Obesity Surgery最新文献

Background: Stapler line reinforcement during sleeve gastrectomy (LSG) was assessed thoroughly in the context of postoperative complications focusing on leakage and bleeding. However, the effect of stapler line reinforcement techniques on the short- and long-term weight loss is still unclear and lacking. We hypothesize that inverting of the stapler line by Lembert suturing could lead to further additional reduction of the remnant gastric volume and accordingly a more significant weight reduction.

Methods: Retrospective analysis of patients that underwent LSG (2012-2018) from the two university hospitals. The first hospital routinely performed oversewing with inversion of the stapler line (first group, Lembert suture), while the second university hospital performed LSG without stapler line oversewing and inversion, but routinely used VeraSeal glue (second group, non-Lembert); both groups were compared in terms of weight loss and complications.

Results: Four hundred eighty and 550 patients underwent LSG in the first and second hospital, consequently. The mean BMI change and EBWL at 1, 3, and 5 years were better in the first group than in second group. The mean last follow-up BMI was significantly lower in Lembert group (29.8 ± 5.2kg/m²) than in non-Lembert group (32.9 ± 6.7 kg/m²), P = 0.001. The mean EBWL at last follow-up point was significantly better for the Lembert group as compared to non-Lembert group (73.7 ± 26.59 versus 57.12 ± 27.71, P = 0.001).

Conclusions: Lembert suture line oversewing and inversion in LSG is associated with noticeable improvement in weight loss outcomes at 1, 3, and 5 years and last follow-up compared to LSG with VeraSeal gluing.

Background: Immunometabolism is the interaction between immune system and nutrient metabolism. Severe obesity is considered a state of meta-inflammation associated with obesity that influences the development of chronic-degenerative diseases.

Objective: We aimed to establish the immunometabolic differences in bariatric patients and to determine whether cellular immunity is associated with metabolic changes.

Methodology: We conducted an observational study in patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). We explored the differences in the immunometabolic profile before and after surgery in the study group, by surgical technique, and we evaluated the changes in immunological variables as a function of metabolic variables with correlation analysis.

Results: The follow-up rate was 88.7%. After the intervention, there were changes in cellular immunity, with a decrease in effector T lymphocytes (CD8+CD28-) and an increase in B lymphocytes, memory helper T cells, and cytotoxic T lymphocytes. LSG resulted in a greater decrease in (CD4+CD62-) T lymphocytes compared with LRYGB. Patients who underwent surgery with LRYGB presented greater clinical and metabolic improvements, as well as improvement of obesity-associated medical problems. Women who underwent LRYGB showed a greater reduction in fat-free mass compared with women who underwent LSG.

Conclusion: Bariatric surgery, mainly LRYGB, leads to immunometabolic changes and improves associated medical problems.

Background: With the rise of artificial intelligence (AI) in medical education, tools like OpenAI's ChatGPT-4 and DALL·E 3 have potential applications in enhancing learning materials. This study aims to evaluate ChatGPT-4o's proficiency in recognizing bariatric surgical procedures from illustrations and assess DALL·E 3's effectiveness in generating accurate surgical illustrations.

Methods: Illustrations of six bariatric surgical procedures (One Anastomosis Gastric Bypass, Roux-en-Y Gastric Bypass, Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy, Sleeve Gastrectomy, Biliopancreatic Diversion, and Adjustable Gastric Banding) were sourced from the IFSO Atlas of Metabolic and Bariatric Surgery. ChatGPT-4 was tasked with identifying each procedure based on these illustrations to evaluate its classification accuracy. Simultaneously, DALL·E 3 was prompted with the specific names of each procedure to generate corresponding medical illustrations.

Results: ChatGPT-4 correctly identified only the Adjustable Gastric Banding illustration, misclassifying the other five procedures. DALL·E 3 failed to produce accurate illustrations for all six procedures.

Conclusion: The study underscores the need for further evaluation of AI in bariatric surgery. Both ChatGPT-4 and DALL·E 3, while promising, have significant limitations in recognizing and generating accurate illustrations of bariatric surgical procedures. These findings call for continued research and development to make AI models suitable for medical education applications in bariatric surgery.

Background/objective: Obesity is linked to increased risks of cardiovascular disease, diabetes, and certain cancers. Bariatric surgery (BS) aids in weight management, significantly altering body composition. This study evaluates the predictive value of five complete blood count (CBC)-derived indices [C-reactive-protein-albumin-lymphocyte (CALLY), glucose-to-lymphocyte ratio (GLR), prognostic nutritional index (PNI), hemoglobin, albumin, lymphocyte, platelet (HALP), and controlling nutritional status (COUNT)] on body composition changes post-BS.

