR-15a-5p, hsa-miR-29c-3p, hsa-miR-144-3p and hsa-miR-19b-3p were lower in non-responders. Hsa-miR-19b-3p was the variable associated with the response to BS in a logistic regression model. (4) Conclusions: The mental health of patients after BS is limited by the success of the intervention. In addition, the expression of basal serum miRNAs related to depression/anxiety could predict the success of BS.

Associations between the gut microbiome and metabolic, inflammatory, and appetitive effects of sleeve gastrectomy

The complex and multifactorial etiology of obesity creates challenges for its effective long-term management. Increasingly, the gut microbiome is reported to play a key role in the maintenance of host health and wellbeing, with its dysregulation associated with chronic diseases such as obesity. The gut microbiome is hypothesized to contribute to obesity development and pathogenesis via several pathways involving food digestion, energy harvest and storage, production of metabolites influencing satiety, maintenance of gut barrier integrity, and bile acid metabolism. Moreover, the gut microbiome likely contributes to the metabolic, inflammatory, and satiety benefits and sustained weight-loss effects following bariatric procedures such as sleeve gastrectomy. While the field of gut microbiome research in relation to obesity and sleeve gastrectomy outcomes is largely in its infancy, the gut microbiome nonetheless holds great potential for understanding some of the mechanisms behind sleeve gastrectomy outcomes as well as for optimizing post-surgery benefits. This review will explore the current literature within the field as well as discuss the current limitations, including the small sample size, variability in methodological approaches, and lack of associative data, which need to be addressed in future studies.

Effect of bariatric surgery on NAFLD/NASH: a single-centre observational prospective cohort study

INTRODUCTION

The prevalence of non-alcoholic fatty liver disease (NAFLD) ranges from 25% in the general population to 90% in patients with obesity scheduled for bariatric surgery. NAFLD can progress towards non-alcoholic steatohepatitis (NASH) associated with complications such as cirrhosis, hepatocellular carcinoma and cardiovascular disease. To date, losing weight and lifestyle modifications are the best known treatments for NASH. Bariatric surgery significantly improves NAFLD/NASH in the short term. However, the extent of this improvement is not yet clear and long-term data on the natural course of NAFLD/NASH after bariatric surgery are lacking. The factors involved in NAFLD/NASH regression after bariatric surgery have not been elucidated.

METHODS AND ANALYSIS

This is an observational prospective cohort study including patients scheduled for bariatric surgery. Extensive metabolic and cardiovascular analyses will be carried out including measurements of carotid intima media thickness and pulse wave velocity. Genomic, proteomic, lipidomic and metabolomic studies will be done. Microbioma analyses before and 1 year after surgery will be done. Transient elastography measurements will be performed before and at 1, 3 and 5 years after surgery. For those with an elevated preoperative transient elastography measurement by Fibroscan, a laparoscopic liver biopsy will be performed during surgery. Primary outcome measures are the change of steatosis and liver fibrosis 5 years after surgery. Secondary outcome measure is the comparison of the transient elastography measurements with the NAFLD Activity Score from the biopsies.

ETHICS AND DISSEMINATION

The protocol has been approved by the Medical Research Ethics Committees United, Nieuwegein, on 1 March 2022 (registration code R21.103/NL79423.100.21). The study results will be submitted for publication in peer-reviewed journals and data will be presented at scientific meetings.

TRIAL REGISTRATION NUMBER

NCT05499949.

Evidence-Based Classification for Post-bariatric Weight Regain from a Benchmark Registry Cohort of 18,403 Patients and Comparison with Current Criteria

INTRODUCTION

There is a need for a standardized, evidence-based classification of post-bariatric weight-regain, to investigate and compare revision procedures and to advice and treat patients in an evidence-based way.

