Obesity Surgery最新文献

Background: RYGB consists of the Roux limb (RL), the biliopancreatic limb (BPL), and the common channel (CC). There is no consensus on the optimal limb lengths.

Methods: Using a mouse model of RYGB, 30 diet-induced obese mice were divided into two groups with varying BPL and CC lengths: a standard BPL with a long CC (RYGB S) and a long BPL with a short CC (RYGB L). Additionally, 9 age-matched, lean control mice (LC) were also included in this study.

Results: RYGB S had limb lengths of RL = 17%, BPL = 24%, and CC = 59%. RYGB L had limb lengths of RL = 17%, BPL = 32%, and CC = 51%. RYGB S and RYGB L had 67% and 40% survival, respectively. Mortality in RYGB L included more instances where the cause of death was not apparent. RYGB L demonstrated greater weight loss, lower energy expenditure, and lower heart mass as compared to RYGB S. Both RYGB groups had lower epidydimal fat mass, spleen mass, and bone mineral density compared to LC. RYGB L had a lower heart mass than RYGB S and LC. While the relative abundance of Eubacterium was lower in RYGB L than in RYGB S, no other gut microbiota differences were observed.

Conclusions: A longer BPL with a shorter CC induces greater weight loss but may lead to adverse effects, including lower heart mass, reduced bone density, and deaths with unclear causes.

Background: Severe obesity is associated with a low-grade chronic inflammation, and high-sensitivity C-reactive protein (hs-CRP) is a marker that can be used to evaluate chronic inflammation status. Metabolic bariatric surgery (MBS) is shown to decrease hs-CRP level, but long-term results are scarce, and association with weight loss outcomes is undetermined. This study aims to evaluate chronic inflammation in patients with obesity using hs-CRP, and its association with long-term weight loss outcomes after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods: The long-term follow-up data of SLEEVEPASS (ClinicalTrials.gov NCT00793143) randomized clinical trial (RCT) was used. Hs-CRP was measured at baseline, and at 6 months, 1, 3, 5, 7, and 10 years after surgery, and the association with weight and weight loss outcomes were analyzed.

Results: Hs-CRP at baseline was available for 59 out of 240 (24.6%) patients. In the whole study population, the nadir hs-CRP (mean estimate 1.14 mg/ml, 95% CI 0.87-1.49) was achieved at 3 years after surgery with a statistically significant difference to baseline (p = 0.003). No statistically significant difference was seen between LSG and LRYGB in hs-CRP change over time (operation*time interaction p = 0.540). Higher hs-CRP correlated with higher BMI at baseline (Spearman correlation 0.282, p = 0.030) and at 10 years (Spearman correlation 0.490, p = 0.001). At 10 years, a greater percentage total weight loss (%TWL) correlated with lower hs-CRP level (Spearman correlation - 0.558, p < 0.001). Baseline hs-CRP (Spearman correlation - 0.152, p = 0.299) and hs-CRP change in first 6 months postoperatively (Spearman correlation 0.167, p = 0.254) did not correlate statistically significantly with %TWL at 10 years.

Conclusions: MBS decreases hs-CRP also at long-term follow-up with weight loss as the driving force. Neither baseline hs-CRP nor hs-CRP change at 6 months were feasible as a predictive marker for long-term outcomes.

Background: The CCBRS is a multidimensional assessment tool developed to aid in the psychosocial evaluation of patients seeking bariatric surgery. To date, three studies support the interrater reliability, internal consistency, and predictive validity of the CCBRS for a number of postoperative outcomes. However, research has predominantly been with White females. This study examines the reliability of the CCBRS with diverse individuals from three surgery clinics. The relative contribution of demographic and psychosocial variables to overall CCBRS ratings and differences in overall CCBRS ratings based on these factors are also explored.

Methods: Patients seeking bariatric surgery (n = 407; 86.2% female; 49.6% Black; mean BMI 48.3 kg/m², SD = 8.5) were evaluated with a standardized multimodal assessment. CCBRS domain and overall ratings were made based on the integration of assessment data. Patient weight, BMI, and weight loss surgery procedure were obtained from the initial bariatric surgery consult.

Results: Internal consistency of the CCBRS was good (Cronbach's alpha = .80) for this sample though lower than previously found. Most patients (75.6%) were cleared for surgery. Statistically significant differences in overall CCBRS ratings were found only based on employment status and referring clinic. Hierarchical regression analysis demonstrated a small effect for demographic and psychosocial factors, with only past alcohol abuse, current substance abuse, and referring clinic explaining statistically significant variance in overall CCBRS ratings.

Conclusions: Results support the reliability of the CCBRS; however, additional research is needed with diverse populations.

Background: The aim of this prospective, randomized, controlled study was to evaluate the effect of ultrasound (US)-guided bilateral erector spinae plane (ESP) block on postoperative opioid consumption and respiratory recovery in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG).

