Obesity Surgery最新文献

Gastric bypass surgery is a highly effective treatment for morbid obesity, offering significant and sustained weight loss and improvement in comorbid conditions. However, the long-term success of this intervention is closely tied to robust postoperative follow-up care. Currently, there is a lack of consensus on the definitions of medium- and long-term follow-up, complicating the comparison of outcomes across studies. This inconsistency, coupled with challenges in patient adherence and healthcare infrastructure, emphasizes the need for better-defined follow-up periods and increased monitoring over time. This commentary addresses the critical need for standardized definitions and practices in medium- and long-term follow-up to optimize patient outcomes.

Background: Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are common bariatric procedures, with GERD being a frequent obesity-associated disease among individuals undergoing these surgeries. RYGB is recommended for patients with GERD due to the increased control of GERD symptoms. This study examines RYGB and SG use in this population and factors influencing procedure choice.

Methods: This study analyzed 2016-2022 data from the MBSAQIP database comprising patients with GERD who underwent SG or RYGB. Statistical analysis included univariate and multivariable logistic regression to identify factors associated with procedure receipt.

Results: RYGB rates are rising annually but remain lower than SG for GERD. Compared to White individuals, Hispanics are 14% less likely, and African Americans are 19% less likely, to receive RYGB.

Conclusions: The study notes a research gap in choosing RYGB or SG for patients with GERD, despite consensus favoring RYGB. It highlights a disparity between recommendations and practice, with GERD predicting the use of RYGB but SG being more prevalent in this population overall. The analysis links race to procedure choice, showing African American and Hispanic patients are less likely to undergo RYGB, indicating potential disparities in access and decision-making.

Metabolic and bariatric surgery (MBS) is a successful surgical option for obesity. However, many patients can experience insufficient weight loss and weight regain post-operatively. Glucagon-like peptide-1 (GLP-1) receptor agonists have become available for effective weight loss treatment due to their effects of suppressing appetite, slowing gastric emptying, and promoting fat loss. This systematic review aims to evaluate the efficacy of using GLP-1 agonists to treat insufficient weight loss or regain after metabolic/bariatric surgery. Pooled analysis demonstrated that GLP-1 agonists have a moderate effect on weight loss after failed weight loss or weight regain following MBS, with a Cohen's d-score of 0.470 (p ≤ 0.001). GLP-1 agonists show promise and deserve additional research as part of the standard of care following MBS with insufficient weight loss.

Since the early 1980s, efforts to standardize ergonomic practices in laparoscopic surgeries have aimed to improve procedural efficiency and reduce complications, but clinical validation remains limited. In metabolic and bariatric surgeries (MBS), innovations in trocar site placements, driven by the popularity of laparoscopic sleeve gastrectomy (LSG), have advanced surgical techniques. However, practices often vary based on individual surgeon preferences rather than standardized evidence-based criteria. This study introduces the Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) checklist, aiming to standardize port placements and improve reporting consistency. A systematic review and meta-analysis of LSG studies were conducted following PRISMA guidelines. Data were extracted from 34 studies involving 7173 cases. Key variables included port configurations, manipulation angles, and outcomes such as operative time and excess weight loss percentage (EWL%). Innovative methods were used to estimate manipulation and azimuth angles from available intraoperative images. Statistical analyses and meta-regression were performed to identify associations between port configurations and surgical outcomes. Findings revealed substantial variability in port placements, with no significant effect of manipulation angles or port numbers on operative time or EWL% at 6, 12, and 24 months (p-values > 0.05). High residual heterogeneity suggests that factors beyond manipulation angles and port counts contribute to outcome variability. The PSPOSO checklist provides a framework for standardizing port placement and ergonomic parameters in MBS, enhancing reproducibility and safety. Future studies should validate the checklist across diverse clinical settings to refine surgical approaches and improve patient outcomes. PROSPERO: CRD42024598674.

Background: Internal herniation (IH) is a potentially life-threatening complication after gastric bypass. Accurate diagnosis of IH remains challenging. This study aims to validate the Eindhoven2020 (EHV20) scoring system for ruling out IH and seeks to improve its diagnostic accuracy through additional radiologic parameters.

Methods: Patients participating in a prospective study on abdominal pain after gastric bypass surgery were selected if a CT scan was performed. CT scans were scored following the EHV20 scoring system containing ten signs of IH to confirm the individual and collective accuracy of these signs. Also, we evaluated the diagnostic value of additional radiologic parameters: delayed passage of contrast, dilated intestinal loops, and free fluid.

Results: A total of 375 patients with abdominal pain were included. IH was confirmed during laparoscopy in 27 patients. On CT, the highest sensitivity was achieved by the swirl sign (66.7%) and the highest specificity by a small bowel behind the superior mesenteric artery (99.7%). The area under the receiver operating characteristic curve (AUC) based on the EHV20 scoring system for ruling out IH was 0.845 (95% CI 0.730-0.959). The AUC could be improved to 0.905 (95% CI 0.825-0.985) (p = 0.088) through the incorporation of several additional signs. Overall, this new scoring system included swirl sign, small bowel obstruction, enlarged nodes, venous congestion, mesenteric edema, dilated alimentary or biliary loop, free fluid, and backward flow in the biliary loop with possible backflow in the residual stomach.

Conclusions: Incorporation of additional CT signs into an existing scoring system can help clinicians to safely rule out IH in patients with abdominal pain after bariatric surgery.

Background: Obesity is increasingly prevalent worldwide and has been linked to various health conditions, including hypothyroidism.