METHODS

We used standard deviations (SD) of the highest (1-2 years) and latest (> 2 years) percentage total weight loss (%TWL) results after primary bariatric surgery from the Dutch Audit for Treatment of Obesity (DATO) bariatric registry as benchmarks for (above) average (≥ - 1SD), poor (- 1SD to - 2SD) and insufficient (< - 2SD) weight loss. Weight regain maintaining (above) average weight loss was called grade 1, weight regain towards poor weight loss grade 2, towards insufficient weight loss grade 3, with subgrades 2a/3a for below average weight loss from the start, and 2b/3b for weight regain from (above) average to below average weight loss. Patient characteristics and diabetes improvement/impairment were compared. Sensitivity and specificity of 14 existing weight regain criteria were calculated.

RESULTS

We analyzed 93,465 results from 38,830 patients (77.1% gastric bypass, 22.5% sleeve gastrectomy). The - 1SD thresholds for early and late weight loss approximated 25%TWL and 20%TWL, the - 2SD threshold for late weight loss 10%TWL. Weight regain could be analyzed for 18,403 patients (2.5-5.2 years follow-up). They regained mean 6.7 kg (5.4%TWL), with 66.8% grade 1 weight regain, 7.2% grade 2a, 7.4% grade 2b, 2.1% grade 3a, and 0.6% grade 3b. There were significant differences in comorbidities, gender, age, weight regain, diabetes impairment, and diabetes improvement across grades. Weight regain criteria from literature were extremely divers. None had high sensitivity.

CONCLUSION

The DATO classification for post-bariatric weight regain combines the extent of weight regain with evidence-based endpoints of weight loss. It differentiated weight regain maintaining (above) average weight loss, two intermediate grades, gradual weight regain with below average weight loss from the start (primary non-response) and steep weight regain towards insufficient weight loss (secondary non-response). The classification is superior to existing criteria and well supported by evidence.

Determination of weight loss effectiveness evaluation indexes and establishment of a nomogram for forecasting the probability of effectiveness of weight loss in bariatric surgery: a retrospective cohort

BACKGROUND

The purpose of this research was to determine the index that contributes the most to assessing the effectiveness of weight loss 1 year following bariatric surgery and to implement it as the clinical outcome to develop and confirm a nomogram to predict whether bariatric surgery would be effective.

METHODS

Patient information was extracted from the Chinese Obesity and Metabolic Surgery Database for this retrospective study. The most contributing weight loss effectiveness evaluation index was created using canonical correlation analysis (CCA), and the predictors were screened using logistic regression analysis. A nomogram for estimating the likelihood of effectiveness of weight loss was constructed, and its performance was further verified.

RESULTS

Information was obtained for 540 patients, including 30 variables. According to the CCA, ≥25 percentage total weight loss was found to be the most correlated with patient information and contribute the most as a weight loss effectiveness evaluation index. Logistic regression analysis and nomogram scores identified age, surgical strategy, abdominal circumference, weight loss history, and hyperlipidemia as predictors of effectiveness in weight loss. The prediction model's discrimination, accuracy, and clinical benefit were demonstrated by the consistency index, calibration curve, and decision curve analysis.

CONCLUSIONS

The authors determined a 25 percentage total weight loss as an index for weight loss effectiveness assessment by CCA and next established and validated a nomogram, which demonstrated promising performance in predicting the probability of effectiveness of weight loss in bariatric surgery. The nomogram might be a valuable tool in clinical practice.

eHealth Intervention via LINE® Social Media as an Adjunct for Postoperative Care After Bariatric-Metabolic Surgery: Single Institution Experience

PURPOSE

Applying eHealth interventions via social media is common in modern medicine. LINE® is a popular communication app in Taiwan that can deliver messages 24 h a day. In addition to being free of charge, it also allows bariatric nurses (BNs) and patients to enjoy bidirectional communication via telecommunication services instead of direct, face-to-face contact for patients undergoing bariatric-metabolic surgery (BMS). We conducted this retrospective study to determine the frequency and reasons for early post-discharge of LINE® messages/calls and investigate the relationship between this frequency and contents of these messages and postoperative outcomes after BMS.

MATERIALS AND METHODS

A retrospective review of prospectively collected data was conducted in an Asian weight management center. The study period ran from August 2016 to December 2021, and a total of 143 native patients with severe obesity were enrolled. All patients were informed of the necessity of a postoperative dietitian consultation before bariatric surgery. The patterns of LINE® communication with the BN and associated actions to resolve patients' needs within 180 days after index BMS were analyzed.

