Obesity Surgery最新文献

Background: Compared to Roux-en-Y gastric bypass, cases of dumping syndrome (DS) occur significantly less frequently after one anastomosis gastric bypass due to the longer gastric pouch. Recent studies have proposed supplementation of gastric bypass with modified fundoplication using the excluded part of the stomach; however, only a few cases have been reported, as this is often performed in revision surgeries. This study aimed to compare the incidence of early and late DS after "FundoRingOAGB" and standard one anastomosis gastric bypass by assessing the OGTT, insulin levels, and Sigstad scores as outcome measures.

Materials and methods: This was a single-center, prospective, interventional, open-label (no masking) RCT (FundoRing Trial) with a 1-year follow-up period. The endpoints were oral glucose tolerance tests (OGTT), insulin levels, Sigstad scores, early and late DS symptoms.

Results: Overall,1000 patients (n=500 FundoRing One-anastomosis gastric bypass [f-OAGB] vs. n=500 standard OAGB [s-OAGB]) with complete follow-up data were included in the study. No leaks, bleeding, or mortality occurred in either group. At 1-year, BMI in the f-OAGB group was 27.0 ± 0.75 vs. 29.0 ± 0.66 s-OAGB group (p=0.04). DS symptoms were observed in 98 (19.6%) and 175 (35%) patients in the f-OAGB and s-OAGB groups, respectively (P =0.001). Sigstad's scores for the f-OAGB and s-OAGB groups were 2.8 ± 0.9 and 5.1 ± 1.3, respectively (p=0.001).

Conclusion: Modified fundoplication of the OAGB-excluded stomach significantly decreased early and late DS symptoms more effectively than standard OAGB at 1 year.

Background: Rectus sheath block (RSB) provides reliable anesthesia to the anteromedial abdominal wall and may offer effective pain control following laparoscopic sleeve gastrectomy (LSG). This study aimed to compare the efficacy of RSB versus local infiltration analgesia (LIA), hypothesizing that RSB would provide superior pain relief.

Methods: In this randomized controlled trial, patients with obesity undergoing LSG received either bilateral ultrasound-guided RSB performed by an anesthesiologist or LIA administered by a surgeon, following anesthesia induction. The primary outcome was intraoperative fentanyl consumption. Secondary outcomes included postoperative pain scores [Numeric Rating Scale (NRS), 0-10], cumulative morphine consumption, and recovery metrics over 48 h.

Results: Sixty-nine patients were analyzed (RSB: 35; LIA: 34). Intraoperative fentanyl use was lower with RSB (median difference: - 25 mcg; 95% CI: - 50 to 0; p = 0.008). RSB reduced pain scores at rest at 0 h (-2 points; p = 0.001), 1 h (-1 point; p = 0.009), and 12 h (-1 point; p = 0.022), and pain during movement at 0 h (-3 points; p < 0.001), 12 h (-1 point; p = 0.043), and 36 h (-1 point; p = 0.019). Pain scores were otherwise comparable. Fewer RSB patients reported moderate-to-severe pain at 0 h and 1 h (rest: p = 0.006 and 0.019; movement: p < 0.001 and 0.033). Postoperative morphine use and recovery metrics were similar between groups.

Conclusion: Pre-incisional RSB demonstrated an intraoperative opioid-sparing effect and superior early postoperative analgesia compared with LIA, supporting its role as a component of multimodal analgesia for LSG.

Recurrent weight gain after metabolic bariatric surgery (MBS) threatens the durability of metabolic and renal benefits, yet its intricate relationship with kidney function remains underexplored. This review synthesizes evidence that weight regain (≥ 20% from nadir weight) reactivates obesity-driven kidney injury pathways, including glomerular hyperfiltration, lipotoxicity (toxic damage from lipid overload), and NOD-like receptor protein 3 (NLRP3) inflammasome activation (an immune complex driving inflammation). Consequently, albuminuria recurs in 20-35% of patients and eGFR decline accelerates. Procedure-specific dynamics modulate outcomes. Roux-en-Y gastric bypass (RYGB) offers superior kidney protection despite moderate regain (5.3-37% at 7 years). In contrast, sleeve gastrectomy (SG) shows higher regain (26.3-76% at 6 years) and weaker renal improvements. Critically, weight recurrence reactivates transforming growth factor-beta (TGF-β)/mothers against decapentaplegic homolog (SMAD) and Wnt/β-catenin fibrotic signaling, driving ectopic renal fat reaccumulation and tubular injury. Emerging strategies, including glucagon-like peptide-1 (GLP-1) agonists (27% albuminuria reduction) and endoscopic revisions, show promise in mitigating renal sequelae. However, definitional heterogeneity in weight regain and insufficient phenotyping of kidney-specific biomarkers impede clinical translation. This review underscores the urgency of personalized interventions to preserve kidney health in the context of post-bariatric weight recurrence, advocating for multidisciplinary approaches and future research into novel antifibrotic therapies.