Methods: Summary-level GWAS data from the UK Biobank and the FinnGen Biobank were used for Mendelian randomization analysis. The impact of BMI on autoimmune hypothyroidism through putative mediators was assessed through a four-step analytical process. Statistical analyses, including the inverse-variance-weighted (IVW) method, weighted median (WM), and MR-Egger methods, were employed to evaluate causal relationships and detect horizontal pleiotropy. Mediation analysis was performed using a two-step method to assess the causal relationships between BMI, putative mediators, and autoimmune hypothyroidism.

Results: Higher BMI was associated with an increased risk of autoimmune hypothyroidism. Mean corpuscular volume, eosinophil count, and cystatin C levels were found to mediate this association.

Conclusions: BMI positively correlates with autoimmune hypothyroidism, with mean corpuscular volume, eosinophil count, and cystatin C levels mediating this relationship. Further research is needed to confirm these findings and explore causal relationships across diverse populations.

Background: This study is part of an initiative to improve the FAIRness (Findability, Accessibility, Interoperability, Reusability) of metabolic bariatric surgery (MBS) registries globally. It explores the extent to which European registry data can be manually integrated without first making them FAIR and assesses these registries' current level of FAIRness. The findings establish a baseline for evaluation and provide recommendations to enhance MBS data management practices.

Methods: Data dictionaries from five national MBS registries in Germany, France, the Netherlands, the UK, and a combined registry for Scandinavia (Norway and Sweden) were evaluated regarding their ability to manually integrate registry datasets with one another. The FAIR Data Maturity Model from the Research Data Alliance (RDA) FAIR Data Maturity Model Working Group was used to assess the FAIRness of both metadata and data of the registries.

Results: The registries showed significant variability in variables and coding structures, with inconsistent numerical formats and without linkage to international standards such as SNOMED CT, LOINC, or NCIt, making data integration labor-intensive and assumption-heavy. Despite the presence of data dictionaries, all registries failed the FAIR assessment because machine-readable data was unavailable, and only human-readable metadata was available in the form of data dictionaries in a spreadsheet.

Conclusion: Our study reveals significant inconsistencies in data structuring and a failure to comply with the FAIR Principles, which limit effective data analysis and comparison. This emphasizes the critical need for standardized data management practices. We recommend four next steps to improve the FAIRness of MBS registries: (1) annotate data elements using standardized terminology systems, (2) deposit registry-level metadata in a repository, (3) request globally unique and persistent identifiers for datasets, and (4) define access restrictions.

Background: There has been a rapid increase in prevalence of obesity, and bariatric surgery is the most effective treatment to reduce all-cause mortality. Gastrointestinal stromal tumors (GISTs) comprise approximately 1% of GI tumors and are the most commonly encountered incidental tumor at the time of bariatric surgery. They have a reported prevalence of approximately 0.5%; however, there are no established guidelines for incidental GISTs.

Methods: This study performed a systematic literature search using PubMed to identify 100 articles from 2005 to 2023 on incidental GIST tumors found during bariatric operations.

Results: Total prevalence of GISTs was 0.54% with an average size of 7.04 mm. Management of these lesions should prioritize negative margins with the least invasive resection. Tumors able to be resected without alteration to bariatric surgery should be managed with a complete wedge resection prioritizing negative margins. In tumors where resection requires alteration to bariatric surgical plan, the decision to proceed with resection and alteration of bariatric surgical plan should be made only if previous discussions have been made with patient. Lastly, if resection of the GIST precludes the ability to perform the bariatric procedure, consideration to resect the GIST with the goal of negative margins should be prioritized with a plan to discuss future bariatric procedures after.

Conclusion: The goal of this paper is to remind bariatric surgeons to be aware of GISTs and provide the possible approaches to management.

Background: This study evaluated the association between staple line reinforcement (SLR) and 30-day outcomes in patients undergoing laparoscopic (LSG) or robotic sleeve gastrectomy (RSG).

Methods: Adults undergoing primary LSG or RSG with and without SLR were analyzed from the 2018-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement (MBSAQIP) database. Baseline characteristic differences by SLR status for LSG and RSG were adjusted using entropy balancing. Multivariable weighted logistic and linear regression was then performed to examine the association between SLR and primary and secondary outcomes.

Results: Of 284,580 patients, 88.6% (n = 252,035) had LSG and 11.4% (n = 32,545) had RSG, of which 63.7% (n = 160,545) and 50.8% (n = 16,541) had SLR, respectively. Compared to LSG and RSG without SLR, both LSG and RSG with SLR encountered higher adjusted odds of emergency department visit (AOR 1.08, 95%CI 1.03-1.10, p < 0.001; AOR 1.10, 95%CI 1.01-1.20, p = 0.029, respectively) as well as lower adjusted odds of leakage (AOR 0.85, 95%CI 0.76-0.94, p = 0.002; AOR 0.71, 95%CI 0.54-0.92, p = 0.011, respectively) and gastrointestinal bleeding (AOR 0.79, 95%CI 0.77-0.91, p < 0.001; AOR 0.77, 95%CI 0.70-0.84, p < 0.001, respectively). LSG with SLR was also associated with greater odds of unplanned intubation (AOR 1.52, 95%CI 1.16-1.99, p = 0.002) and mechanical ventilation (AOR 1.74, 95%CI 1.22-2.50, p = 0.002). RSG with SLR was associated with higher odds of intraoperative conversion (AOR 1.71, 95%CI 1.15-2.54, p = 0.008), and lower odds of acute renal failure (AOR 0.27, 95%CI 0.11-0.65, p = 0.003).

Conclusions: This entropy-balanced analysis of the MBSAQIP registry demonstrated an overall association between SLR and lower postoperative leakage and bleeding after RSG and LSG.