RESULTS

Among the 143 enrolled patients, 100 underwent laparoscopic sleeve gastrectomy and 43 underwent laparoscopic Roux-en-Y gastric bypass. A total of 1205 messages/calls were analyzed concomitantly; most LINE® communications focused on diet problems (47.97%; n = 578), weight problems (11.54%; n = 139), and medications (9.21%; n = 111). Most problems could be resolved by LINE® communications directly, and only a small portion (5.6%) was directed to local clinics or emergency departments. During the COVID-19 pandemic, the usage of LINE® communications significantly increased (12.2 ± 10.4 vs. 6.4 ± 4.9; p < 0.01); nonetheless, a higher frequency of LINE® communications would not hinder the regular clinic visits (r = 0.359; p = 0.01).

CONCLUSION

Based on our limited experience, the LINE® consultation service operated by the BN could effectively address patients' problems. Moreover, it might reduce the need for emergency department visits or unexpected clinic appointments for patients after BMS.

Definition, Mechanisms and Predictors of Weight Loss Failure After Bariatric Surgery

It has been proven that surgery is more effective than non-surgical treatment in obese patients. However, this approach has several disadvantages, especially long-term weight loss. Weight loss failures can be broadly classified into two categories; insufficient weight loss (poor responder) and weight regain. However, a unified definition has not been established yet for each category, and there is no clear standard for the post-surgery time point to be used to assess weight loss failure. In addition, analyzing factors that contribute to weight loss failure will lead to strategies for reducing it. Therefore, many researchers have been interested in this subject and have published conflicting results. This review presents a definition for and describes the mechanisms and predictors of weight loss failure after bariatric surgery.

Evaluation of nonalcoholic fatty liver disease (NAFLD) in severe obesity using noninvasive tests and imaging techniques

The prevalence of nonalcoholic fatty liver disease (NAFLD) and the more severe and inflammatory type, nonalcoholic steatohepatitis (NASH), is increasing rapidly. Especially in high-risk patients, that is those with obesity, metabolic syndrome, and type 2 diabetes mellitus, the prevalence of NAFLD can be as high as 80% while NASH may be present in 20% of these subjects. With the worldwide increase of obesity, it is most likely that these numbers will rise. Since advanced stages of NAFLD and NASH are strongly associated with morbidity and mortality-in particular, cardiovascular disease, liver cirrhosis, and hepatocellular carcinoma-it is of great importance to identify subjects at risk. A great variety of noninvasive tests has been published to diagnose NAFLD and NASH, especially using blood- and imaging-based tests. Liver biopsy remains the gold standard for NAFLD/NASH. This review aims to summarize the different mechanisms leading to NASH and liver fibrosis, the different noninvasive liver tests to diagnose and evaluate patients with severe obesity.

Additional preconditioning program for bariatric surgery: Any benefits? A large cohort study

Postbariatric outcomes may improve by providing an additional preconditioning program (APP) in targeted patients. However, APPs are a demand for health resources while only little and inconsistent evidence consists to support their effectiveness. This cohort study aims to evaluate the effectiveness of APP, by comparing outcomes of patients with and without such APP. We carried out a retrospective single-centre cohort study in a before-after design. Patients signing up for primary gastric bypass or sleeve gastrectomy and eligible for surgery were included if screened as vulnerable patients. Vulnerable patients screened between September 2017 and March 2018 followed an APP and formed the APP-group. Due to a policy change, APPs were no longer performed since September 2018. Vulnerable patients screened between September 2018 and March 2019 thus did not receive an APP (comparator-group). Multidisciplinary follow-up remained unchanged. Endpoints included percentage total weight loss (%TWL), bodyweight, evolution of comorbidities, protein intake, and number of no-shows. The APP-group comprised 231 patients and the comparator-group 153. %TWL differed statistically significantly at 7 (Δ1.5%, p = .01) and 12 months postoperative (Δ2.8%, p < .01) in favour of the comparator-group, as did bodyweight 12 months postoperative (Δ1.8 kg, p < .01). Statistically significant differences were also found in the evolution of comorbidities, protein intake, and the number of no-shows, most in favour for the comparator-group. APP proofed not to be superior to Non-App. It is debatable whether statically significant differences are clinically relevant given their small magnitude. A care pathway without an APP seems at least as effective as a care pathway without.

