Obesity Surgery最新文献

Background: Sleeve gastrectomy (SG) is the most common bariatric procedure but requires revision in ~ 30% of cases due to suboptimal response or persistent obesity-related medical problems. Revisional options include re-sleeve gastrectomy, Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD/DS), and single-anastomosis duodenal switch (SADS), though long-term comparative data are limited.

Objectives: To assess medium- to long-term outcomes of four revisional surgeries after primary SG for suboptimal weight loss or persistent associated medical problems.

Setting: University hospital.

Methods: This retrospective study analyzed a prospectively maintained database of patients who underwent revisional bariatric surgery after SG between 2010 and 2021. Indications included suboptimal clinical response (< 50% excess weight loss), ≥ 20% recurrent weight gain, or persistent non-reflux obesity-related medical problems lasting ≥ 1 year. Revisions included re-sleeve, RYGB, BPD/DS, and SADS. Patients with ≥ 3 years of follow-up were evaluated for weight loss, associated medical problems resolution, and major complications.

Results: Of 113 eligible patients, 89 (79%) had ≥ 3 years of follow-up (median 70 [35] months). Median pre-revision BMI was 43.0 (8) kg/m², highest in duodenal switch-type procedures (p = 0.005). Median BMI reduction was 6.0 (7) kg/m². BPD/DS showed the highest median total weight loss (20% [12]) and diabetes resolution, though not statistically significant (p = 0.148 and 0.089). Major complications beyond 6 months were similar across groups (p = 0.248).

Conclusions: Revisional surgery after primary SG offers modest long-term benefits. Duodenal switch-type procedures show superior trends with comparable safety.

Background: Laparoscopic Adjustable Gastric Band (AGB) has shown suboptimal long-term results with a non-success rate of 20-56% with an accompanying removal rate of 10-50% due to suboptimal clinical response or complications. Conversion to RYGB is proven to be a safe and effective option. However, current literature contains no studies which use additional placement of a silicone ring (MiniMizer) around the pouch. Therefore, this study aims to evaluate the safety and effectiveness of conversion from AGB to ring augmented RYGB (raRYGB).

Methods: All consecutive laparoscopic AGB to raRYGB conversions performed between January 2016 and October 2023 were included. All procedures were performed by a one-stage approach. The primary outcome was percentage total weight loss (%TWL) after 1-year follow-up. Secondary outcomes consisted of %TWL after 2, 3, 4, and 5 years, cumulative %TWL, and early and late complications.

Results: We included a total of 240 patients of whom 195 were female (81.3%). Mean pre-conversion BMI was 40.3 kg/m². The average %TWL 1- and 5-year after the conversion was 25.4% and 18.9%. Cumulative %TWL, calculated from before AGB, was 33.7% after 1 and 30.2% after 5 years. 8 complications occurred within 30 days, 3 of which were ≤ CD3a and 5 ≥ CD3b. A total of 8 MiniMizers were removed.

Conclusion: Conversion from laparoscopic AGB to raRYGB is a valid one-stage conversion method with significant weight loss after 1 and durable weight loss up to 5 years of follow-up. The short- and long-term complication rate is acceptable and ring-specific complications are rare.

Background: Chronotype reflects an individual's intrinsic circadian preference for the timing of daily behaviors, including sleep, eating, and physical activity. It influences not only biological rhythms but also lifestyle patterns that may impact metabolic health. In the context of bariatric surgery, numerous factors may affect postoperative outcomes such as weight loss and the risk of weight regain. Given the growing interest in chronobiology and its relevance to obesity management, this study aimed to explore whether chronotype is significantly associated with key weight loss outcomes following bariatric surgery at 6 and 12 months post-intervention.

Methods: A total of 263 patients underwent bariatric surgery at a single center. Baseline assessments included anthropometric, biochemical, and behavioral evaluations, including chronotype categorization. Postoperative outcomes at 6 and 12 months included absolute weight, BMI, percentage of initial body weight loss (%IBWL), and percentage of excess body weight loss (%EBWL).

Results: There was no significant difference among the three different chronotypes (evening, intermediate, and morning chronotype) in terms of absolute weight, BMI, %EWL and %IBWL at 6 and 12 months after surgery.

Conclusions: Our results suggest that chronotype does not seem to play a critical role in weight loss outcomes in bariatric surgery patients, characterized by severe obesity. Further studies are needed to more thoroughly assess the impact of chronotype on bariatric surgery outcomes and a more detailed characterization of chronotype itself in these patients could be decisive.

