Obesity Surgery最新文献

Background: To investigate the application value of ultrasound in assessing the short-term impact of sleeve gastrectomy (SG) on common carotid artery (CCA) structure and lower limb arterial hemodynamics in patients with metabolic syndrome (MS).

Methods: Twenty-one patients with MS undergoing SG at our hospital were enrolled as the experimental group, with 29 healthy volunteers as the control group. Ultrasound was employed to measure and compare the lumen diameter (D), adventitial thickness (AT), intima media thickness (IMT), peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) of bilateral CCA as well as the PSV and early diastolic reverse flow velocity (R) of lower limb arteries including common femoral (CFA), proximal superficial femoral (SFA), middle superficial femoral and popliteal arteries (POA) at baseline and 1 month after SG. The correlation between laboratory indicators and ultrasound parameters of CCA was analyzed.

Results: The MS group had higher D (P = 0.004 and 0.041, respectively), AT (both P = 0.00), and IMT (both P = 0.00) of right and left CCA, lower EDV of right and left CCA(P = 0.009 and 0.019, respectively), lower PSV of RCCA (P = 0.021) and ultrasound parameters of lower limb arteries at baseline, compared to the control group. One month after SG, the MS group exhibited lower AT (both P = 0.00), IMT (P = 0.001 and 0.00, respectively), PSV and EDV (P = 0.009 and 0.019; P = 0.018 and 0.008, respectively)of right and left CCA, lower D of right CCA (P = 0.030) and certain lower limb arteries compared to preoperative levels. Correlation analysis revealed a positive correlation between white blood cell count (WBC), red blood cell count (RBC), hematocrit (HCT), absolute neutrophil count (NC), monocyte percentage (MP), average glucose (eAG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), very low-density lipoprotein cholesterol (VLDL-C), and ultrasound parameters of CCA (P < 0.05).

Conclusion: Patients with MS exhibited significant improvements in partial ultrasound parameters of CCA and lower limb hemodynamic 1 month after SG, with a significant correlation to laboratory indicators, suggesting that ultrasound can offer clinical application value in assessing postoperative changes following SG in patients with MS and validating the effectiveness of SG.

Background: Obesity, defined as a body mass index (BMI) of ≥ 30 kg/m², is a global health crisis with severe physical and mental health implications. While bariatric surgery offers the most effective solution for severe obesity, long-term success depends on sustained behavioral changes and support (non-professional and professional). This study explores the role of support in promoting a healthy lifestyle after surgery.

Methods: This study surveyed 211 individuals, aged 18-65, who had bariatric surgery more than 2 years ago, using random selection. Data were collected via phone interviews, ensuring anonymity. Questionnaires assessed healthy lifestyle (physical activity and nutrition) as well as professional and non-professional support participants received. Analysis methods encompassed χ² tests, Pearson correlations, t-tests, and multiple regressions for predicting a healthy lifestyle.

Results: Most participants underwent sleeve gastrectomy with varied BMIs (17-47), and only 19.4% had a healthy weight. Two-thirds engaged in physical activities, with generally healthy diets. While 78.7% received post-surgery support, most of this support was provided by surgeons. However, less than half had access to professional psychological support or participated in non-professional support, such as joining support groups. Regression models showed that support significantly predicted nutrition but not physical activity level. However, years from surgery were also an important predictor with the overall model predicting 2% (general nutrition-not appropriate) to 12% (bariatric nutrition) of healthy lifestyle variability.

Conclusions: Most participants sought surgical consultation early post-surgery, but long-term follow-up and engagement with professional services were low. Support from dietitians or psychologists was linked to improved nutritional outcomes, highlighting the importance of sustained professional guidance.

Background: The sustained administration of deep neuromuscular blockade (NMB) improves surgical conditions compared to moderate NMB and might be effective in the laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aimed to evaluate the effect of sustained intravenous deep NMB on improving surgical conditions and pain intensity following LRYGB.

Methods: This randomized, double-blind clinical trial was conducted in São Luís, Maranhão, Brazil, between October 2021 and December 2023. Patients undergoing LRYGB were randomly assigned to moderate (reversed with 2 mg/kg of sugammadex) or deep NMB (reversed with 4 mg/kg of sugammadex).

Results: Seventy-one patients were evaluated in the study, divided into moderate NMB with 37 patients and deep NMB group with 34 patients. There was no difference between the groups regarding gender, age, weight, height, and comorbidities. Also, in the duration of anesthesia (moderate, 2 h 26 min; deep, 2 h 27 min; p = 0.876), duration of surgery (moderate, 1 h 39 min; deep NMB: 1 h 40 min; p = 0.931), time to extubation (moderate, 5 min; deep, 7 min; p = 0.252), time to the first morphine request (moderate, 30 min; deep, 25 min on average; p = 0.776), mean morphine consumption in 24 h (moderate, 14 mg; deep, 10 mg; p = 0.133), and sevoflurane consumption (moderate, 50 mL; deep 50 mL; p = 0.884). There was no significant difference between the groups in pain scores at none of the evaluated moments. The Leiden-Surgical Rating Scale revealed a significant difference between the groups at 20/30 min (p = 0.015) and 60/70 min (p = 0.027), respectively.