Evaluation of the effectiveness of weight loss and the return of lost weight after sleeve gastrectomy in the long term follow-up period

Sleeve gastrectomy, originally proposed as part of a two-stage operation, more than 15 years ago, is recognized as an independent, effective intervention for the treatment of obesity. The purpose of this review was to evaluate the effectiveness of sleeve gastrectomy based on data on long-term follow-up of patients. A search was performed in two databases, 33 literary sources were selected based on the results of the selection. In this review, the authors evaluated some parameters characterizing the effectiveness of sleeve gastrectomy in the long term after surgery. The percentage of follow-up of patients in the long-term period (follow up, %) varied from 5,6% to 97%, the expected decrease in % follow up over time did not occur. The authors have suggested similar results due to the heterogeneity of the data of the analyzed sources. By the five-year period, the detected average % of follow-up did not correspond to the optimal recommended level of follow-up for operated patients by this time. The most common criterion for assessing the return of weight is an increase in body weight by more than 10 kg from the lowest achieved. The prevalence of this phenomenon ranged from 26.3% to 44%. Among the reasons predisposing to weight loss are the initial high BMI, old age, dilatation of the formed stomach. In the absence of a universal definition of various terms (follow up, unsatisfactory result of surgery, weight loss, etc.), the results among the same patients when using different definitions will differ, there is a need to adopt standards when describing these phenomena. Despite the likelihood of weight loss after longitudinal resection, this operation is relatively simple from a technical point of view, safer, it can be used to improve the course of concomitant pathology (diabetes mellitus, hypertension), improve the quality and increase the life expectancy of patients.

Cirugía bariátrica en pediatría, ¿qué impacto tiene? Revisión de la literatura

Introducción. La obesidad en la población pediátrica ha ido aumentando de manera progresiva y el manejo médico de la obesidad mórbida en esta población se ha mostrado insuficiente. El objetivo de este artículo fue describir el estado actual de la literatura científica publicada hasta abril 15 de 2021 sobre el impacto de la cirugía bariátrica en la población pediátrica. Métodos. Se realizó una revisión de la literatura que evaluó dos bases de datos, donde se incluyeron revisiones sistemáticas, reportes de casos, series de casos y ensayos clínicos, publicados desde el 1 de enero de 2010 hasta el 15 de abril de 2021, en español, inglés y francés. Resultados. Se incluyeron 56 documentos y 18 estudios clínicos, en los que se encontró que la cirugía bariátrica (bypass gástrico por Y de Roux, gastrectomía en manga, plicatura gástrica y banda gástrica) alcanzó una pérdida de peso significativa en el primer año, con un adecuado sostenimiento de dicha pérdida al quinto año, además de una resolución completa de las comorbilidades metabólicas y cardiovasculares en la mayoría de los pacientes. Conclusión. La cirugía bariátrica se presenta como una alternativa eficaz en el manejo de la obesidad mórbida y sus complicaciones en el paciente pediátrico

6M50LSG Scoring System Increased the Proportion of Adequate Excess Body Weight Loss for Suspected Poor Responders After Laparoscopic Sleeve Gastrectomy in Asian Population

PURPOSE

We aimed to evaluate the efficacy of the predictive tool, 6M50LSG scoring system, to identify suspected poor responders after laparoscopic sleeve gastrectomy (LSG).

METHODS

The 6M50LSG scoring system has been applied since 2019. Suspected poor responders are defined by EBWL at 1 month < 19.5% or EBWL at 3 months < 37.7% based on the 6M50LSG scoring system. Our analysis included 109 suspected poor responders. Based on the date of LSG, the patients were separated into two groups: the 2016-2018 group (before group, BG, with regular care) and the 2019-2020 group (after group, AG, with upgrade medical nutrition therapy).

