Obesity Surgery最新文献

Background: Pneumoperitoneum and the reverse Trendelenburg (RT) position during laparoscopic sleeve gastrectomy (LSG) can induce autonomic instability and increase the risk of arrhythmias by reducing venous return. This study aimed to evaluate the impact of surgical positioning during LSG on autonomic cardiac function, using hemodynamic parameters and the cardiac electrophysiological balance index (iCEB = QT/QRS) as a biomarker.

Methods: This prospective observational study included 66 patients with severe obesity who underwent LSG. Measurements were recorded at five distinct time points, corresponding to specific patient positioning during the procedure: P-baseline (before induction, supine), P1 (after induction, supine), P2 (after pneumoperitoneum, supine), P3 (during pneumoperitoneum, RT), and P4 (after desufflation, RT).

Results: Systolic, diastolic, and mean arterial pressures (SAP, DAP, and MAP) significantly decreased at all positions compared to baseline (p < 0.001 for each). Compared to post-induction (P1), SAP values were substantially higher in the P2 and P4 positions (p < 0.05, p < 0.001, respectively). Heart rate significantly decreased at P1 compared to baseline (p < 0.004) and subsequently increased at P2 and P3 relative to P1 (p < 0.001 and p < 0.009, respectively). A notable increase in iCEB was observed at P4 when compared to P1, P2, and P3 (p < 0.003, p < 0.001, and p < 0.021, respectively). Despite these changes, iCEB values remained within the reference range across all measured positions.

Conclusion: Despite the observed effects of positional changes and pneumoperitoneum on hemodynamic and cardiac electrical parameters during LSG, most patients tolerated these changes well. Crucially, iCEB values remained within the normal reference range throughout the procedure, indicating preserved cardiac autonomic regulation.

A network meta-analysis of randomized controlled trials (RCTs) was conducted to establish the ranking of various bariatric surgeries in mid- and long-term follow-up durations for people with type 2 diabetes mellitus (T2DM), based on T2DM remission, HbA1c levels, and cardiometabolic outcomes. We searched PubMed, Embase, Medline, and Cochrane Central databases. A common comparator was identified between interventions to develop a network. Mean difference (MD) and 95% confidence interval (CI) were estimated between interventions. Direct and indirect evidence were pooled using the random-effect model. Eleven RCTs and four bariatric surgeries, including Roux-en-Y gastric bypass (RYGB), laparoscopic-adjustable gastric banding (LAGB), biliopancreatic diversion without duodenal switch (BPD), sleeve gastrectomy (SG), and medical/lifestyle treatment (MT) as a comparator group, were included. RYGB, LAGB, BPD, SG, as compared with MT, were all significantly associated with the remission of T2DM and HbA1c levels. While BPD is the best one for remission (MD: -5.14 [95% CI -7.33 to -2.96]), HbA1c (MD: -31.75 [95% CI -37.73 to -25.77]), the evidence is sparse. RYGB was the most effective surgery type for BMI, TG, and DBP for the mid-term follow-up period. Moderate mid- and long-term effects of T2DM remission and HbA1c levels were observed after all surgical procedures. However, BPD appears to be promising for achieving long-term diabetes remission, HbA1c levels, and cardiometabolic profiles. RYGB is the most favourable option to manage HbA1c levels and BMI. The effects of other surgical types on cardiometabolic profiles are inconclusive and require further research.

Background: Sleeve gastrectomy (SG) is a common metabolic and bariatric surgery (MBS) with conflicting effects on gastroesophageal reflux disease (GERD), with some patients improving and others experiencing new or worsened GERD. This study investigated whether preoperative ambulatory 24-h pH monitoring (24-h pH) predicts postoperative GERD in patients undergoing SG, comparing GERD outcomes among those with normal, abnormal, and without preoperative 24-h pH.

Methods: A retrospective study was conducted on 120 patients (88.3% women, 38 ± 9 years, preoperative BMI 38.0 [36.4-40.6] kg/m²) who underwent SG between January 2017 and March 2022. Patients were subjected to clinical evaluation, including physical examination and anthropometric assessment, as well as upper gastrointestinal endoscopy (UGIE) at baseline and 12 months postoperatively. Preoperative 24-h pH was performed in a subset of patients, who were classified as normal (NG), abnormal (AG), and no monitoring (NMG) groups. Furthermore, GERD symptoms were evaluated postoperatively through the GERD questionnaire (Gerd-Q).

Results: At 12 months, the groups had a similar proportion of normal UGIE findings. Grade B esophagitis occurred in 7.5% of the NG vs. 25% of the AG. The NG exhibited lower Gerd-Q total scores and a smaller proportion of positive results compared with the NMG and the AG (2 [0-5] vs. 7 [0.5-18] and 5 [2-11.75]; 12.5% vs. 47.5% and 47.5%, respectively; p < 0.05 for all variables).

Conclusion: Postoperative GERD was more frequent in patients with abnormal or those without preoperative 24-h pH monitoring, whereas those with normal results in this test exhibited lower rates. These findings raise an important discussion regarding the role of 24-h pH monitoring before SG and its impact on clinical decision-making.

Background: Sleeve gastrectomy (SG) is effective but prone to late recurrent weight gain (RWG). Ring-augmented SG (Ra-SG) may preserve restriction and enhance long-term durability.

Methods: In this single-center, prospective, single-blind randomized trial, adults with a BMI > 50 kg/m² were randomized to SG or Ra-SG and followed for 36 months. The primary endpoint was percent total weight loss (%TWL) at 36 months. Secondary outcomes included RWG, gastric pouch volumetry, relapse of associated medical problems, complications, endoscopic findings, laboratory parameters, and patient-reported outcomes (SF-36, Suter).

Results: Ra-SG produced significantly greater weight loss at 36 months (48.8 ± 8.3 vs. 45.5 ± 9.0%TWL; mean difference 3.25% points, 95% CI 0.86 to 5.63; p 0.008). Exploratory analyses showed lower rates of clinically significant RWG (≥ 30% regain: 5.9% vs. 16.3%; absolute risk difference - 10.4%, 95% CI - 19.6 to - 1.2; p = 0.033) and smaller pouch volumes (160.1 ± 8.9 vs. 194.2 ± 10.3 mL; p < 0.001). Perioperative complications were infrequent and comparable. At three years, the prevalence of endoscopic GERD was similar (17.3% vs. 19.6%). Food tolerance scores were consistently better after SG (all p < 0.05). HRQoL improved significantly in both groups, with no differences observed at 36 months. Two Ra-SG patients (1.8%) underwent ring removal.

Conclusions: Ra-SG enhanced weight-loss durability and lowered RWG compared to SG, with similar safety and GERD outcomes but decreased food tolerance at mid-term. Ra-SG may be considered in patients at higher risk of RWG, though multicenter studies with longer follow-up are needed to confirm these findings.