Obesity Surgery最新文献

Postoperative bleeding is a major complication in bariatric surgery, contributing to increased morbidity, longer hospital stays, and healthcare costs. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in reducing surgical blood loss in various specialties. However, there is still no consensus regarding its effectiveness and safety in bariatric surgery. We performed a systematic review and meta-analysis to evaluate the impact of prophylactic TXA on hemoglobin levels, procedural duration, and hospital length of stay in bariatric surgery patients. PubMed, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) and observational studies comparing TXA and non-TXA groups in bariatric surgery up to November 2024. Data were independently extracted by two reviewers, and risk of bias was assessed using ROBINS-I and RoB-2. Outcomes were assessed using random-effects models, with heterogeneity evaluated by I2 statistics. Sensitivity analyses and publication bias assessments were also performed. Nine studies (2 RCTs and 7 observational studies) involving 1,956 patients were included. TXA significantly improved hemoglobin levels (MD 0.46 g/dL; 95% CI 0.08-0.84; P = 0.02), reduced procedure duration (MD -9.70 min; 95% CI -14.79 to -4.61; P < 0.01), and shortened hospital length of stay (MD -0.19 days; 95% CI -0.31 to -0.07; P < 0.01). No significant increase in thrombotic events was observed. Sensitivity analyses confirmed the robustness of these findings despite high heterogeneity. Prophylactic TXA may significantly reduce perioperative bleeding (smaller hemoglobin decline), operative time, and length of hospital stay in bariatric surgery, without a signal of increasing thrombotic risks, but this should be interpreted with caution given small sample sizes and low event rates. These results support the integration of TXA into perioperative care protocols for bariatric surgery, offering potential benefits in patient outcomes and surgical efficiency.

Background: Bariatric surgery is a well-established treatment for severe obesity, leading to sustained weight loss, remission of associated medical problems, and improved quality of life (QoL). However, some patients may experience dissatisfaction or regret after surgery. Understanding the relationship between weight loss, QoL, and patient-reported regret is essential for improve care. This study aimed to evaluate decision regret following bariatric surgery and to explore its association with weight loss outcomes and quality of life.

Methods: A prospective cohort study was conducted among patients who underwent bariatric surgery between 2021 and 2022 at a single institution. Data were collected at baseline and at three-year follow-up via telephone surveys. The Decision Regret Scale and the Short Form-36 (SF-36) were used to assess regret and QoL, respectively. Multivariable analyses were performed to assess associations between regret, weight loss, and QoL.

Results: Of 198 eligible patients, 92 (46.5%) completed the follow-up survey. A high loss to follow-up represents a key limitation of this study, potentially introducing impact on statistical power and generalizability. The majority (88.8%) reported no regret regarding their surgical decision, and 89.9% indicated they would choose to undergo surgery again. All QoL domains showed significant improvement postoperatively (p < 0.05). However, no significant associations were detected between regret scores and weight loss metrics or QoL improvements. The overall decision regret rate was low, with only 1.1% of patients expressing notable regret.

Conclusions: Most patients reported low levels of regret following bariatric surgery, with no associations detected between regret and either weight loss outcomes or improvements in quality of life. These findings underscore the importance of comprehensive preoperative counseling and long-term support to address patient expectations and enhance satisfaction after bariatric surgery.

Background and aims: Obesity-related Gastroesophageal Reflux Disease (GERD) presents a significant clinical challenge, limited by the effectiveness of current treatments. Excess weight impairs the repair of the anti-reflux barrier, and conventional obesity treatments may adversely affect anti-reflux physiology. This study systematically evaluates a modular endoscopic technique that combines Transoral Incisionless Fundoplication (TIF) with Endoscopic Sleeve Gastroplasty (ESG) simultaneously (F-ESG), offering a synergistic solution to both GERD and obesity.

Methods: This single-center pilot study enrolled adults with objectively confirmed pathologic GERD and incomplete symptomatic response to proton pump inhibitor therapy. Participants underwent the combined F-ESG procedure with standardized dietary and behavioral counseling. Outcomes were assessed at baseline, 6 months, and 12 months, including percent total weight loss (%TWL), GERD Health-Related Quality of Life (HRQL), Reflux Symptom Index (RSI), and DeMeester score (DMS) obtained from 48-hour pH monitoring.

Results: Eight participants (mean age 39 ± 6.4 years; 75% female; mean BMI 34.5 ± 3.7 kg/m²) were included. Mean %TWL was 13.1% at 6 months and 15.2% at 12 months. GERD HRQL improved from 26.4 at baseline to 8.3 at 6 months and 8.5 at 12 months (p < 0.01). RSI and DMS also demonstrated significant reductions. By 12 months, all participants had discontinued PPI therapy, and 7 of 8 achieved a normalized DeMeester score.

