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.