Surgery for Obesity and Related Diseases最新文献_第2页

A randomized, double-blind, placebo-controlled trial of weight loss using liraglutide 3.0 mg for weight recurrence after Roux-en-Y gastric bypass 使用利拉鲁肽 3.0 毫克治疗 Roux-en-Y 胃旁路术后体重复发的随机、双盲、安慰剂对照减肥试验。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.soard.2024.08.037

Holly F. Lofton M.D. , Gabrielle Maranga M.P.H. , Robert Hold P.A.-C. , George Fielding M.D. , Heekoung Youn R.N. , Akash Gujral M.S. , Sean Heffron M.D. , Christine Fielding M.D.

Background

Bariatric surgery, such as Roux-en-Y gastric bypass (RYGB) remains the gold standard for treating obesity. Most people regain weight from postsurgery nadir.

Objectives

Liraglutide 3.0 mg is approved for weight management. This study will examine the effects on liraglutide 3.0 mg on weight regain post-RYGB.

Setting

University Hospital, United States.

Methods

A 56-week, double-blind, placebo-controlled study was conducted in 132 subjects, who achieved ≥25% total body weight loss (TBWL) status-post-RYGB and regained ≥10% TBWL after reaching nadir weight (NW). Subjects 18–120 months post-RYGB were randomized to receive liraglutide 3.0 mg/d (n = 89) or placebo (n = 43) with lifestyle counseling regularly for 56 weeks. The co-primary endpoints were the proportion of subjects losing at least 5%, 10%, and 15% TBWL and achieving weight lower than their NW.

Results

53.4% of the placebo group and 65% of the liraglutide group completed the trial due to Severe acute respiratory syndrome coronavirus 2 pandemic. The change in %TBWL from baseline to 56-weeks was −8.8 (8.5, −29.2 to 9.7) and 1.1 (3.5, −7.9 to 5.99) in the liraglutide and placebo groups, respectively. 76% and 17% of subjects achieved ≥5% TBWL at 56 weeks in the liraglutide and placebo groups, respectively; 51% and 26.0% of the liraglutide group achieved ≥10% and ≥15% TBWL, respectively. None of the placebo group lost ≥10% TBWL. Twenty-one percent of subjects receiving liraglutide surpassed postoperative NW. No subjects on placebo met this goal. Nonserious adverse events occurred in 41.6% of subjects on liraglutide. Serious adverse events (SAE) occurred less often on liraglutide.

Conclusions

Liraglutide was significantly more effective than placebo in treating weight regain that occurs post-RYGB without increased SAE.

背景：减肥手术，如 Roux-en-Y 胃旁路术（RYGB），仍然是治疗肥胖症的金标准。大多数人的体重会从手术后的最低点反弹：利拉鲁肽 3.0 毫克已被批准用于控制体重。本研究将探讨利拉鲁肽 3.0 毫克对 RYGB 术后体重反弹的影响：地点：美国大学医院：方法：在 132 名受试者中开展了一项为期 56 周的双盲安慰剂对照研究，这些受试者在 RYGB 术后达到≥25% 的总体重减轻（TBWL）状态，并在达到最低体重（NW）后恢复了≥10% 的总体重减轻（TBWL）。RYGB术后18-120个月的受试者随机接受利拉鲁肽3.0 mg/d（n = 89）或安慰剂（n = 43）治疗，并定期接受生活方式咨询，为期56周。共同主要终点是受试者TBWL至少下降5%、10%和15%以及体重低于其NW的比例：由于严重急性呼吸系统综合征冠状病毒 2 大流行，53.4% 的安慰剂组和 65% 的利拉鲁肽组完成了试验。从基线到56周，利拉鲁肽组和安慰剂组的TBWL%变化分别为-8.8（8.5，-29.2至9.7）和1.1（3.5，-7.9至5.99）。56周时，利拉鲁肽组和安慰剂组分别有76%和17%的受试者实现了≥5%的TBWL；利拉鲁肽组分别有51%和26.0%的受试者实现了≥10%和≥15%的TBWL。安慰剂组中没有人的 TBWL 下降≥10%。21%接受利拉鲁肽治疗的受试者超过了术后净体重。安慰剂组没有受试者达到这一目标。41.6%的利拉鲁肽受试者发生了非严重不良事件。利拉鲁肽的严重不良事件（SAE）发生率较低：结论：利拉鲁肽治疗RYGB术后体重反弹的效果明显优于安慰剂，且不会增加SAE。

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引用次数: 0

Endoscopic bariatric and metabolic therapies and its effect on metabolic dysfunction-associated steatotic liver disease: a review of the current literature 内镜减肥和代谢疗法及其对代谢功能障碍相关脂肪肝的影响：现有文献综述。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.soard.2024.09.012

Varun Aitharaju M.D. , Jonathan Ragheb M.D. , Stephen Firkins M.D. , Roma Patel M.D. , C. Roberto Simons-Linares M.D.

