Obesity Surgery最新文献

Background: Metabolic surgery has shown effectiveness in the management of some patients with type 2 diabetes (T2D). However, the evidence for metabolic surgery in type 1 diabetes (T1D) remains scarce. This pilot study aimed to evaluate the feasibility, safety, and metabolic impact of partial duodeno-ileal diversion (PDID) using a novel magnetic compression small bowel anastomosis (MCA) system in a T1D porcine model.

Methods: Ten adult Yorkshire pigs were subjected to intravenous infusion of streptozotocin (STZ) to induce T1D. Diabetic pigs were randomized to either PDID via MCA or control with no operation. The proximal magnet was placed in the duodenum, and the distal magnet was inserted into the distal ileum about 40 cm proximal to the ileocecal valve through a small enterotomy, and magnetic coupling ensued. Procedural feasibility (MCA device coupling efficiency, anastomotic patency) and safety (e.g. burst pressure, device-related complications, survival) were evaluated. Postoperative changes including fasting plasma glucose (FPG), body weight, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR]) were assessed periodically up to 6 weeks postoperatively. Histopathologic and immunohistochemical changes in the distal ileum and pancreas were also evaluated.

Results: Five adult Yorkshire pigs underwent successful PDID via MCA, and 5 unoperated counterparts served as controls. One pig in each group died soon after induction, likely due to STZ toxicity. Anastomotic magnets were expelled per rectally within 14 days of PDID without any complications. In postoperative week 3, FPG normalized to a mean of 5.13 (±0.618) mmol/L in the PDID group and remained stable, whereas in the control group, mean FPG levels were persistently elevated at a mean of 30.28 (±3.168, p < 0.001) mmol/L. The PDID group had a mean HOMA-IR value of 0.892 (±0.220), in contrast to the control group's mean of 6.056 (±0.803, p < 0.001). Histopathological examinations showed satisfactory tissue healing at the anastomotic sites of all pigs in the PDID group, focal hyperplasia of beta cells in the pancreas of all pigs that underwent PDID, and increased immunostaining for synaptophysin, glucagon-like peptide-1 and proinsulin in the distal ileum and pancreatic tissues in the PDID group, as compared with the controls.

Conclusions: PDID via MCA is safe and effective in optimization of glycemic control in this STZ-induced T1D porcine model. Further preclinical validation and evaluation of metabolic changes in response to this novel intervention in different large animal models of T1D is needed before clinical trials in humans.

One anastomosis gastric bypass (OAGB) is increasingly becoming popular worldwide and is considered a safe and effective procedure. However, data regarding long-term efficacy is lacking. We performed a systematic review of articles reporting outcomes in patients with a minimum follow-up of 10 years. Five retrospective studies comprising 1,750 patients met the inclusion criteria. Overall, the weighted mean percentage of total weight loss was 31.1% ( range 29.6-32.1), and remission rates of type 2 diabetes and hypertension ranged from 70.8 to 90% and 56.7-85%, respectively. Conversion or revisional surgery following OAGB was required in 5.2% ( range 3.3-6.4%) of patients on average. This systematic review suggests that OAGB remains a relatively effective and safe procedure after 10 years.

Background: Obesity is highly prevalent among individuals with spinal cord injury (SCI), primarily due to neurogenic alterations in metabolism and body composition. Despite the established efficacy of metabolic surgery (MS) in the general population, its application in SCI patients remains extremely limited, with scarce data on eligibility, feasibility, and safety.

Objective: This study aims to evaluate the eligibility, perioperative outcomes, and short-term efficacy of a structured metabolic surgery program for patients with SCI and neurogenic obesity.

Methods: This retrospective cohort study utilized prospectively collected data from 530 patients with SCI followed at a national neurorehabilitation center (2022-2025). A multidisciplinary assessment identified suitable candidates for MS. Clinical, functional, and surgical variables were recorded, and postoperative outcomes were analyzed at 6 months.

