Obesity Surgery最新文献

Introduction: Roux-en-Y gastric bypass (RYGB) reversal might be necessary to alleviate refractory surgical or nutritional complications, such as postprandial hypoglycemia, malnutrition, marginal ulceration, malabsorption, chronic diarrhea, nausea and vomiting, gastro-esophageal reflux disease, chronic pain, or excessive weight loss. The surgical technique of RYGB reversal is not standardized; potential strategies include the following: (1) gastro-gastrostomy: hand-sewn technique, linear stapler, circular stapler; (2) handling of the Roux limb: reconnection or resection (if remaining intestinal length ≥ 4 m).

Case presentation: We demonstrate the surgical technique of a laparoscopic reversal of RYGB with hand-sewn gastro-gastrostomy and resection of the alimentary limb with the aim of improving the patient's quality of life. The gastric pouch is horizontally divided proximal to the previous staple line. A hand-sewn end to end anastomosis is created between the distal gastric pouch and the horizontal part of the gastric remnant adjacent to the lesser curve. The posterior wall is sutured in two layers. The anterior layer is closed with continuous 3-0 PDS full-thickness stitches over a 36-French oro-gastric calibration bougie. After evaluation of intestinal limbs and ruling out of hernial defects, the alimentary limb is divided just above the jejuno-jejunal Roux-anastomosis and is resected.

Conclusion: Reversal of RYGB is a precious treatment option for otherwise unmanageable postbariatric complications in well-selected cases. The operation should be performed in high volume bariatric centers after multidisciplinary patient preparation. The early and late complications of the reversal are higher than the rates seen in primary MBS; therefore, patients should be informed and monitored accordingly to ensure the best achievable outcomes.

Laparoscopic adjustable gastric banding (LAGB) is a type of bariatric surgery. Gastric stenosis or obstruction is a known complication of LAGB; however, its occurrence after band removal is extremely rare. A 60-year-old female, who had undergone LAGB 6 years earlier and band removal 4 years prior, presented to the hospital with recurrent vomiting. Abdominal computed tomography revealed gastric stenosis with proximal gastric distension and endoscopy showed deformation of the gastric mid-body with luminal narrowing. Surgical intervention for adhesiolysis was planned, and intraoperatively, severe fibrotic adhesions encircling the mid-body of the stomach were identified. Dissection of the greater omentum near the transverse colon was performed first to expose the posterior wall of the stomach. Adhesions between the posterior wall of the stomach and the supra-pancreatic area tissues near the left gastric artery and splenic artery were meticulously dissected. Subsequently, the adhesions between the anterior wall of the stomach and the tissues along the left gastroepiploic artery were dissected. Postoperative computed tomography and endoscopy revealed a restored normal anatomical structure of the stomach. Adhesion-induced gastric stenosis should be considered as a differential diagnosis even years after the removal of a gastric band, warranting timely adhesiolysis when necessary.

Background: Recurrent weight gain after laparoscopic sleeve gastrectomy (LSG) is common. Revisional endoscopic sleeve gastroplasty (r-ESG) has been shown to be a promising endoscopic bariatric therapy (EBT) to treat weight recurrence after LSG. However, to date, weight loss outcomes beyond 1-year follow-up are unknown. Our study aims as follows: (1) examine 1 year, 18-month, and 24-month weight loss outcomes post-r-ESG and (2) determine if weight loss outcomes post-LSG predict clinical outcomes post-r-ESG.

Methods: This was a retrospective cohort data of patients who completed r-ESG from December 2020 to November 2023. The primary outcome was percentage of total body weight loss (TBWL) at 1-year post-r-ESG. Secondary outcomes included TBWL at 18- and 24-month post-r-ESG. Multivariable logistic regression analysis was used to determine predictors of weight loss ≥ 5% at 12 months.

Results: A total of 55 patients completed r-ESG. TBWL post-r-ESG at 12 months was 8.6% (n = 37), at 18 months was 10.7% (n = 31), and at 24 months was 12.6% (n = 18) (Table 2). There were no statistically significant variables associated with weight loss ≥ 5% at 12 months (Table 3).

Conclusions: Our study demonstrates that r-ESG is an effective and durable EBT for post-LSG weight recurrence. Further research is needed to determine optimal timing of r-ESG for weight recurrence as well as the adjunctive role of anti-obesity medications.

Background: Previous studies showed a high conversion rate and failure of restrictive procedures, including sleeve gastrectomy (SG), adjustable gastric banding (AGB), gastric plication (GP), and vertical banded gastroplasty (VBG) in a long-term follow-up. The current study aims to evaluate the efficacy and safety of a revisional one anastomosis gastric bypass (OAGB) for weight loss and treatment of obesity-related problems after primary metabolic and bariatric restrictive procedures.