Endoscopic bariatric and metabolic therapies (EBMTs) are minimally invasive endoscopic procedures that have shown to demonstrate significant weight loss in people with obesity. While abundant data support their positive effect on weight loss, there remains a notable dearth of information regarding their effects on metabolic dysfunction-associated steatotic liver disease (MASLD). As rates of type 2 diabetes and obesity have grown worldwide, so has the rate of MASLD. Therefore, addressing these knowledge gaps is crucial in improving liver health worldwide. In this review, we aim to provide the existing evidence delineating the effects of primary and secondary endoscopic bariatric therapies on MASLD and determine knowledge gaps requiring future study. Utilizing PubMed search with relevant keywords such as “endoscopic bariatric therapies,” “NAFLD” (nonalcoholic fatty liver disease), “MAFLD” (metabolic dysfunction-associated fatty liver disease), “MASLD” (metabolic dysfunction-associated steatotic liver disease), we gathered case reports, reviews, and retrospective analyses, evaluating their data and limitations. In our manuscript, we detail many primary and secondary endoscopic therapies and the literature available exploring their impact on liver health. This review demonstrates that primary EBMTs improve noninvasive liver markers, weight loss, and overall metabolic syndrome suggesting significant benefit in MASLD. There is, however, a significant lack of literature studying how primary endoscopic therapies compare amongst each other and how revisional therapies affect MASLD. We additionally offer suggestions for future research to deepen our understanding of EBMTs and their effects on MASLD.

内镜减肥和代谢疗法（EBMTs）是一种微创内镜手术，对肥胖症患者的减肥效果显著。虽然有大量数据支持其对减肥的积极作用，但有关其对代谢功能障碍相关性脂肪性肝病（MASLD）影响的信息仍明显不足。随着全球 2 型糖尿病和肥胖症发病率的增加，MASLD 的发病率也在增加。因此，填补这些知识空白对于改善全球肝脏健康至关重要。在这篇综述中，我们旨在提供现有的证据，说明一级和二级内镜减肥疗法对 MASLD 的影响，并确定今后需要研究的知识空白。利用 PubMed 搜索相关关键词，如 "内镜减肥疗法"、"NAFLD"（非酒精性脂肪肝）、"MAFLD"（代谢功能障碍相关性脂肪肝）、"MASLD"（代谢功能障碍相关性脂肪肝），我们收集了病例报告、综述和回顾性分析，评估了它们的数据和局限性。在我们的手稿中，我们详细介绍了许多原发性和继发性内镜疗法，以及探讨这些疗法对肝脏健康影响的现有文献。这篇综述表明，初级 EBMT 可改善非侵入性肝脏指标、体重减轻和整体代谢综合征，对 MASLD 有显著疗效。然而，研究初级内镜疗法之间如何比较以及修正疗法如何影响 MASLD 的文献却非常缺乏。此外，我们还对未来的研究提出了建议，以加深我们对 EBMT 及其对 MASLD 影响的了解。

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引用次数: 0

Magnetic duodenoileal anastomosis with sleeve gastrectomy: a prospective multicenter study 袖带胃切除术的十二指肠磁吻合术：一项前瞻性多中心研究。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.soard.2024.10.020

Laurent Biertho M.D. , Simon Marceau M.D. , Mélanie Nadeau M.Sc. , Stéfane Lebel M.D. , François Julien M.D. , André Tchernof Ph.D. , Thomas Ransom M.D. , Richard T. Spence M.D. , James Ellesmere M.D.

Background

Magnetic digestive anastomosis has the potential to reduce anastomotic complications and complexity. We report the 1-year results of a new surgical technique using Self-forming Neodymium magnet Anastomosis Procedure with Sleeve gastrectomy (SNAP-S; GI Windows).

Methods

This was a prospective, nonrandomized multicenter trial. Participants with type 2 diabetes (T2D) who met criteria for metabolic surgery were recruited. A dual-path duodenoileal anastomosis was created at 300 cm from the ileocecal valve using circular magnetic anastomosis. The proximal magnet was deployed by endoscopy and the distal one by laparoscopy. Sleeve gastrectomy was performed at the same time. Data are reported as mean ± standard deviation or percentage.

Results

Nineteen subjects with T2D were recruited (age 45 ± 9 years, body mass index 43 ± 5 kg/m², hemoglobin A1C 7.3 ± 1.3%). There was no conversion, mortality, or adverse event related to the magnetic anastomosis. Mean time for anastomosis creation was 32 ± 10 minutes. One patient was not implanted because of an inability to bring the ileum to the duodenum. Follow-up rate at 12 months was 95%. A total of 41 procedure-related adverse events were recorded during follow-up. Seven events in 4 subjects were considered serious. Total weight loss at 3, 6, and 12 months was 22 ± 19%, 28 ± 19%, and 31 ± 11%, respectively. Excess weight loss was 45 ± 14%, 59 ± 21%, and 78 ± 33%, respectively. All patients had an hemoglobin A1C ≤6.0% at 12 months with complete T2D remission in 78%.

Conclusion

The SNAP-S procedure is feasible with a low complication rate related to the anastomotic technique itself. The SNAP-S procedure provides significant weight loss and improvement of comorbidities. Additional prospective data are needed to better define the place of SNAP-S procedure.