Introduction: The method for assessing the bowel length is debatable but crucial in bariatric surgeries, especially revisional ones. It may be linked to improved weight loss and reducing nutritional deficiencies; however, it can be time-consuming, increasing the likelihood of complications during and after the surgery. 3D CT volumetry could offer a non-invasive, time-saving alternative for accurate Total Bowel Length (TBL) measurement, potentially reducing operative time and associated risks.

Objective: This study compares small bowel length using 3D CT volumetry versus in vivo laparoscopic measurement with pre-marked graspers, and assesses the time consumed intra-operatively for TBL measurement in cases of revisional bariatric surgery.

Methods: This cross-sectional study included 34 bariatric surgery candidates undergoing revisional or conversion bariatric surgery requiring bowel length estimation. Surgeries included Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), one-anastomosis gastric bypass (OAGB), banded Roux-en-Y gastric bypass (banded RYGB), and distalization. Pre-operatively, 3D CT volumetry-based bowel length measurements were performed and interpreted by the same radiologist, and compared with intraoperative bowel measurements, which were estimated in vivo laparoscopically using pre-marked graspers. A single surgeon did all the surgical procedures.

Results: The participants had an average age of 42.0 years and a mean BMI of 40.4 ± 7.6 kg/m². The cohort was predominantly female (73.5%). The bowel length estimation took an average of 19 ± 4 min intra-operatively. A comparison of radiographic and intraoperative measurements showed no significant differences for TBL (P = 0.264). The intraclass correlation (ICC) for radiographic and intraoperative measurements showed that radiographic TBL shows acceptable consistency (P = 0.007).

Conclusion: 3D CT volumetry can be considered a reliable and safe method for TBL assessment. It aids in accurate preoperative planning, reduces operative time, and avoids the risks encountered during intraoperative bowel measurements in bariatric surgery.

Key points: • An ideal bowel length should achieve effective weight loss while minimizing nutritional deficiencies. • Estimation of total bowel length using 3D CT volumetry shows reliable results compared to intraoperative measurements. • Estimation of total bowel length using 3D CT volumetry minimizes operative time.

Background: The influence of preoperative psychological profiles on weight loss following sleeve gastrectomy (SG) has not been thoroughly examined, particularly with respect to sex differences.

Aim: To analyze the preoperative psychological profiles of individuals with obesity and explore whether sex differences exist in the associations between preoperative psychological factors and weight loss after SG.

Methods: This prospective cohort study involved participants scheduled for SG at an affiliated hospital between November 2020 and September 2022, with a follow-up period of 1-year post-surgery. Preoperative psychological profiles were assessed using validated scales, covering anxiety, depression, self-esteem, internalized weight bias, eating behaviors, sleep quality, and quality of life. Independent t-tests and Pearson correlation analyses were used to assess sex differences and associations between psychological factors and %TWL at 1-year post-surgery. Univariate and multivariate regression analyses were then performed to identify independent predictors of %TWL at 1-year post-surgery, with significance defined as p < .05.

Results: In total, 491 patients with obesity undergoing SG were enrolled, of whom 452 (314 women and 138 men) completed the study. Preoperatively, participants exhibited high levels of internalized weight bias, moderate alterations in eating behaviors, and poor sleep quality and quality of life. Compared to women, men demonstrated significantly lower levels of anxiety, depression, internalized weight bias, and emotional eating, but demonstrated significantly higher health transition scores (i.e., self-perceived improvement in general health compared to one year ago). Among women, 1-year postoperative weight loss was significantly positively associated with preoperative anxiety and internalized weight bias, but negatively associated with self-esteem and quality of life. Conversely, no statistically significant associations were found between preoperative psychological factors and weight loss outcomes in men. In multivariate regression analysis, no psychological factors independently predicted %TWL at 1-year post-surgery in women.

Conclusions: Sex differences were observed in the associations between preoperative psychological factors and weight loss after SG. Among women, psychological factors demonstrated stronger associations with weight loss after SG; however, none of these remained significant predictors in the multivariate regression model. No such associations were observed in males. These findings suggest that the impact of preoperative psychological factors on postoperative weight loss may be complex and merit further investigation.