RESULTS

At the end of the study, the AG group had a significantly higher proportion of adequate weight loss, which was defined as EBWL ≥ 50% at 6 months after LSG, than that in the BG group (18.92% in BG vs. 48.57% in AG, p = 0.003). The AG group demonstrated significantly more 3-months-TWL (BG: 15.22% vs. AG: 17.54%, p < 0.001) and 6-months-TWL (BG: 21.08% vs. AG: 25.65%, p < 0.001). In multivariate analyses and adjustments, the scoring system (AG) resulted in significantly higher chances of adequate weight loss in suspected poor responders (adjusted OR 3.392, 95% CI = 1.345-8.5564, p = 0.010). One year after LSG, suspected poor responders in AG had a significantly higher weight loss than those in BG (BG vs. AG: TWL 27.17% vs. 32.20%, p = 0.014) .

CONCLUSION

This study confirmed that the 6M50LSG scoring system with upgraded medical nutrition therapy increased the proportion of suspected poor responders with adequate weight loss after LSG.

Weight-loss thresholds after bariatric surgery and cardiovascular outcomes: more is better

BACKGROUND/OBJECTIVES

Whether the extent of weight loss (WL) modulates bariatric surgery (BS) cardiovascular benefits has scarcely been assessed. Several WL thresholds have been commonly used to classify BS patients as good or poor responders without a proven clinical relevance. We examined the relationship between the magnitude of WL after BS and post-surgery major adverse cardiovascular-event (MACE) incidence. We also compared the performance of three different insufficient weight-loss (IWL) criteria for their association with MACE.

SUBJECTS AND METHODS

All individuals who underwent a primary Roux-en Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in our institution at least six years before data analysis (12/2020) were included in the study. Data on MACE were available in 1638 of 1700 participants (96.4%). Proportional-hazard Cox analyses were performed to ascertain the association between MACE, WL, and the three IWL criteria. IWL was defined as: <50% excess weight loss (<50% EWL), <20% total body-weight loss (<20% TBWL), and -1 standard deviation of alterable weight-loss percentage (<1 SD% AWL).

RESULTS

During a mean follow-up of 10.2 ± 2.8 years, 86 participants experienced a first post-surgery MACE. Higher WL at one year (HR: 0.77 (95% CI: 0.61-0.98)) and 5 years (HR: 0.63 (95% CI: 0.42-0.92)) was related to a lower incidence of MACE. All short-term criteria for defining IWL were similarly associated with MACE, yet <1 SD% AWL identified more at-risk subjects. Five-year TBWL < 20% and 5-year <1 SD-AWL% were significantly associated with a higher risk for CV events. TBWL < 20% identified more subjects at risk.

CONCLUSIONS

The extent of WL is closely related to long-term MACE incidence. Patients who lost -1SD% AWL at one year or <20% TBWL at five years may be considered poor responders.

Centile Charts for Monitoring of Weight Loss Trajectories After Bariatric Surgery in Asian Patients

BACKGROUND

Following bariatric surgery, accurate charting of weight loss and regain is crucial. Various preoperative factors affect postoperative weight loss, including age, sex, ethnicity, and surgical type. These are not considered by current weight loss metrics, limiting comparison of weight loss outcomes between patients or centers and across time.

METHODS

Patients (n=1022) who underwent sleeve gastrectomy (n=809) and gastric bypass (n=213) from 2008 to 2020 in a single center were reviewed. Weight loss outcomes (% total weight loss) were measured for 60 months postoperatively. Longitudinal centile lines were plotted using the post-estimation predictions of quantile regression models, adjusted for type of procedure, sex, ethnicity, and baseline BMI.

RESULTS

Median regression showed that %TWL was 1.0% greater among males than females (β = +1.1, 95% CI: +0.6 to +1.7, P = <0.0001). Participants who underwent SG had less %TWL compared to GB (β = -1.3, 95% CI: -1.9 to -0.8, P < 0.0001). There was a trend towards less %TWL among the Indian and Malay participants compared to Chinese. Age and diabetes were not significant predictors. Reference centile charts were produced for the overall cohort, as well as specific charts adjusted for type of bariatric procedure, sex, ethnicity, and baseline BMI.