背景：磁性消化道吻合术具有减少吻合并发症和复杂性的潜力。我们报告了自成型钕磁铁吻合术与袖状胃切除术（SNAP-S；GI Windows）这一新手术技术的 1 年结果：这是一项前瞻性、非随机多中心试验。方法：这是一项前瞻性非随机多中心试验，招募符合代谢手术标准的 2 型糖尿病（T2D）患者。使用环形磁性吻合器在距回盲瓣 300 厘米处进行双路径十二指肠吻合术。近端磁体通过内窥镜展开，远端磁体通过腹腔镜展开。袖带胃切除术同时进行。数据以均数±标准差或百分比表示：共招募了 19 名患有 T2D 的受试者（年龄 45 ± 9 岁，体重指数 43 ± 5 kg/m2，血红蛋白 A1C 7.3 ± 1.3%）。没有发生与磁性吻合有关的转换、死亡或不良事件。吻合术的平均时间为 32 ± 10 分钟。一名患者因无法将回肠移至十二指肠而未植入。12 个月的随访率为 95%。随访期间共记录了41起与手术相关的不良事件。4名受试者中的7起事件被视为严重事件。3、6和12个月的总体重减轻率分别为22±19%、28±19%和31±11%。超重率分别为 45 ± 14%、59 ± 21% 和 78 ± 33%。所有患者在 12 个月时的血红蛋白 A1C 均低于 6.0%，78% 的患者 T2D 完全缓解：结论：SNAP-S 手术是可行的，与吻合技术本身相关的并发症发生率较低。SNAP-S手术能显著减轻体重，改善合并症。需要更多的前瞻性数据来更好地确定 SNAP-S 手术的位置。

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引用次数: 0

Racial disparities in the utilization and outcomes of robotic bariatric surgery: an 8-year analysis of Metabolic and Bariatric Surgery Accreditation Quality Improvement Program data 机器人减肥手术使用和结果的种族差异：代谢和减肥手术认证质量改进计划 8 年数据分析。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.soard.2024.09.002

Qais AbuHasan M.D., Payton M. Miller M.D., Wendy S. Li M.D., Charles P. Burney M.D., M.P.H., Tarik K. Yuce M.D., M.S., Dimitrios Stefanidis M.D., Ph.D.

Background

Robotic surgery utilization has been increasing across surgical specialties; however, racial disparities in patient access to care and outcomes have been reported.

Objectives

In this study, we examined racial disparities in the utilization and outcomes of robotic bariatric surgery over an 8-year period.

Setting

Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) centers of excellence across the United States.

Methods

The MBSAQIP database was used to identify adult patients who underwent robotic bariatric surgery between 2015 and 2022. Patients were stratified according to race and ethnicity into non-Hispanic White, non-Hispanic Black or African American (AA), Indigenous, Asian, and Hispanic patients. Multivariable analyses were used to assess predictors of robotic surgery use, odds of minor and major complications, prolonged length of stay (prolonged length of stay (pLOS): ≥3 days), readmissions, reoperations, and mortality within 30 days.

Results

Out of 1,288,359 patients included, robotic surgery was utilized in 196,314 patients (15.2%), with a mean age of 44 ± 12 years and 80.6% females. Rates of robotic surgery increased to 30% by 2022. Compared to White patients, Black/AA patients were more likely to undergo robotic surgery (adjusted odds ratio (aOR) = 1.22, 95% confidence interval (CI) = 1.21-1.24, P < .001). The safety of robotic bariatric surgery improved for both White and Black patients with decreased odds of major complications, readmissions, reoperations, and pLOS over the study period. However, Black/AA patients were more likely to experience minor and major complications, readmissions and have pLOS compared with White patients in 2022 (aOR:1.26, 95% CI:1.19-1.34, P < .001; aOR:1.22, 95% CI:1.06-1.41, P = .006; aOR:1.44, 95% CI:1.28-1.62, P < .001; aOR:2.26, 95% CI:2.06-2.47, P < .001, respectively).

Conclusion

The utilization of robotic bariatric surgery has increased significantly over the past 8 years with continued improvements in its safety profile. While Black/AA patients have improved access to robotic surgery, their clinical outcomes continue to be worse than those of White patients. Efforts to address racial disparities in bariatric surgery outcomes must remain a priority to achieve health equity.

