Obesity Surgery最新文献

This meta-analysis evaluated the analgesic efficacy of erector spinae plane block (ESPB) in metabolic surgery through analysis of ten randomized controlled trials (786 patients). ESPB demonstrated superior pain control compared to placebo from 2-12 h postoperatively, with peak effect at 6 h and sustained movement-related pain reduction through 24 h. ESPB showed comparable analgesic efficacy to other nerve blocks within 24 h postoperatively. The technique significantly reduced intraoperative and postoperative opioid consumption, extended time to first analgesic requirement, and decreased rescue analgesia needs. Additionally, ESPB recipients experienced reduced postoperative nausea and vomiting and shorter hospital stays. These findings support ESPB as an effective component of multimodal analgesia protocols for metabolic surgery, though standardization of techniques and long-term outcome studies are needed.

Background: Obesity is a global health issue that complicates surgical outcomes, particularly in bariatric/metabolic surgery candidates. Assessing functional capacity is critical for optimizing preoperative planning and postoperative care. The Duke Activity Status Index (DASI) is a simple, self-administered questionnaire that estimates functional capacity based on daily activities. This study evaluates the reliability and clinical applicability of the DASI as an alternative to the 6-min walk test (6-MWT) for bariatric/metabolic surgery individuals living with obesity.

Methods: This cross-sectional study included 126 individuals who are candidates for bariatric/metabolic surgery. Participants completed the DASI and 6-MWT. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs), and validity was evaluated through correlations with 6-MWT results. The agreement was measured using the standard error of measurement (SEM) and minimal detectable change (MDC).

Results: The DASI demonstrated excellent internal consistency (Cronbach's alpha = 0.86) and test-retest reliability (ICC = 0.97, 95% CI: 0.96-0.98). A strong correlation was observed between DASI and 6-MWT scores (r = 0.603; p < 0.001). ROC analysis showed an optimal cut-off score of 24.1 (AUC = 0.836), with 72.2% sensitivity and 74.1% specificity. The SEM and MDC values were 2.36 and 6.54 points, respectively.

Conclusions: The DASI is a reliable, accessible tool for bariatric surgeons to assess functional capacity in candidates for bariatric/metabolic surgery. Its simplicity, strong correlation with performance-based measures, and minimal resource requirements make it ideal for preoperative evaluations, particularly in resource-limited settings.

Background: Transoral outlet reduction endoscopy (TORe) and glucagon-like peptide-1 agonist, liraglutide, have individually shown promise in managing weight regain after Roux-en-Y gastric bypass. However, combined effects of adjunctive liraglutide to TORe remain unexplored. A cross-over design was utilized to evaluate the efficacy of liraglutide treatment when initiated immediately post-TORe or 1 year post-TORe.

Methods: Data was analyzed from a double-blinded randomized controlled trial conducted at three outpatient clinics in São Paulo, Brazil, from January 2019 to December 2021. Two cohorts were established: group placebo then liraglutide (group PL) received subcutaneous saline dosed daily for 12 months after TORe then liraglutide for the subsequent 12 months, while group liraglutide then placebo (group LP) started subcutaneous liraglutide followed by subcutaneous saline in a similar fashion. Each participant received placebo and liraglutide for equal duration over the 24-month treatment phase. The primary outcomes were percent total body weight loss (%TBWL) at 12 and 24 months.

Results: The study comprised 58 participants in group PL and 51 participants in group LP, with no significant difference in mean baseline BMI between groups. Group LP showed significantly higher %TBWL than group PL at 6, 9, and 12 months. Surprisingly, at 21 and 24 months, group LP continued to exhibit greater %TBWL than group PL, even after discontinuing liraglutide.

Conclusion: Immediate post-procedure administration of liraglutide appears to be more effective than placebo in reversing weight regain in patients undergoing TORe. Results indicate that the timing of post-TORe liraglutide initiation may enhance the therapeutic benefits of the procedure.

Introduction: Metabolic and bariatric surgery (MBS) is increasingly used for obesity and metabolic disease, with safety profiles showing it is among the safest major operations. The last 20 + years have noted significantly improved safety that has been accompanied by decreasing length of stay and select populations electing for outpatient surgery, leading to continued decreases in cost. Regardless, readmissions and complications still occur, requiring inpatient postoperative care (IP-POC). The current study aimed to identify and characterize at-risk populations for MBS-related IP-POC.

Study design: The 2015-2021 MBSAQIP (n = 1,346,468 records) was used to extract 973,520 primary cases of laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, duodenal switch, and associated IP-POC. Conversions, pediatric cases, and < 30-day follow-up were excluded. IP-POC severity scores were calculated by summing readmissions (1 point), interventions (5 points), and reoperations (15 points). Risk factors associated with IP-POC were identified using zero-inflated Poisson models.

Results: GERD, COPD, smoking, and type of MBS procedure were significantly associated with increased IP-POC incidence and severity. Male sex was associated with increased severity but a lower likelihood of IP-POC, while Black and Hispanic race predicted increased IP-POC likelihood but not severity. ROC curve analysis identified IP-POC score thresholds of ≥ 6 and ≥ 10 as significantly associated with MACE (OR 2.4) and 30-day mortality (OR 4.7).

Conclusion: The weighted IP-POC model demonstrated associations between preoperative characteristics and increased IP-POC likelihood and severity. These findings add to the current understanding of MBS patient care dynamics, and can be used to improve patient counseling, refine postoperative protocols, and optimize resource allocation.