Conclusion: This study demonstrated improved surgical field visibility with deep compared to moderate NMB, without significant differences in other evaluated variables.

Background: Obesity is a major public health issue. Although metabolic bariatric surgery is recommended for patients with obesity and related comorbidities, several patients drop out after receiving surgical eligibility. This study aims to assess dropout rate and identify predictors of attrition before surgery.

Methods: This retrospective monocentric study included patients enrolled between June 2007 and December 2019 at a metabolic bariatric surgery center. Sociodemographic, clinical, and psychopathological data were collected. Patients were divided into operated group and attrition group. Univariate analysis and multivariate binary logistic regression were performed to identify independent predictors of attrition.

Results: Of the 447 patients, the dropout rate was 22.25%. Depressed mood, binge eating disorder, and impulsivity traits at the time of psychiatric evaluation were correlated with dropout from the bariatric pathway (p < 0.05), but these variables lost significance at multivariate analyses. Significant predictors of attrition included male gender (OR = 3.723, p = 0.001), active smoking (OR = 2.852, p = 0.009), and ex-smoker status (OR = 2.860, p = 0.044). Protective factors were socio-familial support (OR = 0.194, p = 0.003) and the metabolic syndrome (OR = 0.078, p = 0.047). The average waiting time for surgery was 11.57 ± 9.36 months.

Conclusions: The study identifies key factors influencing patients' dropout in the surgical pathway, emphasizing the need for targeted interventions to improve retention. Although the presence of depressed mood, binge eating disorder, and impulsivity traits lost statistical significance at the multivariate analyses, their potential clinical relevance should be considered. The findings offer valuable insights for developing strategies to reduce attrition, enhance health care resource to support patients in achieving better health outcomes.

Intragastric balloons (IGBs) are widely used as a minimally invasive weight loss intervention for patients with obesity. While the recommended implantation period for most IGBs is 6 to 12 months, exceeding this duration is associated with an increased risk of complications such as deflation, migration, obstruction, and gastric perforation. However, the long-term safety of retained IGBs remains inadequately studied. We report a rare case of an asymptomatic 5.5-year retention of a Spatz3 IGB in a 29-year-old male patient. Initially implanted for obesity management with a body mass index (BMI) of 38 kg/m², the patient experienced an initial 15 kg weight loss, followed by partial weight regain. Despite multiple attempts to schedule removal, the patient postponed the procedure due to personal reasons and was lost to follow-up. Upon returning 5.5 years later, he remained asymptomatic with a BMI of 37.3 kg/m². Endoscopic examination revealed an intact gastric mucosa and a fully inflated balloon without evidence of degradation or leakage. The balloon was successfully removed endoscopically under sedation, and the postoperative course was uneventful. This case highlights that, under certain conditions, IGBs may remain intact beyond their recommended duration without causing immediate complications. However, this should not be interpreted as evidence of safety, as prolonged retention poses significant risks. Regular patient education, adherence to follow-up schedules, and improved tracking systems are crucial to prevent unintended long-term IGB retention and its associated complications.

Background: Little is known about factors associated with protein intake post-laparoscopic sleeve gastrectomy, especially in Chinese weight loss patients over 6 months. This project aimed to identify possible factors to improve protein intake and investigate protein supplement usage to reduce complications such as malnutrition.

Methods: A prospective observational study was conducted on 120 eligible patients at a tertiary hospital. They completed study measures at baseline, 3 months post-surgery (T0), and 6 months post-surgery (T1). Univariate and multivariate Linear regressions were utilized to analyze factors related to protein intake.

Results: At 6 months post-surgery, most patients did not meet the recommended protein intake of ≥ 60 g/day. Patients who intake protein < 60 g/day lost more weight at T0, but patients who intake protein ≥ 60 g/day lost more weight at T0 to T1. The three macronutrients for all patients were significant differences in dietary and protein supplement sources between T0 and T1. Multi-factor linear regression found that lower educational level, pre-operative hypertension, and the lower EBBS total score at 6 months were significant predictors of insufficient daily protein intake.

Conclusions: Findings shed new light on factors that may account for deficiency protein intake, which have implications for guiding effective interventions targeting this behavior.

Background: Bariatric surgery (BS) is an effective intervention for severe obesity, but some patients may experience sub-optimal weight loss. This study investigates the role of preoperative body composition parameters, measured via bioelectrical impedance analysis (BIA), in predicting postoperative weight loss outcomes.

Methods: A retrospective analysis was conducted on 102 patients who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one-anastomosis gastric bypass (OAGB) between January 2020 and April 2023. Preoperative body composition metrics, including fat mass (FM), fat-free mass (FFM), body cell mass (BCM), and phase angle (PhA), were correlated with percentages of excess weight loss (%EWL) and total weight loss (%TWL) at 12 months post-surgery.