背景：机器人手术在各外科专科的使用率不断上升，但有报道称，患者在接受治疗和治疗效果方面存在种族差异：各外科专科对机器人手术的使用率一直在上升；然而，有报道称患者在获得护理和治疗结果方面存在种族差异：在这项研究中，我们考察了 8 年间机器人减肥手术在使用和结果方面的种族差异：背景：美国各地的代谢与减肥手术认证质量改进计划（MBSAQIP）卓越中心：方法：使用MBSAQIP数据库识别2015年至2022年期间接受机器人减肥手术的成年患者。根据种族和民族将患者分为非西班牙裔白人、非西班牙裔黑人或非裔美国人（AA）、土著人、亚裔和西班牙裔患者。多变量分析用于评估使用机器人手术的预测因素、轻微和严重并发症的几率、住院时间延长（住院时间延长（pLOS）：≥3 天）、再入院、再次手术和 30 天内死亡率：在纳入的 1,288,359 名患者中，196,314 名患者（15.2%）使用了机器人手术，平均年龄为 44±12 岁，女性占 80.6%。到 2022 年，机器人手术率将增至 30%。与白人患者相比，黑人/非裔美国人患者更有可能接受机器人手术（调整赔率比 (aOR) = 1.22，95% 置信区间 (CI) = 1.21-1.24，P < .001）。在研究期间，白人和黑人患者接受机器人减肥手术的安全性都有所提高，主要并发症、再入院、再手术和 pLOS 的几率都有所下降。然而，与白人患者相比，黑人/美国黑人患者在2022年更有可能出现轻微和严重并发症、再入院和pLOS（aOR:1.26，95% CI:1.19-1.34，P < .001；aOR:1.22，95% CI:1.06-1.41，P = .006；aOR:1.44，95% CI:1.28-1.62，P < .001；aOR:2.26，95% CI:2.06-2.47，P < .001）：在过去的 8 年中，机器人减肥手术的使用率显著提高，其安全性也不断改善。虽然黑人/非裔患者接受机器人手术的机会增加了，但他们的临床治疗效果仍然比白人患者差。为实现健康公平，必须继续优先解决减肥手术结果中的种族差异问题。

{"title":"Racial disparities in the utilization and outcomes of robotic bariatric surgery: an 8-year analysis of Metabolic and Bariatric Surgery Accreditation Quality Improvement Program data","authors":"Qais AbuHasan M.D., Payton M. Miller M.D., Wendy S. Li M.D., Charles P. Burney M.D., M.P.H., Tarik K. Yuce M.D., M.S., Dimitrios Stefanidis M.D., Ph.D.","doi":"10.1016/j.soard.2024.09.002","DOIUrl":"10.1016/j.soard.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Robotic surgery utilization has been increasing across surgical specialties; however, racial disparities in patient access to care and outcomes have been reported.</div></div><div><h3>Objectives</h3><div>In this study, we examined racial disparities in the utilization and outcomes of robotic bariatric surgery over an 8-year period.</div></div><div><h3>Setting</h3><div>Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) centers of excellence across the United States.</div></div><div><h3>Methods</h3><div>The MBSAQIP database was used to identify adult patients who underwent robotic bariatric surgery between 2015 and 2022. Patients were stratified according to race and ethnicity into non-Hispanic White, non-Hispanic Black or African American (AA), Indigenous, Asian, and Hispanic patients. Multivariable analyses were used to assess predictors of robotic surgery use, odds of minor and major complications, prolonged length of stay (prolonged length of stay (pLOS): ≥3 days), readmissions, reoperations, and mortality within 30 days.</div></div><div><h3>Results</h3><div>Out of 1,288,359 patients included, robotic surgery was utilized in 196,314 patients (15.2%), with a mean age of 44 ± 12 years and 80.6% females. Rates of robotic surgery increased to 30% by 2022. Compared to White patients, Black/AA patients were more likely to undergo robotic surgery (adjusted odds ratio (aOR) = 1.22, 95% confidence interval (CI) = 1.21-1.24, <em>P</em> < .001). The safety of robotic bariatric surgery improved for both White and Black patients with decreased odds of major complications, readmissions, reoperations, and pLOS over the study period. However, Black/AA patients were more likely to experience minor and major complications, readmissions and have pLOS compared with White patients in 2022 (aOR:1.26, 95% CI:1.19-1.34, <em>P</em> < .001; aOR:1.22, 95% CI:1.06-1.41, <em>P</em> = .006; aOR:1.44, 95% CI:1.28-1.62, <em>P</em> < .001; aOR:2.26, 95% CI:2.06-2.47, <em>P</em> < .001, respectively).</div></div><div><h3>Conclusion</h3><div>The utilization of robotic bariatric surgery has increased significantly over the past 8 years with continued improvements in its safety profile. While Black/AA patients have improved access to robotic surgery, their clinical outcomes continue to be worse than those of White patients. Efforts to address racial disparities in bariatric surgery outcomes must remain a priority to achieve health equity.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"21 2","pages":"Pages 158-165"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comment on: Endoscopic bariatric and metabolic therapies and its effect on MASLD: a review of the current literature 评论：内镜减肥和代谢疗法及其对 MASLD 的影响：当前文献综述。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.soard.2024.10.029

Donovan Hui M.D., Thomas H. Shin M.D., Ph.D.

引用次数: 0

Comment on: Patients’ experience with preoperative use of anti-obesity medications and associations with bariatric surgery expectations 评论：患者术前使用抗肥胖药物的经验以及与减肥手术期望值的关联。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.soard.2024.10.030

Sol Lee M.D., Mélissa V. Wills M.D., Matthew Kroh M.D.