Methods: A retrospective study on prospectively collected data was conducted on a sample of 151 patients who experienced insufficient weight loss or weight regain after primary restrictive surgeries and underwent OAGB as a revisional procedure.

Results: A total of 151 patients with a history of previous restrictive metabolic and bariatric surgery who underwent a revisional OAGB were included in this study. The restrictive procedures consisted of SG (n = 79), AGB (n = 45), GP (n = 15), and VBG (n = 12). Total weight loss percent (%TWL) after the revisional OAGB was 27.03 ± 9.12, 27.74 ± 10.05, 24.62 ± 9.87, and 24.34 ± 8.05 after 12, 24, 60, and 84 months, respectively. After 24 months of follow-up, TWL was significantly higher in the GP group compared to the AGB group. However, weight loss outcomes were not significantly different after 60 months of follow-up. The revisional OAGB was associated with a significant resolution of obesity-related problems, including type 2 diabetes (55.55%), hypertension (50%), dyslipidemia (77%), and obstructive sleep apnea (100%) after 2 years of follow-up. There was no serious complication after the revisional OAGB in the short- and long-term follow-up.

Conclusion: OAGB is an efficient and safe option as a conversion surgery after restrictive procedures.

Background: This study evaluated the long surgical gauze (SurG) technique as a liver retraction method in laparoscopic sleeve gastrectomy (LSG). Traditional methods involve the Nathanson retractor, associated with ischemia and necrosis complications. In addition, these techniques require an additional trocar with an incision that increases postoperative pain. Our aim, therefore, was to reduce such complications through the use of SurG and evaluate recovery and outcome implications.

Methods: In this retrospective study, patients who underwent laparoscopic sleeve gastrectomy (LSG) between January and December 2023 were divided into two groups based on the liver retraction method used: NR or SurG. Demographic data, surgery times, postoperative liver enzyme levels (AST, ALT), C-reactive protein (CRP), pain scores, and analgesic use (VAS) were collected from medical records and statistically analyzed.

Results: The SurG group demonstrated significantly lower postoperative pain scores and reduced analgesic use compared to the NR group (p < 0.001). Additionally, liver enzyme levels (AST, ALT, CRP) were lower in the SurG group, indicating less liver stress. Early mobilization was achieved more quickly in the SurG group, aligning with Enhanced Recovery After Surgery (ERAS) protocols. However, the SurG method showed some limitations during the dissection of the greater curvature due to the narrower field of view.

Conclusions: The long surgical gauze method provides a viable alternative to the Nathanson retractor, offering advantages such as less postoperative pain, reduced liver stress, and quicker mobilization. Despite some technical limitations, this method can improve patient outcomes in sleeve gastrectomy.

Background: Several studies have documented a beneficial short-term effect on lipid profile after Roux-en-Y gastric bypass (RYGB), but there is limited data on long-term changes.

Objectives: To describe long-term (> 10 years) changes in lipid profile after RYGB and to explore the relationship of lipid changes to changes in weight and baseline and demographic parameters.

Methods: The BAROBS study is a prospective observational study post RYGB conducted at three different hospitals. Surgical procedures were performed between 2003 and 2009, and the collection of data was in 2018-2020. Data on lipid profile, weight, body mass index (BMI), percentage of total weight loss (%TWL), and pre- and postoperative type II diabetes mellitus (DMII) was collected at baseline, 1-2, 5, and 10 years post-surgery and was available for 314 of 546 patients in the study.

Results: The mean (SD) follow-up was 11.5(± 1.5) years, with a mean reduction of 11.7% for LDL, 29.7% for TG, and 7.7% for total cholesterol compared to baseline. Except for HDL and total-/HDL-cholesterol-ratio, all lipid variables reached their greatest change after 1-2 years with an attenuation of changes at end of study. HDL and total-/HDL-cholesterol-ratio had stable values from 5 to 10 years post-surgery. Lipid profile improved more in patients with greater weight loss. There was a 59% reduction in DMII at end of study, and there was a significant relation between preoperative DMII and long-term lipid values.

Conclusion: There is an improvement of all lipid parameters after 10 years post RYGB related to both the magnitude of weight loss and the presence of DMII.

Background: In cirrhotic patients, portal hypertension increases mortality after surgery. We evaluated the impact of pre-operative transjugular intrahepatic portosystemic shunt (TIPS) on the outcomes of bariatric surgery in cirrhosis.

Methods: Multicentric retrospective cohort. The decision for TIPS placement has been made according to hepatic venous pressure gradient (HVPG) values and centers' policy. The primary outcome: 1-year decompensation-free survival; secondary outcomes: 1-year acute-on-chronic liver failure (ACLF) and survival.