CONCLUSION

Centile charts provide a clinically relevant method for monitoring of weight trajectories postoperatively and aid in realistic and personalised goal setting, and the early identification of "poor responders". This is the first study to present post-bariatric surgery centile charts for an Asian cohort.

Place Work on a Scale: What Do We Know About the Association Between Employment Status and Weight Loss Outcomes After Bariatric Surgery?

Despite the initial successful weight loss after bariatric surgery, a significant amount of patients experience weight loss failure and weight regain. Several factors are known to contribute to this, though the impact of employment status is unknown. The objective of this systematic review was to examine the impact of employment status on post-surgical weight loss outcomes. Eight studies were included with a follow-up ranging between 2 and 10 years. Employed patients seemed to present more weight loss (9.0-11.0% EWL, 1.3-1.6% BMI loss) compared to unemployed patients, but none of these numbers were statistically significant. Moreover, there were contrasting findings in terms of weight regain. This review may highlight the importance of working status after bariatric surgery and warrants further investigation on this topic.

Reporting Weight Loss 2021: Position Statement of the Dutch Society for Metabolic and Bariatric Surgery (DSMBS)

Prevailing recommendations on reporting weight loss after bariatric and metabolic surgery are not evidence-based. They promote the outcome metric percentage excess weight loss (%EWL), sometimes indicated as percentage excess body mass index loss (%EBMIL). Many studies proved that this popular outcome measure, in contrast to other weight loss metrics, is inaccurate and error-sensitive when comparing weight loss within and between studies. It is inappropriate for assessing poor weight loss response and weight regain as well. The percentage (total) weight loss metric is the best alternative. The Dutch Society for Metabolic and Bariatric Surgery (DSMBS) recommends to stop using the %EWL (or %EBMIL) metric as primary outcome measure in all cases and calls on the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) to propagate this evidence-based recommendation.

What Is Weight Loss After Bariatric Surgery Expressed in Percentage Total Weight Loss (%TWL)? A Systematic Review

Percentage total weight loss (%TWL) might be better than percentage excess weight loss to express weight loss in bariatric surgery. In this systematic review, performed according to the PRISMA statement, results of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) are assessed in %TWL. A total of 13,426 studies were screened and 49 included, reporting data of 24,760 patients. The results show that, despite limiting data, LRYGB is favorable over LSG in terms of weight loss in short-term follow-up. Although recent guidelines recommend to use %TWL when reporting outcome in bariatric surgery, this study shows that there is still insufficient quality data in %TWL, especially on LSG. The use of %TWL as the primary outcome measure in bariatric surgery should be encouraged.

Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy in Terms of Efficacy and Safety: a Comparative Study During 11-Year Experience

PURPOSE

This cohort study was designed to compare the efficacy and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) for the management of morbid obesity during the 11-year experience.

MATERIALS AND METHODS

This study was conducted between July 2006 and August 2019. Annually we recorded data about the weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage of weight loss (%WL), weight regain, and postoperative complications into a prospectively collected database.

RESULTS

A total of 1146 patients (LRYGB=396 and LSG=750) aged >18 years old were included in the study. Over the first 7 years after surgery, the weight loss rate was significantly higher in the LRYGB-treated group than the LSG-treated group, and weight regain was significantly lower in the LRYGB-treated group in comparison with the LSG-treated group. Our results revealed that statistically, but not clinically, the efficacy of LRYGB and LSG is equivalent in terms of %WL, %EWL, and weight regain within 8 years and more. Besides, there were no significant differences in surgery-related mortality and severe complications between the two procedures.

CONCLUSION

Our study's results indicated that the clinical efficacy of LRYGB in the management of obesity is better than LSG during the 11-year experience. But the differences in weight loss and weight regain were not statistically relevant at 8 years and more after the surgery. Also, a comparison of severe complications did not indicate significant differences between the two groups.

