Obesity Surgery最新文献

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.

This study aimed to analyze the independent risk factors for irregular menstrual cycles in women with obesity without polycystic ovary syndrome (PCOS), describe the changes in menstrual cycle regularity after bariatric surgery, and explore the influencing factors of these changes. A retrospective analysis was conducted on 430 women with obesity patients without PCOS who underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) at the First Affiliated Hospital of Jinan University between January 2019 and January 2022. Patients were categorized into a regular group (n = 200) and an irregular group (n = 230) based on the regularity of their preoperative menstrual cycles. Demographic data, anthropometric indicators, and laboratory parameters were collected preoperatively and at 1, 3, 6, and 12 months postoperatively. Propensity score matching (1:1) and unconditional logistic regression analysis were employed to identify risk factors. After propensity score matching, elevated C-peptide (OR = 1.487, 95% CI: 1.187 - 1.863, p = 0.001) and serum ferritin (SF) (OR = 1.006, 95% CI: 1.000 - 1.013, p = 0.041) were identified as independent risk factors for preoperative irregular menstrual cycles. In contrast, elevated progesterone (OR = 0.895, 95% CI: 0.830 - 0.965, p = 0.004) was a protective factor. The incidence of irregular menstrual cycles decreased from 53.5% preoperatively to 22.6% at 12 months postoperatively. In the irregular group, higher C-peptide levels at 1 month, larger hip circumference at 3 months, and higher aspartate aminotransferase (AST) levels at 12 months were associated with persistent irregularity. Laparoscopic sleeve gastrectomy (LSG) demonstrated a more significant improvement in menstrual regularity than LRYGB within 1 year (p < 0.05). The study concluded that bariatric surgery effectively improves menstrual cycle regularity in women with obesity without PCOS. C-peptide, SF, and progesterone are key factors affecting preoperative menstrual regularity, while dynamic changes influence postoperative recovery in metabolic and anthropometric indicators.

Disclaimer: This case report describes an investigational, non-standard technique performed in a high-expertise center. It should not be considered standard of care and should not be attempted outside carefully selected indications, multidisciplinary oversight, and appropriate institutional governance (e.g., IRB/innovation review).

Background: The coexistence of achalasia in a patient with morbid obesity presents a unique, rare, and complex clinical challenge. One might consider a staged approach, addressing the achalasia first and morbid obesity at a later date. Alternatively, a myotomy (POEM or Heller) may be performed along with a bariatric procedure. However, the technical expertise required would be beyond the abilities of most surgeons.

Objectives: To describe, for educational and hypothesis-generating purposes, a novel, single-stage surgical technique that addresses both morbid obesity and achalasia using a stapled trans-sphincteric esophagojejunostomy, achieving full-thickness myotomy while preserving the stomach and avoiding the technical limitations of standard dual approaches.

Setting: Academic tertiary care center, United States.

Methods: We present a case of a 54-year-old woman with a BMI of 45 kg/m², severe GERD, and type II achalasia confirmed by EGD, manometry, and esophagogram. The procedure involved a stapled esophagojejunostomy through the lower esophageal sphincter, achieving a full-thickness myotomy combined with a Roux-en-Y Gastric Bypass anatomy.

Results: The patient demonstrated resolution of dysphagia and reflux symptoms, tolerance of oral intake, and 76% excess weight loss at two years without perioperative complications and with excellent nutrition and vitamin levels. These findings are limited to a single case and carry specific risks and can only be considered cautiously, while this technique allows definitive treatment of both disorders while avoiding the technical challenges of the traditional approaches and potentially minimizing recurrence, its broader safety and efficacy remain unproven.

Conclusions: This report illustrates a technically feasible but investigational approach for a highly selected patient with concurrent achalasia and morbid obesity. It simplifies the anatomy, preserving gastric tissue and enabling a complete myotomy; however, it is based on a single case, and broader application would require formal evaluation under controlled investigational protocols.

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.