Method: A retrospective study was conducted on 240 patients undergoing BS at Sina Hospital, Tehran, Iran. Indices were calculated using routine laboratory tests, and body composition changes were measured using bioelectrical impedance analysis at 3 and 6 months post-surgery.  RESULTS: Higher pre-surgical GLR values positively correlated with increased fat-free mass (FFM) (p = 0.005 ¹, p = 0.003 ²), muscle mass (MM) (p = 0.011 ¹, p = 0.008 ²), and total body water (TBW) (p = 0.005 ¹, p = 0.005 ²) post-surgery. In contrast, higher PNI was negatively associated with changes in FM (p = 0.029 ¹, p = 0.015 ²), FFM (p = 0.002 ¹, p = 0.018 ²), TBW (p = 0.002 ¹, p = 0.015 ²) and MM (p = 0.003 ²), particularly after laparoscopic sleeve gastrectomy (LSG). Furthermore, there was a significant correlation between pre-surgical HALP score and changes in FFM (p = 0.002 ¹, p = 0.042 ²), TBW (p = 0.002 ¹) and MM (p = 0.011 ¹, p = 0.041 ²). In addition, the modified HALP score showed a more significant correlation compared to the HALP score to predict the changes FM (p = 0.002 ¹, p = 0.002 ²), FFM (p = 0.001 ¹, p = 0.006 ²), TBW (p = 0.001 ¹, p = 0.003 ²) and MM (p = 0.001 ¹, p = 0.023 ²) particularly, after 6 months.

Conclusion: Our findings suggest that pre-surgical assessment of GLR, PNI, and HALP indices may provide valuable insights into predicting changes in body composition after bariatric surgery. Specifically, these indices could serve as tools for tailoring preoperative nutritional strategies and post-surgical interventions. However, as this study is retrospective, further prospective research with longer follow-ups is required to validate these findings and evaluate their utility in clinical practice. ¹ 3 months after metabolic bariatric surgery. ² 6 months after metabolic bariatric surgery.

Background: Obesity is a chronic disease constituting a public health issue, and its prevalence is alarmingly on the rise worldwide. This disease represents a chronic and multifactorial condition, one of the factors being related to the psychological aspect of the patients. Bariatric is an effective tool for obesity control, with weight regain observed more frequently between the third and sixth postoperative years. Behavioral and psychological aspects would be one of the main weight loss and weight regaining risk factors in bariatric patients. The objective of the study is to demonstrate the importance of postoperative behavioral follow-up in the weight control of patients who underwent bariatric surgery.

Methods: The bariatric surgery division database was reviewed, and telephone surveys were performed. A total of 100 patients were included. Overall, 87% of them have a postoperative time of 5 or more years. Weight, percentage of excess weight loss, and percentage of weight regain were evaluated. The group was divided between patients who had or had no behavioral follow-up at 1, 2, 3, and 5 postoperative years.

Results: It was observed that weight loss was statistically higher, and weight regain was statistically lower in the group of patients with behavioral follow-up. This tendency was observed after 1, 2, 3, and 5 years.

Conclusions: Psychological therapy has been shown to be an enhancer for weight loss as well as a protection against weight regain after bariatric surgery. This manifests the need for a long-term postoperative psychological follow-up.

Background: Obesity, characterized by excessive adipose tissue, is associated with chronic low-grade inflammation and elevated inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP). This inflammation is linked to obesity-associated medical problems, including cardiovascular diseases. One anastomosis gastric bypass (OAGB) has emerged as an effective metabolic and bariatric surgical procedure to address severe obesity and its associated inflammatory state. This study aims to evaluate the changes in hs-CRP levels following OAGB in patients with obesity.

Methods: In this prospective cohort study, 71 participants with BMI > 35 kg/m², with or without obesity-associated medical problems, underwent OAGB. The hs-CRP levels were measured at baseline, 1 day, 5 days, 30 days, and 6 months post-surgery.

Results: The median baseline hs-CRP level was 8.5 mg/L, initially increasing post-surgery to 19 mg/L, but significantly decreased to 3.5 mg/L at 6 months (p < 0.001). Significant reductions in weight and BMI were also observed, with median total weight loss (%TWL) of 29% and excess weight loss (%EWL) of 68.2% over 6 months. Pre-operative hs-CRP levels were the only significant predictor of CRP reduction post-surgery.

Conclusions: OAGB significantly reduces systemic inflammation by decreasing hs-CRP levels, alongside substantial weight loss. These findings support OAGB as a beneficial intervention for mitigating inflammation and improving metabolic conditions in patients with obesity. Further, long-term studies are warranted to evaluate the sustained impact of OAGB on inflammatory markers and obesity-associated medical problems.