Results: Among 201 patients with obesity (BMI >30 kg/m²), 76 underwent full evaluation, and only 12 (6%) proceeded to surgery. Primary exclusion reasons included psychiatric disorders (22%), eating disorders (23%), and patient refusal (8%). Surgical techniques employed were sleeve gastrectomy (n=7) and Roux-en-Y gastric bypass (n = 5), with no intraoperative complications. Postoperative complications occurred in 4 patients (33%), including one Clavien IVa. At 6 months, %TWL reached 26.5%, with significant fat mass reduction and preserved skeletal muscle when adjusted for body weight. Functional capacity improved or was maintained.

Conclusions: Metabolic surgery is a feasible and safe option in a highly selected subgroup of patients with SCI. However, complex biopsychosocial barriers limit its widespread applicability. Specialized centers with multidisciplinary teams are essential to optimize outcomes and minimize complications in this vulnerable population.

Obesity management is challenged by high rates of recurrent weight gain following initial loss. We systematically reviewed 29 randomized controlled trials comparing long-term outcomes of lifestyle interventions, semaglutide, and metabolic and bariatric surgery (MBS). Databases were searched to March 2025, and data were synthesized using pairwise and network meta-analysis. Lifestyle interventions ranked highest in preventing recurrent weight gain, while semaglutide may support sustained weight reduction during ongoing therapy but is followed by rebound after discontinuation. MBS demonstrated relatively sustained weight loss (> 10% maintained at 5-10 years), although RCT evidence was limited. These findings highlight the need for long-term, structured maintenance strategies and further high-quality trials with standardized outcomes.

Background: Postoperative bleeding is a potentially severe complication of bariatric surgery. reported in 1-4% of patients. Despite recognition of several risk factors. no validated multivariable model combining surgical and early postoperative laboratory data has been developed to support discharge decisions within Enhanced Recovery After Bariatric Surgery (ERABS) pathways.

Methods: We performed a retrospective cohort study of all patients undergoing laparoscopic sleeve gastrectomy or gastric bypass (Roux-en-Y or one-anastomosis) between January 2017 and December 2023 at a high-volume bariatric center. The primary outcome was postoperative bleeding within 30 days. defined as any surgical or endoscopic intervention for suspected bleeding or transfusion requirement. Candidate predictors included demographic. surgical. and routinely available perioperative laboratory data. A multivariable logistic regression model was constructed using backward stepwise selection. Model discrimination and calibration were assessed. and internal validation was performed using bootstrap resampling (500 iterations).

Results: Of 2.024 patients screened. 1.925 were included. with 49 bleeding events (2.5%). Bleeding occurred more often after gastric bypass. in male patients. in those with hypertension. lower preoperative BMI. and with excessive postoperative drainage. Significant perioperative laboratory changes included greater hemoglobin decline and postoperative increases in platelets and white blood cells. The final model incorporated five predictors: procedure type. excessive postoperative day 1 drainage. and perioperative changes in hemoglobin. platelets. and white blood cells. The model demonstrated excellent discrimination (AUC = 0.92) and calibration (Hosmer-Lemeshow p = 0.81). Bootstrap validation confirmed minimal optimism (corrected AUC = 0.917).

Conclusions: The POD 1-DISCHARGE model offers a pragmatic. inexpensive. and accurate method for early risk stratification of bleeding after bariatric surgery. Its reliance on POD 1 clinical and laboratory data makes it readily applicable across diverse centers. supporting safer discharge practices within ERABS. Prospective multicenter validation will determine its broader applicability.

Objective: To evaluate two-year costs to insured patients treated with Roux-en-Y gastric bypass (RYGB) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for type 2 diabetes (T2D) and obesity.

Methods: Using the 2017 to 2023 Merative™ claims database, we identified adult patients with severe obesity and T2D who were treated with a RYGB or GLP-1 RAs. Patients with RYGB had no treatment with GLP-1 RAs, and those who received GLP-1 RAs therapy with tirzepatide or semaglutide for ≥ 2 years had no metabolic and bariatric surgery (MBS) procedures. The study cohorts were matched on demographics including obesity, associated medical problems, and baseline direct or out-of-pocket (OOP) costs to patients in the year prior to treatment initiation. Direct costs included those from outpatient services, inpatient admissions, and outpatient prescription filled that were paid directly by patients. We compared this cost up to two years after treatment initiation using paired t-tests.

