Obesity Surgery最新文献

Background: Laparoscopic BariClip gastroplasty (LBCG) is a new reversible bariatric procedure designed to replicate the restrictive effects of laparoscopic sleeve gastrectomy (LSG) by placing a clip vertically on the stomach. This technique achieves gastric lumen restriction without the need for resection, ensuring organ preservation and reversibility. However, concerns have arisen regarding potential complications such as gastroesophageal reflux disease (GERD), slippage, or erosion of the stomach. The aim of the study is to evaluate the outcomes and complications of LBCG.

Methods: This is a monocentric retrospective study. We analyzed 149 patients who underwent LBCG procedure between July 2021 and November 2023. A minimum follow-up period of 6 months was observed for all patients, recording clinically relevant GERD through GERD-Q score questionnaires. Weight loss was monitored through body mass index (BMI) and % total weight loss (%TWL), registered during follow-up visits.

Results: Overall, 149 patients were eligible for this study. Overall complication rate was 8% (12/149). The average BMI went from 40 ± 4.37 kg/m² to 28 ± 4.29 kg/m² (p < 0.05) in 6 months, while the mean %TWL was 22.6% after at least 6 months of follow-up. Clinically relevant GERD went from 18.1% (27/149) to 10.7% (16/149), p = 0.1262. As expected, also the PPI usage was not altered significantly (17.8% vs 16.4%), p = 0.8714.

Conclusions: LBCG remains an experimental procedure that must be approached with caution. Nonetheless, the potential of LBCG to reproduce the effects of LSG while reducing GERD makes it a promising new reversible option for the treatment of morbid obesity.

Purpose: Dumping syndrome (DS) is a common complication of metabolic surgery, occurring in as many as 40% of bariatric patients. The reference diagnostic test is oral glucose tolerance testing (OGTT) which is often poorly tolerated and may induce false positive results. Continuous glucose monitoring (CGM) is better tolerated and can monitor patients for about 2 weeks in everyday life. This study aimed at testing the diagnostic capacity of CGM in patients with and without DS, as validated by OGTT.

Material and methods: This is a retrospective monocentric study including adults after bariatric surgery, who complained of DS-compatible symptoms and who had OGTT. CGM characteristics were compared in DS-positive (n = 37) and DS-negative patients (n = 14).

Results: None of the CGM parameters differed between the two groups: mean, variability, time in range, and time above or below range. OGTT induced different hematocrit and pulse rate responses (by DS definition) but no difference in blood glucose values.

Conclusion: Despite being a better-tolerated test than OGTT, CGM should not be recommended for the diagnosis of DS. It may still be useful for monitoring glucose values in everyday life to help patients modify their diet, when DS is caused by carbohydrates with high glycemic index. The reference diagnostic test for dumping syndrome is poorly tolerated and artificial. CGM is useful in everyday life, and changes in glucose might be a signal of dumping syndrome. However, CGM is not a valid diagnostic test for dumping syndrome.

Indocyanine green (ICG) is a nontoxic, fluorescent iodide dye with rapid hepatic clearance that has been used in medical applications since the mid-1950s. In abdominal surgery, ICG can be used to identify anatomical structures such as the biliary tract, urinary tract, blood vessels, tissue perfusion on different organs, or anastomosis in the digestive system. The application of ICG during bariatric surgery may be useful in primary and revisional procedures at different steps of the surgery. The purpose of this study is to examine the role of indocyanine green during the SADI-S procedure and to highlight the key aspects of this procedure. We present a case series of 22 patients with morbid obesity who underwent a multidisciplinary evaluation and were selected for the SADI-S procedure via a laparoscopic approach. The ICG dose and timing were as recommended in the International Society for Fluorescence Guided Surgery guidelines. For arteriography, 3 ml (7.5 mg) was used, and the detection time was 30-60 s after intravenous administration. For visualization of the common bile duct, we used 1 ml (2.5 mg) applied intravenously at least 45 min before the procedure. For the leak test, a dilution of 1 ml (2.5 mg) of ICG + 5 ml of methylene blue in 100 cc of sterile water, which was prepared just before the test, was used, and the mixture was passed through an orogastric tube. We expose the surgical steps in which ICG can improve outcomes or prevent complications when performing the SADI-S procedure. Key Points • The role of ICG during SADI-S is described. • The step-by-step results of ICG during the SADI-S procedure are highlighted. • ICG was shown to be safe and useful during bariatric surgery in morbidly obese patients.

Purpose: The optimal bowel limb lengths for laparoscopic Roux-en-Y gastric bypass (LRYGB) to maximize weight loss while minimizing nutritional deficiencies in severe obesity treatment remain a topic of debate. The multi-center Dutch Common Channel Trial (DUCATI) aims to compare the outcomes of a very long Roux Limb Roux-en-Y gastric bypass (VLRL-LRYGB) with a standard Roux-en-Y gastric bypass (S-LRYGB).

Methods: A total of 444 patients were randomly assigned in a 1:1, double-blind manner to undergo either VLRL-RYGB or S-LRYGB. Five-year follow-up data were assessed, concentrating on weight loss, obesity-related medical conditions, complications, re-operations, and malnutrition.

Results: Both groups had comparable total alimentary lengths (RL + CC). The VLRL-LRYGB group demonstrated significantly greater %TWL (32.2% vs. 28.6%, p = 0.002) and %EWL (81.2% vs. 70.3%, p = 0.002) at 5 years. Eight (3.6%) patients in the VLRL-LRYGB group versus 2 (0.9%) in the S-LRYGB group (p = 0.055) needed modification surgery for malabsorption. Suboptimal clinical response rate was significantly higher (22.0% vs. 8.3%) in S-LRYGB group. No significant differences for nutrient deficiencies in favor of the S-LRYGB group were found.

Conclusion: A 100-cm common channel with a relatively long Roux limb provides superior, sustainable weight loss over 5 years, without significantly increased rate of malabsorption-related re-operations. These results suggest that a longer Roux limb can still ensure adequate micronutrient uptake in the total alimentary tract. These findings should be considered in discussions regarding the optimal Roux-en-Y limb length for severe obesity treatment.

In the last years, one-anastomosis gastric bypass (OAGB) has been proposed more frequently as obesity surgery technique. Several trials have demonstrated that the easier technical feasibility does not affect the long-term surgical result. However, concern about increased risk of gastric and esophageal cancers has been expressed by several bariatric surgeons. The present study reports the 2nd case of cancer of the gastrointestinal-jejunal anastomosis in a OAGB patient focusing the attention on some technical issues correlated and offering a systematic review of the literature.