引用次数: 0

American Society for Metabolic and Bariatric Surgery literature review on risk factors, screening recommendations, and prophylaxis for marginal ulcers after metabolic and bariatric surgery 美国代谢与减肥手术协会关于代谢与减肥手术后边缘溃疡的风险因素、筛查建议和预防措施的文献综述。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.soard.2024.10.013

R. Wesley Vosburg M.D. , Abdelrahman Nimeri M.D. , Dan Azagury M.D. , Brandon Grover M.D. , Sabrena Noria M.D. , Pavlos Papasavas M.D. , Jonathan Carter M.D.

Background

Marginal ulcers (MU) are a significant postoperative complication following anastomotic metabolic and bariatric surgeries including Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and biliopancreatic diversion with duodenal switch (BPD/DS). This review summarizes current knowledge on MU risk factors, screening, and prophylactic strategies.

Objectives

The goal of this review is to examine technical and patient-related risk factors for MU, assess screening strategies, and recommend prophylactic approaches to reduce MU incidence after anastomotic metabolic and bariatric surgery (MBS).

Setting

A comprehensive review was conducted by members of the American Society for Metabolic and Bariatric Surgery (ASMBS) Clinical Issues Committee, based on available literature from 2000 to the present.

Methods

A systematic search was performed using Ovid MEDLINE and PubMed databases. Relevant studies were screened for inclusion. Technical and patient-related factors were evaluated, and recommendations for MU prevention were formulated.

Results

Several risk factors for MU were identified, including large gastric pouch size, circular stapled anastomoses, use of nonabsorbable sutures, smoking, nonsteroidal anti-inflammatory drugs use, and immunosuppression. While prophylactic proton pump inhibitor (PPI) therapy is widely recommended, its optimal duration remains debated. The role of Helicobacter pylori in MU development is not clearly defined.

Conclusions

Prophylactic PPI therapy for at least 3 months postsurgery significantly reduces the risk of MU. Risk stratification and individualized treatment plans are essential to minimize postoperative complications. Further research is needed to clarify the role of H. pylori and optimize prophylactic strategies.

背景：边缘溃疡（MU）是吻合口代谢和减肥手术（包括 Roux-en-Y 胃旁路术 (RYGB)、单吻合口胃旁路术 (OAGB) 和十二指肠转流胆胰转流术 (BPD/DS)）后的重要术后并发症。本综述总结了目前有关 MU 风险因素、筛查和预防策略的知识：本综述旨在研究 MU 的技术和患者相关风险因素、评估筛查策略并推荐预防方法，以降低吻合器代谢和减肥手术 (MBS) 后的 MU 发生率：美国代谢与减肥手术学会（ASMBS）临床问题委员会成员根据 2000 年至今的现有文献进行了一次全面审查：方法：使用 Ovid MEDLINE 和 PubMed 数据库进行系统检索。对相关研究进行了筛选。对技术因素和患者相关因素进行了评估，并提出了预防 MU 的建议：结果：发现了导致 MU 的几个风险因素，包括胃袋过大、环形缝合吻合口、使用不可吸收缝线、吸烟、使用非甾体抗炎药和免疫抑制。虽然预防性质子泵抑制剂（PPI）疗法被广泛推荐，但其最佳疗程仍存在争议。幽门螺杆菌在 MU 发病中的作用尚未明确：结论：手术后至少 3 个月的预防性 PPI 治疗可显著降低 MU 风险。风险分层和个体化治疗方案对于最大限度地减少术后并发症至关重要。要明确幽门螺杆菌的作用并优化预防策略，还需要进一步的研究。

{"title":"American Society for Metabolic and Bariatric Surgery literature review on risk factors, screening recommendations, and prophylaxis for marginal ulcers after metabolic and bariatric surgery","authors":"R. Wesley Vosburg M.D. , Abdelrahman Nimeri M.D. , Dan Azagury M.D. , Brandon Grover M.D. , Sabrena Noria M.D. , Pavlos Papasavas M.D. , Jonathan Carter M.D.","doi":"10.1016/j.soard.2024.10.013","DOIUrl":"10.1016/j.soard.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Marginal ulcers (MU) are a significant postoperative complication following anastomotic metabolic and bariatric surgeries including Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and biliopancreatic diversion with duodenal switch (BPD/DS). This review summarizes current knowledge on MU risk factors, screening, and prophylactic strategies.</div></div><div><h3>Objectives</h3><div>The goal of this review is to examine technical and patient-related risk factors for MU, assess screening strategies, and recommend prophylactic approaches to reduce MU incidence after anastomotic metabolic and bariatric surgery (MBS).</div></div><div><h3>Setting</h3><div>A comprehensive review was conducted by members of the American Society for Metabolic and Bariatric Surgery (ASMBS) Clinical Issues Committee, based on available literature from 2000 to the present.</div></div><div><h3>Methods</h3><div>A systematic search was performed using Ovid MEDLINE and PubMed databases. Relevant studies were screened for inclusion. Technical and patient-related factors were evaluated, and recommendations for MU prevention were formulated.</div></div><div><h3>Results</h3><div>Several risk factors for MU were identified, including large gastric pouch size, circular stapled anastomoses, use of nonabsorbable sutures, smoking, nonsteroidal anti-inflammatory drugs use, and immunosuppression. While prophylactic proton pump inhibitor (PPI) therapy is widely recommended, its optimal duration remains debated. The role of <em>Helicobacter pylori</em> in MU development is not clearly defined.</div></div><div><h3>Conclusions</h3><div>Prophylactic PPI therapy for at least 3 months postsurgery significantly reduces the risk of MU. Risk stratification and individualized treatment plans are essential to minimize postoperative complications. Further research is needed to clarify the role of <em>H. pylori</em> and optimize prophylactic strategies.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"21 2","pages":"Pages 101-108"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Utilization patterns of glucagon like Peptide-1 receptor agonists prior to bariatric and metabolic surgery: a multicenter study 减肥和代谢手术前使用胰高血糖素样肽-1 受体激动剂的模式：一项多中心研究。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.soard.2024.09.010

