Obesity Surgery最新文献

Background: Metabolic bariatric surgery (MBS) such as the Roux-en-Y gastric bypass (RYGB) is effective in the treatment of obesity. However, not every patient achieves optimal clinical response and recurrent weight gain remains a concern. Hypothetically, a narrow longer pouch could lead to better results by preventing pouch dilatation and slowing down gastric emptying rates. The aim of this study is to evaluate the effect of an extended pouch gastric bypass (EP-RYGB) on weight loss and quality of life 5 to9years (median 109 months [104-116]) postoperatively.

Methods: Follow-up study of a single-blinded RCT including 62 patients who underwent a standard Roux-en-Y gastric bypass (S-RYGB, n = 30) versus EP-RYGB (n = 32) between September 2014 and October 2015. Outcomes on weight loss, obesity related complications, health-related quality of life (HRQoL), and gastro-intestinal symptomswere compared between S-RYGB and EP-RYGB.

Results: Mean total weight loss (%TWL) was higher in EP-RYGB compared to S-RYGB (26.1 ± 11.2%, versus 24.1 ± 10.1%) although not statistically significant. More patients in the S-RYGB group tended to experience recurrent weight gain compared to EP-RYGB (70% versus 47%, p = 0.07). HRQoL and gastro-intestinal symptoms were comparable between groups (p > 0.05 for all).

Conclusion: EP-RYGB results in slightly better weight loss outcomes and similar HrQoL compared to S-RYGB 5 to 9 years postoperatively. However, due to loss to follow up, the current study is underpowered and a definitive long term advantage of EP-RYGB cannot be concluded.

Background: Previouarch indicates varyings rese effects of bariatric surgery on thyroid function. This meta-analysis aims to evaluate time-dependent changes in thyroid hormone levels following bariatric surgery in patients with obesity.

Methods: PubMed, Embase, and Scopus databases were systematically searched until July 2025 for observational studies including patients with obesity (body mass index ≥ 30 kg/m²) undergoing bariatric surgery, reporting changes in thyroid-stimulating hormone (TSH), free thyroxine (T4), or free triiodothyronine (T3) following surgery. A random-effects model was used for the meta-analysis, with meta-regression and subgroup analyses to evaluate the impact of age, sex, region, preoperative thyroid function, and surgery type on outcomes.

Results: A total of 57 studies with 8,030 participants were included. Significant reductions in TSH and FT3 levels were observed at 6-month (TSH: SMD: -1.43, 95% CI: -2.22 to -0.63; FT3: SMD: -1.89, 95% CI: -3.14 to -0.65) and 1-year (TSH: SMD: -1.38, 95% CI: -2.44 to -0.31; FT3: SMD: -2.14, 95% CI: -3.52 to -0.75). However, these reductions became non-significant at > 1-year follow-ups. No significant changes were observed in FT4 levels across all follow-up periods. Subgroup analyses indicated significant reductions in TSH and FT3 following sleeve gastrectomy, Roux-en-Y gastric bypass, and gastric banding, while bilio-pancreatic diversion did not result in significant hormone changes.

Conclusion: Bariatric surgery leads to significant reductions in TSH and FT3 levels at 6-month and 1-year follow-ups, with no significant change in FT4 level. Further studies are needed to explore the mechanisms of thyroid changes after bariatric surgery and develop strategies to optimize thyroid health in these patients.

Background: Weight loss has been shown to favorably affect obesity-related comorbid disease. Prior studies have shown that a 10% preoperative weight loss is associated with fewer complications after gastric bypass surgery. Although the optimal preoperative preparation for bariatric surgery is not standardized, prerequisite weight loss prior to bariatric surgical procedures is often mandated, typically around 10%, and includes a calorie-restrictive preoperative diet.

Objectives: To evaluate the association between extensive preoperative weight loss and perioperative outcomes in patients undergoing bariatric surgery.

Methods: To determine optimal weight loss prior to bariatric surgery, we compared patients who lost over 10% of their highest weight preoperatively to patients who did not within the MBSAQIP database from 2015 to 2021, which included over 1.3 million patients.