Conclusions: In this single-center pilot study, same-session F-ESG was feasible and safe, with improvements in subjective and objective GERD metrics and weight loss through 12 months. Larger multicenter comparative studies are warranted to evaluate efficacy and durability.

Background: Metabolic and bariatric surgery (MBS) is the most effective and reliable treatment for weight loss and resolution of associated medical problems. However, postoperative weight loss outcomes vary, and psychological factors may contribute to these differences. In our practice, clinical psychologists assess patients' perceptions of major contributors to their weight gain prior to surgery, but limited research has examined how these perceptions relate to postoperative outcomes. Understanding this relationship may inform perioperative counseling and support individualized care plans.

Methods: This retrospective study included patients who underwent MBS at a single institution in 2019 and 2020. Patient responses describing perceived contributors to weight gain were coded using a combined inductive-deductive approach. Chi-square tests examined associations between perceived contributor categories. Univariate and multivariable regression models assessed the relationship between perceived contributors and percent total body weight loss (%TBWL) at 36 months post-surgery. Analyses were conducted in Stata 18.0 with p < 0.05 for significance.

Results: The study included 73 patients with a mean baseline age of 44 years (SD = 13). Most participants were female, non-Hispanic, and identified as White. The mean %TBWL at 36 months post-surgery was 23.7 (SD = 11.7). In univariate regression analyses, perceived contributors such as genetics, environmental/occupational factors, and reporting more than 1 contributor were significantly or marginally associated with %TBWL. These associations were not significant in the multivariable model.

Conclusion: Prospective studies with larger, more diverse cohorts across multiple sites are needed to better clarify the relationship between perceived contributors to weight gain and MBS outcomes.

Background: Metabolic Dysfunction-Associated Steatohepatitis (MASH) and hepatic fibrosis are common in patients undergoing sleeve gastrectomy (SG). Whether histological liver injury influences postoperative weight loss remains uncertain. This study examined the association of biopsy-proven MASH and fibrosis severity with 12-month weight-loss outcomes after SG.

Methods: We retrospectively analyzed 417 patients who underwent SG with intraoperative liver biopsy. Steatosis, inflammation, and ballooning were graded by the NAFLD Activity Score, and fibrosis was staged F0-F4. Weight-loss outcomes included total weight loss (%TWL), excess weight loss (%EWL), and attainment of the expected BMI (eBMI). Logistic regression identified factors associated with eBMI and ≥ 50%EWL achievement.

Results: At 12 months, patients with MASH and those without achieved comparable percentage of %TWL and %EWL (32.08 vs. 30.23%; 88.64 vs. 93.82%). Fibrosis severity, rather than MASH status, showed an association with individualized BMI attainment, whereas proportional weight-loss outcomes (%TWL and %EWL) did not differ significantly across fibrosis stages.

Conclusions: In this biopsy-confirmed SG cohort, MASH did not affect short-term weight loss, whereas moderate fibrosis was linked to greater likelihood of reaching individualized BMI targets.

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver condition, closely associated with obesity and type 2 diabetes mellitus.

Objectives: Despite its prevalence, there are no approved pharmacotherapies, making the search for effective treatments crucial.

Methods: This study investigates the impact of vertical sleeve gastrectomy (VSG) on NAFLD, focusing on changes in bile acid metabolism as a potential therapeutic mechanism. We employed an ApoE-/- mouse model to simulate human NAFLD conditions. Mice were divided into two groups: one underwent VSG and the other served as a control. We monitored body weight, food intake, liver function, lipid profiles, and histological changes in hepatic tissues. Bile acid profiles were analyzed using Ultra Performance Liquid Chromatography coupled with Tandem Mass Spectrometry (UPLC-MS/MS).

Results: Post-VSG, mice exhibited significant weight loss and reduced food intake. Biochemical analyses showed substantial improvements in liver function tests (ALT and AST), lipid profiles (cholesterol and triglycerides), and glucose regulation. Histological examination revealed marked reductions in hepatic steatosis and inflammation. Notably, VSG led to significant alterations in bile acid profiles, particularly increased primary bile acids and decreased secondary bile acids, correlating with improved liver histology and metabolic parameters.

Conclusion: Our findings suggest that VSG, beyond its role in weight reduction, significantly improves NAFLD. The surgery alters bile acid metabolism, which may contribute to its therapeutic effects. These results highlight the potential of VSG as a metabolic surgery for NAFLD and open avenues for exploring bile acid-related therapies.