Results: Fifty-three patients were included (2010-2022): 92% Child-Pugh A, MELD score 8, age 55 years, BMI 38.3 ± 13 kg/m², 9 (18%) had TIPS. At baseline, patients with TIPS had more esophageal varices (89% vs 10%, p < 0.001), more previous decompensations (22% vs 0%, p = 0.002), and a higher HVPG (14 vs 7 mmHg, p < 0.001). All patients in the TIPS group had clinically significant portal hypertension vs 11% of patients without TIPS, p < 0.001. One-year decompensation-free survival was 77.8% and 93.2% in patients with and without TIPS, p = 0.064. ALCF occurred in 3 patients (6.8%) without TIPS and none with TIPS. All patients were alive 1 year after surgery.

Conclusions: In patients with cirrhosis and clinically significant portal hypertension (CSPH) undergoing bariatric surgery, TIPS placement was safe and had similar outcomes after surgery as patients without TIPS.

Background: Obesity is a significant risk factor for chronic kidney disease (CKD), with metabolic bariatric surgery offering potential renal benefits. However, there is limited comparative data on the impact of Roux-en-Y gastric bypass (RYGB) versus laparoscopic sleeve gastrectomy (LSG) on renal function in individuals with obesity without end-stage renal disease (ESRD). The objective of this study was to compare renal function outcomes following RYGB and LSG in patients with obesity, focusing on estimated glomerular filtration rate (eGFR), serum creatinine, albumin-creatinine ratio (ACR), and serum cystatin C.

Methods: A systematic review and meta-analysis were conducted following Cochrane and PRISMA guidelines. Data from 17 observational studies (n = 3339) were analyzed. Primary outcomes included changes in eGFR, ACR, serum creatinine, and cystatin C. Secondary outcomes included excess weight loss (%EWL) and total weight loss (%TWL). Statistical analysis involved fixed and random-effects models based on heterogeneity levels.

Results: RYGB demonstrated significant improvements in eGFR (SMD =  - 0.71; 95% CI - 0.89 to - 0.52, p < 0.00001) and serum cystatin C (MD =  - 0.10; 95% CI - 0.17 to - 0.03, p = 0.004) compared to LSG. No significant differences were found for serum creatinine (MD =  - 1.06; 95% CI - 4.42 to 2.30, p = 0.54) or ACR (MD = 1.95; 95% CI - 0.39 to 4.29, p = 0.10). RYGB also showed greater long-term weight loss, particularly at 5 years (%EWL: MD = 22.00; 95% CI 6.56 to 37.44, p = 0.005).

Conclusions: RYGB offers similar renal improvements with superior weight loss compared to LSG in individuals with obesity without ESRD. These findings emphasize the need for personalized treatment approaches and further research to validate these outcomes.

This meta-analysis and trial sequential analysis (TSA) investigated the effects of probiotic supplementation on triglyceride levels in patients after bariatric surgery. A comprehensive literature search identified seven randomized controlled trials involving 411 participants. The meta-analysis revealed a significant reduction in triglyceride levels favoring probiotic supplementation (mean difference =  - 18.46 mg/dL, 95% confidence interval [- 29.73, - 7.2], p = 0.001) with no heterogeneity (I² = 0%). The observed reduction in triglycerides (18.46 mg/dL) exceeds the reported minimal clinically important difference (MCID) threshold for triglycerides (i.e., 7.97 mg/dL), suggesting clinically meaningful improvements. TSA confirmed that sufficient evidence has been accumulated to support the effect of probiotics on triglycerides, with the cumulative Z-curve crossing the required information size of 313 participants. These findings suggest that probiotic supplementation could be a valuable adjunct therapy for managing lipid profiles in patients undergoing bariatric surgery. Future research should focus on optimizing probiotic interventions, including identifying the most effective strains, dosages, and duration of supplementation.

This study evaluates the feasibility of ChatGPT-4 as a knowledge resource in bariatric surgery. Using a problem set of 30 questions covering key aspects of bariatric care, responses were reviewed by three bariatric surgery experts. ChatGPT-4 achieved strong performance, with 50% of responses scoring the highest possible rating for alignment with clinical guidelines. However, limitations were noted, including outdated criteria, lack of specificity, and occasional poor response structuring. The study highlights the potential of ChatGPT-4 as a supplementary tool for patient education and healthcare provider support, as well as its broader public health applications, such as obesity prevention and healthy lifestyle education. Despite its promise, challenges such as handling complex clinical cases, reliance on up-to-date evidence, and ethical concerns like privacy and misinformation must be addressed. Future research should refine the model's applications and explore its integration into clinical practice and public health strategies.