Shlomi Rayman M.D. , Evyatar Morduch , Anat Reiner-Benaim Ph.D. , Netta-lee Catzman R.N., M.N. , Idan Carmeli M.D. , Dvir Froylich M.D. , David Goitein

Background

Glucagon-like-peptide-1 receptor agonists (G1RA) have gained popularity as a treatment for weight loss in patients who are overweight or obese, but their utilization patterns and impact on candidates for metabolic and bariatric surgery (MBS) remain understudied.

Objective

We aimed to investigate the prevalence, characteristics, and outcomes of patients with a history of G1RA utilization among MBS candidates.

Setting

Five high-volume MBS centers in Israel.

Methods

Data were collected retrospectively from February 1st, 2023, to September 30th, 2023. Demographic, clinical, and treatment data were analyzed to assess a history of G1RA use, associated factors, adverse events, and treatment outcomes.

Results

Four hundred thirty-four MBS candidates were included in the study. A history of G1RA utilization was obtained in 275 (63%) MBS candidates, with Liraglutide and Semaglutide being the most commonly used agents. Younger age, type 2 diabetes mellitus, dyslipidemia, and no previous MBS history were associated with a higher rate of G1RA utilization. With these medications, median maximal weight loss was 5.38 kg, and mean duration of use was 19 weeks. Patients using G1RA for ≥6 weeks experienced significantly greater weight loss compared to those using it for shorter periods (6.3 ± 6.43 vs 1.65 ± 1.69; P < .001). GI-related adverse events were reported in 57.8% of patients. Over 95% of patients discontinued G1RA due to insufficient weight loss and/or adverse effects. Patients reaching the maximal recommended dose exhibited significantly greater weight loss versus patients who did not reach it for both Liraglutide (5.9 ± 4.98 kg vs. 3.9 ± 5.53 kg; P = .03) and Semaglutide (6.5 ± 7.8 kg vs. 2.5 ± 3.8 kg; P = .016).

Conclusion

Pre-MBS G1RA utilization and failure are prevalent among MBS candidates. Our study underscores the need for further research to understand the role of G1RA therapy in obesity management and the development of guidelines for its appropriate use in MBS candidates.

背景：胰高血糖素样肽-1 受体激动剂（G1RA）作为超重或肥胖患者的一种减肥治疗方法已越来越受欢迎，但其使用模式及其对代谢和减肥手术（MBS）候选者的影响仍未得到充分研究：目的：我们旨在调查代谢与减重手术候选者中使用过 G1RA 的患者的患病率、特征和结果：方法：回顾性收集以色列五家高容量 MBS 中心的数据：方法：回顾性收集 2023 年 2 月 1 日至 2023 年 9 月 30 日期间的数据。对人口统计学、临床和治疗数据进行分析，以评估 G1RA 使用史、相关因素、不良事件和治疗结果：研究共纳入了 434 名 MBS 候选人。275名（63%）MBS候选者有使用G1RA的历史，其中利拉鲁肽和赛马鲁肽是最常用的药物。年龄较小、2 型糖尿病、血脂异常以及既往无 MBS 病史者使用 G1RA 的比例较高。这些药物的最大减重中位数为 5.38 千克，平均用药时间为 19 周。与使用时间较短的患者相比，使用 G1RA≥6 周的患者体重减轻幅度明显更大（6.3 ± 6.43 vs 1.65 ± 1.69；P < .001）。57.8%的患者出现了消化道相关不良事件。超过 95% 的患者因体重减轻不足和/或不良反应而停用 G1RA。利拉鲁肽（5.9 ± 4.98 kg vs. 3.9 ± 5.53 kg; P = .03）和塞马鲁肽（6.5 ± 7.8 kg vs. 2.5 ± 3.8 kg; P = .016）达到最大推荐剂量的患者与未达到最大推荐剂量的患者相比，体重减轻幅度明显更大：结论：在 MBS 候选者中，MBS 前 G1RA 利用率和失败率很高。我们的研究强调了进一步研究的必要性，以了解 G1RA 治疗在肥胖管理中的作用，并为在 MBS 候选者中适当使用 G1RA 制定指南。

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引用次数: 0

Changes in pancreatic steatosis by computed tomography 24 months after sleeve gastrectomy in youth with severe obesity 袖带胃切除术后 24 个月，通过计算机断层扫描观察重度肥胖症青少年胰腺脂肪变性的变化。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.08.034

Imen Becetti M.D. , Ana Paola Lopez Lopez M.D. , Francesca Galbiati M.D. , Clarissa C. Pedreira M.D. , Meghan Lauze B.S. , Karen Olivar Carreno M.D. , Florian A. Huber M.D. , Olivier Bitoun M.D. , Hang Lee Ph.D. , Brian Carmine M.D. , Vibha Singhal M.D., M.P.H. , Madhusmita Misra M.D., M.P.H. , Miriam A. Bredella M.D., M.B.A.