Results: The study found that patients with higher preoperative BCM and PhA showed significantly better weight loss outcomes. Specifically, patients with optimal weight loss had a mean BCM of 35.2 ± 3.5 kg and a PhA of 6.1 ± 0.5, whereas those with sub-optimal outcomes had a mean BCM of 29.8 ± 4.2 kg and a PhA of 4.9 ± 0.6 (p < 0.01 for both). Additionally, higher FM was associated with lower %EWL (r =  - 0.40, p < 0.01). Multivariable logistic regression analysis identified BCM (OR 2.1, 95% CI 1.3-3.4) and %FM (OR 0.7, 95% CI 0.5-0.9) as independent predictors of successful weight loss.

Conclusions: Preoperative BIA parameters, particularly BCM and %FM, are significantly associated with weight loss outcomes in BS patients. These findings suggest a potential role in guiding pre-surgical patient assessment and tailored care, while acknowledging that this relationship is correlational and not necessarily causal.

Background: Like any major operation, sleeve gastrectomy (SG) has its reported postoperative complications. Among them are venous thromboembolic complications (VTE) that may predispose to mortality. Despite the proven efficacy of the traditional anticoagulants, such as low molecular weight heparins (LMWHs) for VTE management, they have their limitations. Direct oral anticoagulants (DOACs) have been currently adopted for the management of VTE. We conducted this study to evaluate the efficacy and safety of apixaban against VTE after laparoscopic sleeve gastrectomy in comparison with LMWH.

Methods: This was a randomized controlled trial that included 100 adult patients who underwent SG and received LMWH (Group A) or apixaban (Group B) for VTE prophylaxis. We recorded and analyzed the postoperative events up to the 30th day after surgery.

Results: This study included Group A (n = 50) and Group B (n = 50). No VTE occurred in either group (0%). Postoperative bleeding was encountered in one patient of each group (2%). The follow-up venous Doppler study was unremarkable in the two groups.

Conclusion: Apixaban was shown to be comparable to LMWH for the prevention of VTE after LSG with similar efficacy and safety making it a promising alternative to LMWH in patients undergoing bariatric surgery.

This study aimed to propose and evaluate a severity rating in obesity (SERO) based on a new priority index for bariatric surgery (PIBS). We compared the waiting time for surgery (WTS) in a simulated list of 200 patients diagnosed, classified, and hypothetically submitted to bariatric surgery using two prioritization criteria: date of inclusion in the list and PIBS. Our simulations show that patients spent an average of 350.44 days waiting for surgery while in the first case, when PIBS was adopted as the prioritization criterion, the WTS varied according to the severity of each patient's condition so more severe cases waited an average of 82.56 days, i.e., up to 75.55% less time considering statistical significance in the differences (p < 0.05). Therefore, the proposed prioritization model proved effective, fair, and reproducible and can be used to manage waiting lists for bariatric surgery.

Background: Obesity is increasingly prevalent and associated with higher morbidity and mortality. Bariatric surgery, particularly sleeve gastrectomy, provides durable weight loss and improves obesity-related conditions like type 2 diabetes and cardiovascular disease. Despite its benefits, significant concerns regarding inequities in access to bariatric surgery persist. This study aims to evaluate recent trends in bariatric surgery rates and to investigate patterns of access to bariatric surgery.

Methods: A population-based study of age-adjusted bariatric procedure rates in adults in NSW, Australia, was conducted over the financial years 2013/14 to 2021/22. Trends in age-adjusted procedure rates were assessed by demographics and healthcare settings.

Results: In 2021/22, 179.6 bariatric procedures per 100,000 population were performed, an 89.7% increase since 2013/14 (p < 0.001). Laparoscopic sleeve gastrectomy, the most common procedure, increased by 94.1% to 112.6/100,000/year (p < 0.001). Females had 3.6 times higher rates than males (232.3/100,000/year vs 64.9/100,000/year). The greatest increases occurred in younger patients (125.9% in the 18-24 age group; 142.4% in the 25-34 age group, p < 0.001). Private hospital rates were 15.6 times higher than public (132.2/100,000/year vs 8.5/100,000/year) and rose 92.3% (p < 0.001), whilst public hospital rates declined by 17.9% (p = NS). Patients from regional areas had the highest rates (175.7/100,000/year) and largest increase (169.8%; 89.4/100,000/year to 241.8/100,000/year, p < 0.001).

Conclusions: Bariatric surgery rates continue to increase, particularly among females, despite similar obesity prevalence between sexes. Most surgery is conducted in the private sector, suggesting differential access based on financial circumstances. Rates are highest in younger people, although obesity-related comorbidities increase with age. Regional patients undergo surgery at higher rates than rural patients despite greater obesity prevalence with increasing rurality. Efforts to address these disparities are essential to improve equitable access to obesity treatments.