With the rising incidence of type 2 diabetes mellitus (T2DM) worldwide, the search for effective treatments has become an important direction of contemporary medical research. Bariatric metabolic surgery, as a new therapeutic approach, has made remarkable progress in improving T2DM in recent years. In this paper, we collected studies on the mechanisms by which metabolic surgery improves T2DM by altering the intestinal flora and its metabolites in the last 5 years, and systematically analysed the effects of different weight loss surgeries, such as gastric bypass and sleeve gastrectomy, on the composition of the intestinal flora. Then, the changes in the metabolites of the flora triggered by these surgeries and the possible downstream molecular mechanisms were explored. Although it has been revealed that the intestinal flora is altered by bacterial genera after metabolic surgery, the downstream mechanisms remain unclear. The aim of this review is to provide a new perspective for a deeper understanding of the microbiological mechanisms of metabolic surgery for T2DM and to provide a theoretical basis for future microbiome-based therapeutic strategies.

Introduction: Although laparoscopic sleeve gastrectomy (LSG) effectively addresses obesity, its outcomes on hyperuricemia (HUA) remission remain inconsistent. We aimed to identify baseline predictors and develop a nomogram for HUA persistence six months following LSG.

Methods: We retrospectively analyzed patients with obesity and HUA undergoing primary LSG at Huashan Hospital. An independent validation cohort from the Affiliated Hospital of Xuzhou Medical University was included. Clinical data, including demographics, anthropometric measurements, and biochemical markers were analyzed. Logistic regression analyses identified independent predictors of persistent HUA, and a predictive nomogram was developed and externally validated.

Results: A total of 631 patients was enrolled in this study. Persistent HUA was observed in 41.8% (159/380) of patients in the training cohort. Multivariate analysis identified male sex (OR = 4.97, 95% CI: 2.35-10.51, P < 0.001), waist circumference (WC; OR = 1.06, 95% CI: 1.02-1.10, P = 0.006), and baseline UA levels (OR = 1.01, 95% CI: 1.01-1.02, P < 0.001) as significant predictors. The nomogram demonstrated excellent discriminative ability (AUC = 0.85, 95% CI: 0.82-0.86) and calibration. In the validation cohort, persistent HUA was observed in 35.5% (89/251), and the nomogram maintained robust predictive performance (AUC = 0.81, 95% CI: 0.76-0.82).

Conclusion: Male sex, increased WC, and elevated baseline UA predict postoperative persistent HUA. The nomogram provides a practical clinical tool for predicting short-term HUA non-remission post-LSG.

Background: Sleeve gastrectomy becomes increasingly popular worldwide, with ongoing efforts to minimize abdominal trauma and postoperative pain and enhance aesthetic outcomes. Bikini line sleeve gastrectomy (BLSG) is a novel technique that achieves improved cosmetic results while maintaining the fundamental goal of effective weight loss. We aim to evaluate the feasibility and safety of three-port bikini sleeve gastrectomy in achieving both aesthetic satisfaction and weight reduction.

Methods: A prospective cohort study included 85 patients who underwent laparoscopic sleeve gastrectomy between October 2018 and October 2019 at Ain Shams University Hospitals, with 24-month follow-up. Based on BMI and defined anthropometric criteria, patients were allocated to Group I (n = 40), who underwent laparoscopic bikini line sleeve gastrectomy (BLSG), while Group II (n = 45), who underwent conventional laparoscopic sleeve gastrectomy (LSG). Outcomes assessed included patient satisfaction with scar appearance, percentage of excess weight loss, and early and late postoperative complications. Statistical analyses used chi-square and t-tests, with significance at p < 0.05.

Results: There was no statistically significant difference in weight loss outcomes between groups at any of the measured time points (6, 12, 18, and 24 months). The bikini line sleeve gastrectomy group reported significantly higher satisfaction with scar appearance. Despite the modest ergonomic challenges of the lower abdominal access in the bikini group, BLSG demonstrated low complication rates, confirming its safety.

Conclusions: In appropriately selected patients, three-port bikini line sleeve gastrectomy demonstrates a favourable safety profile and significantly enhances patient satisfaction while maintaining comparable clinical efficacy. Large multicentre randomized trials are warranted to further validate these outcomes. Key Points • In selected patients, three-port BLSG is reliable technique without compromising weight loss efficacy. • Three-port BLSG provides enhanced cosmetic satisfaction for patients prioritizing aesthetic outcomes. • With proper patient selection, the procedure can be safely integrated into routine practice • Future advancements in technique and instrumentation may broaden the application of three-port BLSG to patients with higher BMI and larger abdominal dimensions.