Methods: The study was conducted on 40 patients scheduled for LSG. The patients were randomly allocated into either the ESP block group or the control group. The US-guided bilateral ESP block was performed preoperatively. The control group received no intervention.

Results: Postoperative median [IQR] tramadol consumption was significantly lower in the ESP block group [150.0 [100-200] mg vs 450.0 [400-500] mg, p < 0.0001]. Postoperative spirometric variables were significantly impaired in both groups, compared with preoperative variables (p < 0.0001). Intraoperative median [IQR] fentanyl consumption was 200.0 [200-200] µg in the ESP block group, and 350.0 [300-400] µg in the control group (p < 0.0001). Postoperative mean pain scores at rest and during movement were significantly lower in the ESP block group, at all time points (p < 0.05). In terms of mean arterial PH, Horowitz ratio, and PaCO₂, there was no statistically significant difference between the groups (p > 0.05). None of the patients experienced postoperative respiratory adverse events and/or block-related complications.

Conclusions: US-guided bilateral ESP block significantly reduced both intraoperative and postoperative analgesic consumptions and provided effective postoperative pain control for patients with obesity undergoing bariatric surgery. Following bariatric surgery, all patients' postoperative pulmonary functions deteriorated. The effect of US-guided bilateral ESP block on postoperative respiratory recovery could not be clearly demonstrated. Randomized controlled studies with a larger patient population are necessary.

This study aimed to investigate the efficacy of one-anastomosis gastric bypass (OAGB) on gastroesophageal reflux disease (GERD) compared with Roux-en-Y gastric bypass (RYGB) in patients with obesity. Three databases (Medline, Cochrane Central, and Scopus) were searched for relevant articles published until August 12, 2024. A total of nine randomized controlled trials, including 643 patients, were selected. OAGB was statistically significantly associated with a higher risk of GERD than RYGB (OR = 3.14, 95% CI 1.23-8.03, p < 0.05). The odds for de novo GERD after OAGB are almost six times higher than after RYGB (OR = 5.65, 95% CI 1.53-20.82, p < 0.05). RYGB has a lower incidence of de novo GERD cases and is more effective than OAGB in reducing GERD.

Purpose: Recent changes in the profile of liver transplant (LT) recipients include an increasing number of patients with metabolic-associated steatotic liver disease (MASLD), which is associated with obesity and cardiovascular risk. We aimed to investigate the trend in the presence of obesity among LT recipients and its association with cardiovascular risk.

Materials and methods: Single-centre retrospective study, which included LT recipients between 2015 and 2020. Obesity and patient's demographic were assessed before LT and 12 months thereafter. Cardiovascular risk factors including ASCVD score were recorded and compared between patients with and without obesity.

Results: During the study period, 358 LT were performed. The mean BMI before LT significantly increased over time during the study period (p_trend = 0.04). Pre-LT, patients with obesity were older and had a higher prevalence of MASLD, diabetes, hypertension and dyslipidaemia. Twelve months after LT, most patients gained weight, although mean BMI did not significantly increase over time (p_trend = 0.072). LT recipients with obesity 12 months after LT more frequently presented with diabetes and hypertension and had higher ASCVD score than LT recipients with BMI < 30 kg/m². One-year mortality was similar between patients with or without obesity before LT (p = 0.816).

Conclusion: In the past few years, there has been a significant increase in the prevalence of obesity in LT recipients. LT recipients with obesity present a higher cardiovascular risk as assessed by the presence of cardiovascular risk factors and the ASCVD score. Our results may be useful when designing strategies to directly target obesity and weight management in this population.

The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing in parallel with obesity. One anastomosis gastric bypass (OAGB) is considered effective to treat both T2DM and obesity. The aim of this study was to evaluate the efficacy of OAGB versus sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for treatment of T2DM, analyzing data exclusively from randomized control trials (RCTs). Α systematic review of published RCTs comparing OAGB versus RYGB or SG (control groups) in T2DM patients regarding diabetes remission and weight loss was performed. Primary endpoints were T2DM remission rate and 1-year and 5-year % weight loss postoperatively. Initial search identified 39 references, of which 8 RCTs were considered eligible for meta-analysis inclusion, comprising 636 patients (311 OAGB, 122 RYGB, 203 SG patients). Main meta-analysis findings were: i) higher 1-year %EWL for OAGB than control group (p = 0.04); ii) higher 5-year %EWL for OAGB than control group (p < 0.01); iii) no difference in 1-year remission rate of T2DM between OAGB and control group (p = 0.14); iv) 28% higher 5-year remission rate of T2DM for OAGB than control group (p < 0.01). OAGB had statistically significant better outcomes compared to RYGB and SG regarding T2DM remission and %EWL at 5 years. Further pathophysiologic studies are needed to indicate the most potent bariatric procedure in patients with T2DM and obesity.