Prevention and treatment of nutritional complications after bariatric surgery

Obesity and the corresponding burden of related diseases is a major public health issue worldwide that is reaching pandemic proportions. Bariatric surgery is the only intervention that has been shown to result in substantial and lasting weight loss, and a decrease in overall mortality for patients with severe obesity. Consequently, the population of patients having undergone this procedure is increasing. Multifactorial weight-dependent and independent mechanisms underlying metabolic diseases could also drive preventable, but potentially life-threatening, long-term nutritional complications. However, given post-bariatric patients are prone to functional gastrointestinal symptoms and substantial weight loss, nutritional complications might be challenging. This Review is focused on the prevention and treatment of nutritional complications after bariatric surgery in the clinical setting.

A systems biology approach to understand gut microbiota and host metabolism in morbid obesity: design of the BARIA Longitudinal Cohort Study

INTRODUCTION

Prevalence of obesity and associated diseases, including type 2 diabetes mellitus, dyslipidaemia and non-alcoholic fatty liver disease (NAFLD), are increasing. Underlying mechanisms, especially in humans, are unclear. Bariatric surgery provides the unique opportunity to obtain biopsies and portal vein blood-samples.

METHODS

The BARIA Study aims to assess how microbiota and their metabolites affect transcription in key tissues and clinical outcome in obese subjects and how baseline anthropometric and metabolic characteristics determine weight loss and glucose homeostasis after bariatric surgery. We phenotype patients undergoing bariatric surgery (predominantly laparoscopic Roux-en-Y gastric bypass), before weight loss, with biometrics, dietary and psychological questionnaires, mixed meal test (MMT) and collect fecal-samples and intra-operative biopsies from liver, adipose tissues and jejunum. We aim to include 1500 patients. A subset (approximately 25%) will undergo intra-operative portal vein blood-sampling. Fecal-samples are analyzed with shotgun metagenomics and targeted metabolomics, fasted and postprandial plasma-samples are subjected to metabolomics, and RNA is extracted from the tissues for RNAseq-analyses. Data will be integrated using state-of-the-art neuronal networks and metabolic modeling. Patient follow-up will be ten years.

RESULTS

Preoperative MMT of 170 patients were analysed and clear differences were observed in glucose homeostasis between individuals. Repeated MMT in 10 patients showed satisfactory intra-individual reproducibility, with differences in plasma glucose, insulin and triglycerides within 20% of the mean difference.

CONCLUSION

The BARIA study can add more understanding in how gut-microbiota affect metabolism, especially with regard to obesity, glucose metabolism and NAFLD. Identification of key factors may provide diagnostic and therapeutic leads to control the obesity-associated disease epidemic.

Interpretation of laboratory results after gastric bypass surgery: the effects of weight loss and time on 30 blood tests in a 5-year follow-up program

BACKGROUND

Long-term follow-up with blood tests is essential for bariatric surgery to be a successful treatment for obesity and related co-morbidities. Adverse effects, deficiencies, and metabolic improvements need to be controlled.

OBJECTIVE

We investigated the effects of time and weight loss on laboratory results in each postoperative phase after laparoscopic Roux-en-Y gastric bypass (LRYGB).

SETTING

Bariatric center of excellence, general hospital, Netherlands.

METHODS

We retrospectively evaluated results of 30 blood tests, preoperatively and at 6 months, 1 year, 2 years, and 5 years after LRYGB. The 2019 Dutch bariatric chart was used to define weight loss responses as outstanding (>p[percentile curve]+1 SD), average (p+1 SD to p-1 SD), and poor (<p-1 SD). Results are presented with fifth and 95th percentile cutoff values per blood test for each of these 3 weight loss responses at each of the 4 postoperative time intervals. We used ANOVA to determine mutual relations.