Results: Patients who lost more than 10% of their highest preoperative weight were more likely to experience postoperative complications, including reoperation (1.40% vs. 1.21%, p<.001), bleeding (0.85% vs. 0.67%, p<.001), emergency department visits (7.11% vs. 6.57%, p<.001), and dehydration (3.92% vs. 3.61%, p<.001). These differences remained significant with multivariable logistic regression analysis controlling for multiple patient factors and procedure type. Patients who lost more than 10% of their highest preoperative weight were also found to have a higher mortality (0.10% vs. 0.08%, p=.04) and readmission (3.92% vs. 3.60%, p<.001), however after multivariable logistic regression analysis these two findings did not retain their statistical significance.

Conclusion: Preoperative weight loss prior to bariatric surgery may be beneficial, however over 10% preoperative weight loss is associated with worse outcomes and should be cautioned.

Introduction: Metabolic and bariatric surgery (MBS) causes greater weight loss (WL) compared with low-calorie diet (LCD) that may be due to changes in appetite and gut hormones. The objective of this study was to quantify appetitive sensations in individuals who underwent LCD or MBS at equivalent weight loss (T2) and at one year (T3).

Methods: Visual analog scales (VAS) and the food craving inventory were used to assess appetite. Glucagon-like peptid-1 (GLP-1) levels were quantified by ELISA.

Results: Participants available for both T1 and T2 were as follows: LCD (n = 15), surgery (n = 24). By T3, LCD (n = 12) and surgery (n = 15). At T2, percent total WL (%TWL) was similar between LCD vs surgery (14.9% vs 14.6%; p = 0.94). At T3, there was greater %TWL after surgery compared with LCD (30.2% vs 14.6%; p < 0.0001). At T2, there was a significant increase in postprandial fullness and decreases in hunger and prospective eating only after surgery. Cravings decreased in both groups at T2 but remained decreased at T3 only after surgery. There was almost a two-fold increase from T1 to T2 in postprandial GLP-1 after surgery (p < 0.0001) that correlated with the increase in fullness (r = 0.69; p = 0.038); no change was noted after LCD (p = 0.34).

Conclusions: After equivalent WL, MBS results in favorable changes in appetitive sensations and GLP-1 levels compared with LCD. Such changes may support the ability to achieve greater reduction in body weight after MBS.

Introduction: Obesity significantly increases cardiovascular risk through insulin resistance, dyslipidemia, hypertension, and systemic inflammation. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and metabolic bariatric surgery (MBS) are effective weight-loss interventions that may improve cardiovascular outcomes. However, evidence comparing the long-term cardiovascular benefits of GLP-1RAs versus MBS remains limited. We systematically compare the impact of GLP-1RAs versus MBS on cardiovascular outcomes, including major adverse cardiovascular events (MACE), and heart failure (HF) in patients with obesity.

Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Embase were searched up to July 30, 2025, for studies comparing cardiovascular outcomes of GLP-1RAs and MBS. Inclusion criteria encompassed studies reporting cardiovascular disease (CVD), including MACE and HF. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses were performed using the R meta package. Heterogeneity was evaluated with I² statistics, and publication bias was assessed via funnel plots and Egger's test.

Results: Six cohort studies, including over 282,450 participants, compared cardiovascular outcomes of MBS versus GLP-1RAs. MBS was associated with a significantly lower prevalence of CVD (RR = 0.63; 95% CI: 0.49-0.81; I² = 87.7%) and HF (RR = 0.50; 95% CI: 0.37-0.66; I² = 70.2%) compared to GLP-1RAs. For cerebrovascular events, a non-significant trend favored MBS (RR = 0.68; 95% CI: 0.34-1.36; I² = 91%). Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected.

Conclusions: Compared to GLP-1RAs, metabolic bariatric surgery is linked to better cardiovascular outcomes and a decreased prevalence of heart failure in individuals with obesity. Although trends point to possible cerebrovascular benefits, there is insufficient research to draw firm conclusions. These findings might help physicians tailor their approaches to managing obesity in order to maximize the reduction of cardiovascular prevalence.