Obesity Surgery最新文献

Recurrent weight gain after metabolic bariatric surgery (MBS) threatens the durability of metabolic and renal benefits, yet its intricate relationship with kidney function remains underexplored. This review synthesizes evidence that weight regain (≥ 20% from nadir weight) reactivates obesity-driven kidney injury pathways, including glomerular hyperfiltration, lipotoxicity (toxic damage from lipid overload), and NOD-like receptor protein 3 (NLRP3) inflammasome activation (an immune complex driving inflammation). Consequently, albuminuria recurs in 20-35% of patients and eGFR decline accelerates. Procedure-specific dynamics modulate outcomes. Roux-en-Y gastric bypass (RYGB) offers superior kidney protection despite moderate regain (5.3-37% at 7 years). In contrast, sleeve gastrectomy (SG) shows higher regain (26.3-76% at 6 years) and weaker renal improvements. Critically, weight recurrence reactivates transforming growth factor-beta (TGF-β)/mothers against decapentaplegic homolog (SMAD) and Wnt/β-catenin fibrotic signaling, driving ectopic renal fat reaccumulation and tubular injury. Emerging strategies, including glucagon-like peptide-1 (GLP-1) agonists (27% albuminuria reduction) and endoscopic revisions, show promise in mitigating renal sequelae. However, definitional heterogeneity in weight regain and insufficient phenotyping of kidney-specific biomarkers impede clinical translation. This review underscores the urgency of personalized interventions to preserve kidney health in the context of post-bariatric weight recurrence, advocating for multidisciplinary approaches and future research into novel antifibrotic therapies.

Objective: The objective of this study was to evaluate the incidence of and risk factors for surgery-related pressure injuries (PIs) in bariatric surgery patients and to assess the effect of postoperative mobility on PI development.

Methods: This prospective, correlational, monocentric study included 279 individuals who underwent bariatric surgery. Patients were assessed for PIs every 8 hours during the first 48 hours postoperatively. Mobility status was evaluated via the Observer Mobility scale, and PI risk was measured via the Munro and Braden scales.

Results: The incidence of surgery-related PIs was 19%, with most patients classified as stage 1, predominantly affecting the knees, coccyx, and abdominal region. Independent risk factors for PI development included abnormal skin (p = 0.015), higher Munro scale scores (p < 0.001), increased postoperative pain (p < 0.001), and reduced mobility (p = 0.006).

Conclusions: In bariatric surgery patients, the use of surgery-specific risk assessment tools, effective pain management, early mobilization, and proper device placement play critical roles in reducing the risk of surgery-related PIs.

Introduction: The optimal biliopancreatic limb (BPL) length in One Anastomosis Gastric Bypass (OAGB) remains debated, largely due to limited long-term outcome data. The primary objective of this study was to evaluate five-year results of weight loss, metabolic outcomes, and complication rates following OAGB with a fixed 150 cm BPL.

Methods: This retrospective study was conducted at a high-volume bariatric center within the National Health Service (NHS) in the United Kingdom. We reviewed patients who underwent OAGB with a fixed 150 cm BPL between December 2015 and June 2019. Perioperative care followed the standard bariatric protocol of our institution. Patients were followed at six-month intervals for two years, and again at five years post-operatively.

Results: 274 patients were included, with a five-year follow-up rate of 73.7%. At two years, Mean %Excess Weight Loss (%EWL) was 77.0% (95% CI: 73.5-80.5) and Mean %Total Weight Loss (%TWL) was 35.0% (95% CI: 33.5-36.5). At five years, mean %EWL was 64.1% (95% CI: 60.7-67.5) and %TWL was 29.4% (95% CI: 27.9-30.9). Remission rates for type 2 diabetes, hypertension, and dyslipidemia were 55.8%, 32.2%, and 22.7%, respectively. The marginal ulcer rate was 4.5% (n = 9). Conversion to Roux-en-Y configuration (RYC) occurred in 5.9% (n = 12) of patients, and the malnutrition rate at five years was 0.5% (n = 1).

Conclusion: OAGB with a 150 cm BPL demonstrated effective outcomes with acceptable complication rates and a favorable balance between efficacy and safety, with a low incidence of severe malnutrition.

Background: One-anastomosis gastric bypass (OAGB) has gained global prominence as the third most performed bariatric procedure. Despite evidence of short-term efficacy, long-term outcomes remain understudied.

Methods: This PRISMA-compliant systematic review and meta-analysis evaluated long-term (≥ 5 years) outcomes of OAGB as primary and revisional procedures. Quality assessment and bias evaluation were conducted systematically.

Results: Analysis included 32 studies with 19,125 patients (76% primary OAGB) from 14 countries with mean follow-up of 6.7 years. At five years, mean excess weight loss(EWL) was 75%, increasing to 77% beyond five years. Obesity associated diseases resolution was substantial: type 2 diabetes (80%), obstructive sleep apnea (89%), and hypertension (61%). Complications were minimal: bile reflux (4%), marginal ulceration (2%), and malnutrition (1%). For revisional OAGB, %EWL at five years was 71%. The conversion rate to other bariatric procedures (all RYGB) was reported in 3% of patients following OAGB.

Conclusion: This analysis demonstrates OAGB's effectiveness for sustained weight loss and obesity associated diseases improvement at ≥ 5 years, supporting its role in long-term obesity management as a primary and revisional bariatric intervention.