Background: The efficacy of Glucagon-Like Peptide-1 Receptor Agonists (GLP1RA) for the treatment of obesity has led to considerably increased demand for these medications. GLP1RA use prior to bariatric surgery may represent a novel approach to treating obesity. The objectives of this study were to (1) describe trends in pre-bariatric GLP1RA use, (2) investigate social and clinical factors associated with their use, and (3) evaluate differences in clinical outcomes based on preoperative GLP1RA use.

Methods: Patients who underwent bariatric surgery at three Indiana hospitals from 2018 to 2023 were identified. Patients who utilized GLP1RA in the year preceding surgery were compared to those who did not. Social factors included insurance, income, and unemployment. Outcomes included rates of GLP1RA use, 30-day postoperative readmissions, ED visits, and percent total weight lost (%TWL) at 1 year. Associations between preoperative GLP1RA use and outcomes of interest were evaluated using multivariable logistic and linear regressions.

Results: Of 2169 patients who underwent surgery, 293 (13.5%) utilized GLP1RA preoperatively. The rate of GLP1RA utilization increased threefold from 2018 to 2023. Males were more likely to receive preoperative GLP1RA (20.1% vs, 12.2%, p<0.001). There were no significant differences in social determinants of health or 30-day postoperative outcomes between patients who did and did not use GLP1RA preoperatively. Similarly, there were no significant differences in %TWL at 1 year postoperatively between groups (median 25.5% vs. 27.3%, coefficient, -0.78, 95%CI, -2.26 to 0.70).

Conclusions: Utilization of GLP1RA in the year prior to bariatric surgery has increased threefold. Preoperative GLP1RA use is not associated with worse 30-day outcomes or differences in %TWL at 1 year postoperatively. Further work is needed to evaluate whether GLP1RA dosing and duration of treatment impact postoperative outcomes.

Background: Bariatric surgeries, such as laparoscopic sleeve gastrectomy (LSG), not only result in significant weight loss but also improve the inflammatory state in obese patients. This study aimed to investigate the effects of LSG on weight loss and inflammation status in bariatric patients 1-year post-procedure.

Methods: This prospective cohort study was conducted from September 2022 to May 2024. Fifty obese adults were enrolled for LSG. All patients underwent assessments of body measurements, as well as levels of interleukin-6 (IL-6) and interleukin-10 (IL-10) at baseline, and then at 3 and 12 months post-surgery.

Results: Twelve months post-surgery, body measurements showed a significant reduction, with a median excess weight loss (%EWL) of 56.8%, indicating the clinical success of the bariatric procedure. %EWL showed a strong correlation with waist circumference (R = - 0.738, p < 0.00001). A logistic regression model indicated that a reduction of just 1 cm in initial waist circumference increases the likelihood of a positive outcome in laparoscopic sleeve gastrectomy by 12%. Moreover, a significant increase was observed for IL-10 (p < 0.0001), simultaneously with a significant decrease in IL-6 (p < 0.0001).

Conclusions: This study provides valuable evidence supporting the benefits of laparoscopic sleeve gastrectomy for both weight loss and reducing inflammation. Waist circumference emerged as a strong predictor of metabolic success 1-year post-surgery, while increased IL-10 levels signaled positive immunological changes.

Background: Anastomotic ulcers (AU) at the gastroenterostomy are a common postoperative complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Possible risk factors for ulcer formation include active smoking, the use of non-steroidal anti-inflammatory drugs, increased tension or ischemia at the anastomosis, or factors that increase the acid secretion of the gastric pouch. Therefore, a longer gastric pouch may increase risk of AU formation after LRYGB.

Methods: This study is a retrospective analysis of prospective collected data from patients undergoing LRYGB between 2009 and 2019 with a minimum follow-up of 2 years. In 2018, we changed the operative technique from short to long gastric pouch LRYGB. We analyzed AU formation, dumping syndrome, age, weight evolution, obesity-associated medical problems, and NSAID in two groups: long (LP-GP) vs. short pouch (SP-GP) LRYGB.

Results: A total of 1058 patients were included in the analysis (178 with LP-GP and 880 with SP-GP). A long gastric pouch significantly increased the rate of AU (LP-GP 12.4% vs. SP-GP 2.6%, p ≤ 0.01, OR 5.3). In contrast, the appearance of dumping syndrome improved in patients undergoing LP-GP (LP-GP 49% vs. SP-GP 60%, P ≤ 0.01, OR 1.5). However, no difference was observed between the groups in terms of weight loss in the first 2 years postoperative.

Conclusion: LRYGB with a long compared to a short gastric pouch increases the rate of AU while decreasing the appearance of dumping syndrome. These findings influence the postoperative course of patients undergoing LRYGB, particularly concerning prolonged proton pump inhibitor prophylaxis and a possible tailored surgical approach.