Results: 1012 matched RYGB and GLP-1 RAs patients were analyzed, including 35% male. At 1-year after treatment initiation, healthcare costs paid directly by patients were similar for the RYGB ($2,301) and GLP-1 RAs ($2,179) (delta = $122, p = 0.15) cohorts. From one to two years after index treatment date, OOP costs were significantly lower in the RYGB treatment group ($1,277 vs. $2,104, p < 0.01). Two years after treatment initiation, RYGB patients spent $704 less in OOP costs than similar patients treated with GLP-1 RAs medications (p < 0.01).

Conclusions: Direct OOP healthcare costs were lower for RYGB compared to treatment with GLP-1 RAs two years after treatment initiation.

Background: The global epidemics of obesity and type II diabetes highlight the need for reliable tools to predict surgical outcomes, particularly diabetes remission. The applicability of the Advanced DiaRem (Ad-DiaRem) score to Iranian patients undergoing Roux-en-Y gastric bypass (RYGB) remains uncertain due to cultural, genetic, and environmental differences. This study aimed to validate the predictive value of the Ad-DiaRem score in an Iranian cohort.

Methods: This mixed cohort study included 280 diabetic adults who underwent RYGB from 2016 to 2023. Ad-DiaRem scores were calculated based on preoperative clinical variables. Diabetes remission was defined as HbA1c < 6.5% (or fasting blood glucose < 126 mg/dL) at least three months post-surgery without diabetes medications. Various cut-offs were tested, and the Ad-DiaRem's predictive performance was assessed using sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) analysis.

Results: Remission episodes were recorded in 57.9% of patients. Those achieving remission had significantly lower median Ad-DiaRem scores (6 vs. 9). At the cut-off score of 7, Ad-DiaRem showed 51.9% sensitivity, 78.0% specificity, 76.4% positive predictive value, 54.1% negative predictive value, and 62.9% accuracy for predicting remission. The area under the ROC curve (AUC) was 66.7%.

Conclusions: In Iranian patients, the Ad-DiaRem score demonstrated limited predictive performance for diabetes remission after RYGB, with lower accuracy than previously reported in other populations. Recalibration of Ad-DiaRem components is necessary, and development of population-specific scoring systems validated in larger cohorts with longer follow-up is recommended.

Background: Transoral outlet reduction (TORe) is increasingly performed for recurrent weight gain or suboptimal clinical response after Roux-en-Y gastric bypass (RYGB). However, the durability of outcomes beyond one year remains uncertain.

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Six databases were searched to June 2025 for RCTs and cohort studies of adults undergoing TORe after RYGB with ≥ 12 months of follow-up. Outcomes included % total weight loss (%TWL), % excess weight loss (%EWL), and adverse events (AEs). Data were pooled using random effects restricted maximum likelihood models.

Results: Twenty-five studies (3 RCTs, 22 observational; 2667 patients) were included. Pooled baseline age was 47.3 years, 86.0% were female, mean BMI was 38.0 kg/m², and mean interval from RYGB to TORe was 9.5 years. At 12 months, pooled %TWL was 8.0% (95% CI 6.3-9.7) and pooled %EWL was 20.3% (95% CI 14.1-26.5). Weight loss declined at longer follow-up, with pooled estimates of 7.7% TWL and 16.3% EWL at 24 months, and 4% TWL at 36 months. In meta-regression, years since RYGB predicted greater %TWL and %EWL. The pooled AE rate was 5% (95% CI 3-7%), and the pooled SAE rate was 0.3% (95% CI 0.1-0.5%), with no procedure-related mortality.

Conclusion: TORe can provide modest but clinically meaningful weight loss at 12 months with a low rate of serious AE although durability beyond two years appears limited. It may be best regarded as an anatomically corrective intervention that is most effective when incorporated into comprehensive, long-term obesity management.