Introduction: Internalized bias and stigma is consistently linked to increased depression, anxiety, sadness, low self-esteem, negative body image, disordered eating behaviours, and decline in mental health-related quality of life (HRQOL). Internalization of weight bias has also been associated with higher degree of obesity, lesser motivation to engage in physical activity, poorer adherence to dietary modification and weight-regain post bariatric surgery. While it has been studied extensively in the Western world, limited data exists on its prevalence in India.

Aims and objectives: To assess the degree of weight bias internalization (WBI) among people with obesity seeking consultation for metabolic and bariatric surgery in the Indian context.

Methods: A cross-sectional study to assess weight bias internalization was conducted among 142 participants attending a metabolic and bariatric clinic using the Weight Bias Internalization Scale (WBIS). 78.9% of the study participants were women. The participants were classified based on their average WBIS scores. Correlation of WBI scores with BMI and age was performed.

Results: The mean WBIS score was 4.7 ± 1.2, with 71.1% of participants scoring above the neutral threshold, indicating a high prevalence of internalized weight bias for all items. Responses to individual items further reflected a general pattern of dissatisfaction with body weight, low self-worth, and emotional distress associated with obesity. Age showed negative correlation with WBIS scores suggesting that younger the person, more the bias. BMI on the other hand had a positive correlation and participants with higher BMI showed greater internalized bias.

Conclusion: This is the first study in India that throws some light on the high burden of internalized weight bias among individuals with obesity seeking metabolic and bariatric surgery consultation. The findings underscore the need for focused interventions to address internalized bias and stigma to enhance psychological well-being, and encourage health-seeking behaviour in people living with obesity.

Introduction: Obesity is a complex and multifaceted condition that can lead to serious health issues. Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is highly effective treatment for severe obesity but may often leads to significant skeletal muscle loss, compromising long-term metabolic outcomes. Structured exercise may mitigate these effects, yet its impact on comprehensive surgical success remains underexplored. This randomized controlled trial evaluated the synergistic effects of a 16-week combined exercise program on the SF-BARI score, a holistic composite measure of weight loss and comorbidity remission, in post-RYGB patients.

Methods: Thirty-seven patients (mean age 46.9 ± 11.4 years, BMI 42.9 ± 5.14 kg/m²) underwent RYGB and were randomized to a supervised intervention group (IG, n = 19) or control group (CG, n = 17). The IG completed three 55-minute sessions weekly (aerobic and resistance training) starting one month post-surgery for 16 weeks. Outcomes, including anthropometry, percentage total weight loss (%TWL), SF-BARI score (integrating %TWL and remission of type 2 diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea), and complications, were assessed at one, five, eleven, and seventeen months post-surgery.

Results: Both groups achieved substantial weight loss (%TWL: IG 37% vs. CG 32.5% at 17 months after surgery and 12 months after exercise program, p = 0.139, d = 0.506), with no between-group differences in BMI or weight. However, the IG showed superior SF-BARI scores at 5 months after surgery and immediately after the exercise program (T0-months: 104 ± 13.8 vs. 92.3 ± 12, p = 0.012, d = 0.883) and 11 months after surgery and 6-months after the exercise program (T6-months: 107 ± 13.2 vs. 96.2 ± 16.8, p = 0.007, d = 0.526), driven by enhanced remission of hypertension (0% vs. 41.2%, p = 0.002) and dyslipidemia (0% vs. 23.5%, p = 0.025) at 17 months. Type 2 diabetes mellitus remission was high in both (> 94%, p = 0.935), and effect sizes indicated large clinical benefits in the short-to-medium term.

Conclusions: A 16-week combined exercise program post-RYGB significantly improves comprehensive outcomes via the SF-BARI score, enhancing metabolic comorbidity resolution beyond weight loss alone. These findings support integrating supervised exercise into postoperative care to optimize surgical outcomes. Sustained interventions may be needed for long-term gains.

Background: Linear magnetic compression is a novel technique to perform gastrointestinal anastomosis.

Objective: This Italian multi-center clinical investigation aimed to evaluate the feasibility, safety and efficacy of the creation of a side-to-side compression anastomosis using the GT Metabolic Solutions™ Magnet System, DI Biofragmentable (MagDI™ System) to achieve duodeno-ileal diversion.

Methods: Patients with a body mass index (BMI) of ≥ 30 to 50 kg/m² and weight regain and/or type 2 diabetes mellitus (T2DM) after sleeve gastrectomy (SG) and patients with a BMI of ≥ 30 to 35 kg/m² and T2DM underwent a side-to-side duodeno-ileal diversion using the GT Metabolic™ DI Magnet (linear, 39 mm).

Results: 28 patients (19 F) underwent surgery in 4 centers in the time between 09/24 and 02/25. Mean age and BMI were 44 years and 36.7 ± 4.4 kg/m². Mean operative time and hospital stay were 73.2 min and 1.6 days. Paired magnets were expelled in all patients in a mean of 37.3 days. There were three procedure-related serious adverse events (Clavien Dindo III, one ileal perforation on POD 1, one liver insufficiency leading to reversal on POD 144 and one trocar site hernia on POD 203). Mean BMI, %EWL and %TWL at 90 days (n = 23) were 32.7 ± 0.8 kg/m², 36.6 ± 4.6% and 10.4 ± 1.1%. Mean HbA1c decreased from 6% at baseline to 5.7% at 30 days and to 5.5% at 90 days.

Conclusion: Preliminary data shows that side-to-side magnet compression duodeno-ileal anastomosis was feasible, safe and effective. Future follow-up data is necessary.