Obesity Surgery最新文献

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.

Background: The Bikini-line sleeve gastrectomy is a modification of standard laparoscopic sleeve gastrectomy designed primarily to improve aesthetic outcomes by relocating trocars to the lower abdomen. It offers aesthetic advantages without additional metabolic or functional benefit.

Purpose: The study compared early clinical outcomes, pain, scar satisfaction, and post-operative pain between Bikini-line sleeve gastrectomy and standard laparoscopic sleeve gastrectomy.

Materials and methods: This retrospective cohort study of 364 patients: 216 in laparoscopic sleeve gastrectomy and 148 in bikini line sleeve gastrectomy operated from January 2023 to December 2023. Demographics, operating time, length of hospital stay, excess weight loss, pain scores, scar satisfaction, and complications have been assessed. Patients with BMI ≥ 30 kg/m² with T2DM, BMI 35-39.9 kg/m² with comorbidities, and BMI ≥ 40 kg/m² were included. However, patients with a progressive history of a major open abdominal surgery, persistent hiatal hernia of more than 4 cm, and patients who refused to use the bikini-line method were excluded. The study applied the Kolmogorov-Smirnov test to ascertain the normality of the data. Student's t-test was used for normally distributed variables, and the Mann-Whitney U test for non-normally distributed ones. Chi-square and Fisher exact tests ensured stable examination of operative time, pain, scar satisfaction, EWL, and complications.

Results: The laparoscopic sleeve gastrectomy group had a higher preoperative BMI (42.49 ± 6.19 vs. 38.52 ± 4.72, p < 0.001). No significant differences were observed in excess weight loss % at 3, 6, and 12 months between laparoscopic sleeve gastrectomy and bikini-line sleeve gastrectomy (35.8% vs. 35.9%, p = 0.667; 49.6% vs. 49.2%, p = 0.356; 56.0% vs. 56.3%, p = 0.390). Postoperative 12 h pain was significantly lower in the bikini line sleeve gastrectomy group (4.14 ± 0.78 vs. 5.35 ± 1.02, p < 0.001), while scar satisfaction scores at discharge and at 12 months were markedly higher (p < 0.001). Complication rates (bleeding p = 0.149; thromboembolism p = 1.000; infection p = 0.125) and operation times (p = 0.131) were similar between groups.

Conclusion: Bikini-line sleeve gastrectomy demonstrated comparable weight loss and complication rates to standard laparoscopic sleeve gastrectomy, while significantly reducing early postoperative pain and improving scar satisfaction. Although feasible and safe in selected patients with appropriate closure, Bikini-line sleeve gastrectomy is primarily an aesthetic adaptation rather than a replacement for standard laparoscopic sleeve gastrectomy.

Background: Constipation is a common yet often underrecognized gastrointestinal complication following metabolic and bariatric surgery (MBS). It not only affects patients' quality of life but may also lead to abdominal pain, bowel obstruction, and nutrient malabsorption. However, current findings regarding its incidence, risk factors, and variations across surgical procedures remain inconsistent.

Objective: To comprehensively assess the risk of postoperative constipation, its procedure-specific differences, and related clinical characteristics after MBS, providing evidence-based insights for postoperative management and intervention.

Methods: This systematic review and meta-analysis followed the PRISMA guidelines and was prospectively registered in PROSPERO (Registration No. CRD 420251162054 ). A comprehensive search was conducted in PubMed, Embase, Web of Science, MEDLINE, and the Cochrane Library up to October 2025. Studies reporting constipation outcomes after MBS were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model, and subgroup analyses were performed based on surgical type.

Results: Eight studies comprising 4,838 participants were included. The pooled analysis demonstrated no significant association between MBS and constipation risk (OR = 1.04, 95% CI: 0.62-1.73, p = 0.83), with substantial heterogeneity (I² = 82.9%). Subgroup analyses revealed procedure-dependent differences: biliopancreatic diversion (BPD) (OR = 0.19, 95% CI: 0.07-0.52) and Roux-en-Y gastric bypass (RYGB) (OR = 0.12, 95% CI: 0.04-0.38) were associated with a reduced risk, whereas adjustable gastric banding (AGB) significantly increased constipation risk (OR = 2.40, 95% CI: 1.08-5.33).Results for laparoscopic sleeve gastrectomy (LSG) were heterogeneous, with pooled data showing no significant association (OR = 1.31, 95% CI: 0.62-2.77). Sensitivity analyses and publication bias assessments confirmed the robustness of the findings.

Conclusions: The risk of constipation following MBS is strongly procedure-dependent. Malabsorptive or mixed procedures (e.g., BPD, RYGB) may lower constipation risk, whereas restrictive procedures (e.g., AGB) appear to increase it. LSG shows no consistent association. Individualized postoperative management-including adequate dietary fiber and fluid intake, maintenance of regular bowel habits, and early preventive interventions-may improve postoperative quality of life. Further large-scale, multicenter, prospective studies are needed to elucidate the underlying mechanisms and refine postoperative care strategies.

Background: Over the past three decades, metabolic and bariatric surgery (MBS) has undergone significant changes in Iran, mirroring global trends and incorporating regional innovations. This study aims to investigate MBS trends in Iran over 15 years (2009-2024), with a focus on demographic patterns and procedural distribution.

Methods: Data from the Iranian National Obesity Surgery Database (INOSD) provided the basis for a retrospective study. The study encompassed all patients with MBS between 2009 and 2024. The demographic traits, body mass index (BMI), obesity-associated medical disease, surgical operation type, and trends over time were analyzed.

Results: In total, 55,936 patients were included, most of whom were female (80%). The majority (62%) were aged 25-45 years. With a declining number of patients with BMI > 50 kg/m² over time, most patients fell in the range of 40-50 kg/m². The most common obesity-associated medical problems were hypertension (15%), severe obstructive sleep apnea (12%), type 2 diabetes mellitus (11%), and dyslipidemia (11%). Rising from 2.6% in 2009 to 56% in 2024, sleeve gastrectomy (SG) surpassed Roux-en-Y gastric bypass (RYGB), which decreased from 92% in 2009 to 13% in 2024. Especially in higher BMI patients, one anastomosis gastric bypass (OAGB) demonstrated a consistent rise. Rates of revisional and conversional surgery rose over time, specifically in OAGB.

Conclusions: With an increasing inclination for SG and OAGB, MBS trends in Iran mirror a worldwide movement toward safer and more effective treatments.

Background: While bariatric surgery (BS) is an effective treatment for gout in patients with morbid obesity, little is known about how BS influences subsequent use of gout medications. We investigated the impact of BS on gout medication use.

Methods: This retrospective nationwide cohort study used data from South Korea, including all patients who underwent BS in 2019-2020. A control group was created using propensity score matching. The primary outcome was the change in the proportion of patients using gout medications, categorized as urate-lowering therapy (ULT) or acute medications. We assessed hazard ratios for discontinuation and reinitiation of medications after BS using Cox regression.

Results: The study included 3804 participants in the BS group and 15,240 propensity score-matched controls. Over the 3 years after surgery, ULT use in the BS group declined to rates comparable to those in controls from month 13 onward, and discontinuation was more likely in the BS cohort (adjusted hazard ratio, 1.80; 95% confidence interval, 1.37-2.37). In contrast, although acute medication use also decreased after BS, its rate remained higher than in controls, and discontinuation did not differ significantly. Similarly, the 3-year rate of gout medication reinitiation did not differ significantly between groups.

Conclusions: Over 3 years after BS, overall gout medication use in the BS group declined to a level comparable to that in controls, with a significantly higher ULT discontinuation rate. Discontinuation of acute gout medications did not differ significantly.