Background

Pancreatic steatosis has been associated with obesity and the metabolic syndrome. Studies in adults have demonstrated improvement in pancreatic steatosis following sleeve gastrectomy (SG) with concomitant improvement in glucose homeostasis.

Objectives

To examine changes in pancreatic steatosis in youth with severe obesity 24 months following SG.

Setting

Academic hospital system.

Methods

Forty-seven youth (13–24 years) with severe obesity (37 females) were followed for 24 months; 23 had SG and 24 were nonsurgical (NS) controls. Attenuations of the pancreas and spleen were measured using computed tomography (CT) at baseline, 12- and 24-month follow-up. Subjects underwent magnetic resonance imaging (MRI) for subcutaneous and visceral adipose tissue (SAT, VAT), dual energy x-ray absorptiometry (DXA) for body composition, blood sampling for glycated hemoglobin (A1C), and fasting and postprandial insulin and glucose. Linear mixed effects (LMEs) models were used to compare within- and between-group changes over 24 months.

Results

At baseline, SG had higher body mass index (BMI) versus NS (P = .033). Over 24 months, significant reductions were noted in weight, BMI, VAT, SAT, fat mass (FM), and lean mass (LM) in the SG versus NS groups (P ≤ .0001). There was a significant 24-month decrease in pancreatic steatosis in the SG group (P = .006). In the whole group, 24-month reductions in pancreatic steatosis correlated with BMI and FM decreases. No associations were found between pancreatic steatosis and glucose homeostasis parameters.

Conclusions

Pancreatic steatosis measured by CT improved after SG in youth. Further studies are needed to understand the relationship between pancreatic steatosis and glucose homeostasis.

背景：胰腺脂肪变性与肥胖和代谢综合征有关。成人研究表明，袖带胃切除术（SG）后胰腺脂肪变性有所改善，同时葡萄糖稳态也得到改善：目的：研究袖带胃切除术 24 个月后，重度肥胖青少年胰腺脂肪变性的变化：地点：学术医院系统：对 47 名患有严重肥胖症的青少年（13-24 岁）（37 名女性）进行了为期 24 个月的随访；其中 23 人接受了 SG 治疗，24 人为非手术（NS）对照组。在基线、12 个月和 24 个月的随访期间，使用计算机断层扫描（CT）测量了胰腺和脾脏的衰减情况。受试者接受了皮下和内脏脂肪组织（SAT、VAT）的磁共振成像（MRI）、身体成分的双能 X 射线吸收测量（DXA）、糖化血红蛋白（A1C）的血液采样以及空腹和餐后胰岛素和葡萄糖的检测。线性混合效应（LMEs）模型用于比较 24 个月中组内和组间的变化：基线时，SG 的体重指数（BMI）高于 NS（P = .033）。在 24 个月内，SG 组与 NS 组相比，体重、BMI、VAT、SAT、脂肪量（FM）和瘦肉量（LM）均有明显下降（P ≤ .0001）。24 个月后，SG 组的胰腺脂肪变性明显减少（P = .006）。在全组中，胰腺脂肪变性在 24 个月内的减少与 BMI 和 FM 的减少相关。胰腺脂肪变性与糖稳态参数之间没有关联：结论：青少年接受 SG 治疗后，通过 CT 测量的胰腺脂肪变性有所改善。需要进一步研究以了解胰腺脂肪变性与葡萄糖稳态之间的关系。

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引用次数: 0

The relationship of decision regret with quality of life and comfort level in patients undergoing laparoscopic sleeve gastrectomy: a cross-sectional study 腹腔镜袖状胃切除术患者决策后悔与生活质量和舒适度的关系：一项横断面研究。

IF 3.5 3区医学 Q1 SURGERY

Surgery for Obesity and Related Diseases

Pub Date : 2025-01-01 DOI: 10.1016/j.soard.2024.08.030

Tülay Kılınç Ph.D. , Ayşegül Yayla Ph.D. , Zeynep Karaman Özlü Ph.D. , Duygu Balaban M.Sc.

Background

Laparoscopic sleeve gastrectomy (SG) is one of the effective methods of weight loss. It is essential to determine patients' regret and predictive factors to improve their quality of life and comfort. No study has investigated decision regret and affecting factors in patients undergoing SG in Turkey.

Objectives

The study aimed to determine the relationship of decision regret with quality of life and comfort level in patients undergoing SG.