Background: Metabolic bariatric surgery leads to improved life expectancy in younger individuals, but whether older (> 60 years) individuals benefit from metabolic bariatric surgery is uncertain. This study examined mortality and causes of death in patients with metabolic bariatric surgery at age 60 years or older.

Materials and methods: This was a population-based matched cohort study based on all healthcare in Denmark, Finland, and Sweden between 1996 and 2024. All patients who had primary metabolic bariatric surgery at age > 60 years were included and exactly matched 1:5 to comparison individuals of the same age, sex, country, and calendar year with non-operative treatment for obesity. Cox regression provided hazard ratios with 95% confidence intervals for mortality adjusted for multiple obesity-related diseases and frailty.

Results: In total, 3879 (16.7%) patients with metabolic bariatric surgery and 19395 (83.3%) patients with non-operative treatment for obesity were included and followed for 176632 person-years. The cumulative mortality was 17.5% (n = 677) among operated patients compared to 23.5% (n = 4536) in the non-operated. In adjusted analyses, metabolic bariatric surgery was associated with 32% decreased mortality (HR 0.68, 95% CI 0.63-0.73). The results were consistent in patients of age > 60-70 years at the time of surgery, but there was no apparent benefit in patients operated at age > 70 years (HR 1.14, 95% CI 0.89-1.47). Operated patients were less likely to die from cardiovascular disease (57.6% versus 65.8%, p < 0.001), but other causes of death were similarly distributed between the groups.

Conclusion: Metabolic bariatric surgery may decrease mortality in older patients with severe obesity.

Background: Vitamin D deficiency is common in people with obesity and can worsen after bariatric surgery. As the reproductive years and post-menopausal status can place additional demands on vitamin D requirements, we studied vitamin D status after bariatric surgery in women under 45 years of age compared with women over 45.

Methods: We conducted an observational cohort study of 305 women undergoing primary bariatric surgery at a university teaching hospital in North West England. Participants were stratified by age into women under 45 years (Wu45, n = 123) and over 45 years (Wo45, n = 182). Patients were routinely prescribed daily calcium and vitamin D supplementation after bariatric surgery. Serum 25-hydroxyvitamin D, adjusted calcium, parathyroid hormone (PTH) and metabolic parameters were measured preoperatively and at intervals over 24 months postoperatively.

Results: After bariatric surgery, vitamin D levels rose significantly within 4 months but were lower in Wu45 at 12 and 24 months (p < 0.05). Adjusted calcium levels declined over time, with Wu45 showing significantly lower levels at 12 and 24 months. PTH levels, initially lower in Wu45, increased and equalized with Wo45's levels by 12 months.

Conclusions: Women under 45 are at increased risk of vitamin D and calcium deficiencies after bariatric surgery. This may reflect higher physiological demands and variable adherence to supplementation. Patient education and tailored supplementation strategies may be required to prevent long-term micronutrient complications.

Background: Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity; however, a significant subset of patients do not achieve the expected weight loss or experience substantial weight recurrence over time. While intestinal energy absorption potentially influences weight loss outcomes, this phenomenon has not been investigated in post-MBS patients. Therefore, we assessed the relationship between diet, intestinal energy absorption, and weight outcomes in individuals post-MBS.

Methods: Caloric intake, determined via dietary questionnaires, and fecal energy density, determined via bomb calorimetry, were used as a proxy to assess calorie absorption before and after gastric bypass or sleeve gastrectomy. Within a total of 67 patients, fecal energy density was measured at 0, 1, 6, 12, 18, and 24 months. A dynamic linear mixed-effects model was used to examine the longitudinal association between intestinal energy harvest and subsequent weight loss following MBS. Multivariate regression was developed to identify potential weight loss predictors, and random forest algorithms were employed to forecast weight results based on intestinal energy absorption.

Results: Intestinal energy absorption changed over the pre- and post-MBS periods. Random forest models indicated that intestinal energy absorption enhanced the predictability of patient weight loss outcomes.Fecal energy density was modestly but significantly associated with weight loss at later postoperative time points (p = 0.04), suggesting that reduced intestinal energy absorption contributes to more sustained weight reduction post-MBS. Associations between diet and energy absorption were not significant.

Conclusion: MBS changes energy absorption capacity post-surgery. A higher relative fecal energy content (lower energy absorption) at early timepoints are associated with better weight loss outcomes at later timepoints post-MBS. Findings may guide the development of diagnostic tools and treatment guidelines for patients at risk of suboptimal weight loss outcomes.