RESULTS

Results of 4835 patients were analyzed. Five-year follow-up was 58%. Blood levels of ferritin, mean-corpuscular-volume, thrombocytes, vitamin D, parathyroid-hormone, glycated hemoglobin (HbA1C), triglyceride, total-cholesterol, C-reactive-protein, gamma-glutamyl-transferase, alkaline-phosphatase, creatinine, vitamin B1, and total protein were related with weight loss response. All 30 blood tests were also related with time. For several blood tests, weight loss and time did not only influence median results, but also fifth and 95th percentile cutoff values. Many patients had better vitamin levels after the operation. We observed an increase of parathyroid-hormone and ongoing iron depletion up to 5 years post surgery.

CONCLUSIONS

Presenting results of 30 routine blood tests, including cutoff values based on fifth and 95th percentile, grouped by weight loss response and postoperative time interval after gastric bypass surgery is new. The elaborate tables and graphs could serve as practical guide for proper interpretation of laboratory results in postbariatric surveillance. Results underline the need for long-term follow-up, including blood tests.

Gastrojejunal Anastomotic Technique. Does It Matter? Weight Loss and Weight Regain 5 Years After Laparoscopic Roux-en-Y Gastric Bypass

Purpose

The gastrojejunostomy during laparoscopic Roux-en-Y gastric bypass (LRYGB) can be constructed by hand sewn (HSA), linear (LSA) and circular (CSA) stapler technique. They are all considered safe; however, it is not known which the best technique is. Short-term follow-up suggest no difference in weight loss or weight regain between them. However, there is no information on these parameters in the long term. Theatre time and cost are other important factors defining the best way to form gastrojejunostomy.

Materials and Methods

In a prospective longitudinal cohort study consecutive patients following primary LRYGB were recruited to a bariatric database in a tertiary care centre. Anastomotic technique, diameter, the length of operations and associated costs, weight loss and weight regain were recorded. Patients were followed up for 5 years.

Results

A total of 385 patients with an initial body mass index of 47.1 kg/m² (35–68) were enrolled to this study. This decreased to 33.3 kg/m² (21–54 kg/m²) after 5 years. There was no difference in %TWL after 3 years, P = 0.296, or 5 years, P = 0.187, between the techniques. The number of patients with weight regain was not different after 3 years, P = 0.224, or 5 years, P = 0.795. All techniques had similar operative time. CSA has a higher material cost. Early anastomotic stricture was more common following HSA; however, the difference was not significant.

Conclusion

Mid-term weight loss and weight regain are not related to anastomotic technique, and there is no difference in operative time associated to them. Circular stapler technique has a higher material cost due to the additional stapler.

Check point to get adequate weight loss within 6-months after laparoscopic sleeve gastrectomy for morbid obesity in Asian population

Purpose of this study is to develope a scoring system to predict the likelihood of excess body weight loss (EBWL) ≥ 50% 6-months after laparoscopic sleeve gastrectomy (LSG). From April 2016 to September 2018, data was collected from 160 patients (BMI ≥ 32) who underwent primary LSG with at least 6-months follow-up. They were separated into score generation (operated by one surgeon, n = 122) and validation groups (operated by 3 different surgeons, n = 38). EBWL at 6-months ≥ 50% was considered adequate weight loss. Independent variables including age, gender, initial body mass index (BMI), comorbidities, life-style habits, percentage of EBWL and percentage of total body weight loss at 1-week, 1-month, and 3-months were analyzed with mutivariate logistic regression to generate the scoring system. The system was applied to internal and external validation groups to determine efficacy. As results, between the score generation and internal validation groups, the only significant difference in patient characteristics was in exercise participation. EBWL at 1-month > 19.5% (1 point) and EBWL at 3-months > 37.7% (2 points) were identified as independent factors to predict EBWL at 6-months ≥ 50%. When scores were > 1, the system had 94.03% positive predictive value (PPV) and 81.82% negative predictive value (NPV) (AUC: 0.923). Internal validation scores > 1 had a 95.83% PPV and 85.71% NPV (AUC: 0.975). External validation results showed 88.59% PPV and 72.00% NPV (AUC: 0.802). We concluded that this scoring system provides a reliable, objective prediction of EBWL at 6-months ≥ 50%. Patients requiring more aggressive clinical follow-up and intervention can be detected as early as 1- to 3-months after LSG.