Setting

The research was carried out with patients who had undergone SG in a private hospital in the west of Turkey.

Methods

The research was conducted as a descriptive, correlational, and cross-sectional study. Data were collected between March and May 2023, and the study was completed with 286 patients. Data were collected using the Personal Information Form, Decision Regret Scale (DRS), Quality of Life Following Obesity Surgery Scale (QoL-OS), and Comfort Scale.

Results

Patients’ mean score on the DRS was 5.27 ± 13.41 (0-100), the total mean score on the QoL-OS-Biopsychosocial dimension was 79.57 ± 9.35 (18-90), the mean score on the QoL-OS-Complications dimension was 17.17 ± 4.60 (7-35), and the environmental comfort score average was 8.87 ± 2.23 (0-10). Patients’ decision regret was significantly affected by the QoL-OS-Biopsychosocial Area dimension in the first place (Beta = −.516; P < .001), social comfort in the second place (Beta = −.278; P < .001), postoperative weight gain in the third place (Beta = .221; P < .001), and complication development in the fourth place (Beta = .163; P < .001).

Conclusions

The study revealed that patients’ decision regret levels were very low up to 3 years after surgery and found that low postoperative quality of life and social comfort level, postoperative weight gain, and complications affected decision regret.

背景：腹腔镜袖带胃切除术（SG）是有效的减肥方法之一。为提高患者的生活质量和舒适度，确定患者的后悔程度和预测因素至关重要。在土耳其，还没有研究对接受袖带胃切除术的患者的后悔决定及其影响因素进行调查：该研究旨在确定接受胃肠切除术的患者的决策后悔与生活质量和舒适度之间的关系：研究对象为在土耳其西部一家私立医院接受 SG 手术的患者：研究以描述性、相关性和横断面研究的形式进行。数据收集时间为 2023 年 3 月至 5 月，共有 286 名患者完成了研究。数据收集使用了个人信息表、决定后悔量表（DRS）、肥胖手术后生活质量量表（QoL-OS）和舒适量表：患者在 DRS 上的平均得分为 5.27 ± 13.41（0-100）分，QoL-OS-生物心理社会维度的总平均得分为 79.57 ± 9.35（18-90）分，QoL-OS-并发症维度的平均得分为 17.17 ± 4.60（7-35）分，环境舒适度的平均得分为 8.87 ± 2.23（0-10）分。QoL-OS-Biopsychosocial Area维度对患者决策后悔度的影响明显，排在第一位（Beta = -.516; P < .001），社会舒适度排在第二位（Beta = -.278; P < .001），术后体重增加排在第三位（Beta = .221; P < .001），并发症发展排在第四位（Beta = .163; P < .001）：研究显示，患者在术后3年内的决策后悔程度很低，并发现术后生活质量和社会舒适度低、术后体重增加和并发症影响了决策后悔程度。

{"title":"The relationship of decision regret with quality of life and comfort level in patients undergoing laparoscopic sleeve gastrectomy: a cross-sectional study","authors":"Tülay Kılınç Ph.D. , Ayşegül Yayla Ph.D. , Zeynep Karaman Özlü Ph.D. , Duygu Balaban M.Sc.","doi":"10.1016/j.soard.2024.08.030","DOIUrl":"10.1016/j.soard.2024.08.030","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic sleeve gastrectomy (SG) is one of the effective methods of weight loss. It is essential to determine patients' regret and predictive factors to improve their quality of life and comfort. No study has investigated decision regret and affecting factors in patients undergoing SG in Turkey.</div></div><div><h3>Objectives</h3><div>The study aimed to determine the relationship of decision regret with quality of life and comfort level in patients undergoing SG.</div></div><div><h3>Setting</h3><div>The research was carried out with patients who had undergone SG in a private hospital in the west of Turkey.</div></div><div><h3>Methods</h3><div>The research was conducted as a descriptive, correlational, and cross-sectional study. Data were collected between March and May 2023, and the study was completed with 286 patients. Data were collected using the Personal Information Form, Decision Regret Scale (DRS), Quality of Life Following Obesity Surgery Scale (QoL-OS), and Comfort Scale.</div></div><div><h3>Results</h3><div>Patients’ mean score on the DRS was 5.27 ± 13.41 (0-100), the total mean score on the QoL-OS-Biopsychosocial dimension was 79.57 ± 9.35 (18-90), the mean score on the QoL-OS-Complications dimension was 17.17 ± 4.60 (7-35), and the environmental comfort score average was 8.87 ± 2.23 (0-10). Patients’ decision regret was significantly affected by the QoL-OS-Biopsychosocial Area dimension in the first place (Beta = −.516; <em>P</em> < .001), social comfort in the second place (Beta = −.278; <em>P</em> < .001), postoperative weight gain in the third place (Beta = .221; <em>P</em> < .001), and complication development in the fourth place (Beta = .163; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>The study revealed that patients’ decision regret levels were very low up to 3 years after surgery and found that low postoperative quality of life and social comfort level, postoperative weight gain, and complications affected decision regret.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"21 1","pages":"Pages 41-51"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0