Surgery for Obesity and Related Diseases最新文献

Background

Objectives

Setting

Methods

Results

Conclusions

Background

Metabolic and bariatric surgery (MBS) is a potent intervention for addressing obesity-related medical conditions and achieving sustainable weight loss. Beyond its conventional role, MBS has demonstrated potential to serve as a transitional step for patients requiring various interventions. However, the implications of MBS in the context of neoplasia remain understudied.

Objectives

To explore the feasibility of MBS as a possible attempt to reduce surgical and treatment risks in patients with benign tumors or low-grade cancers.

Setting

Multicenter review from twelve tertiary referral centers spanning 8 countries.

Methods

A retrospective review of patients with a diagnosis of primary neoplasia, deemed inoperable or high-risk due to obesity, and receiving primary MBS prior to neoplastic therapy. Data encompassed baseline characteristics, neoplasia characteristics, MBS outcomes, and neoplastic therapy outcomes.

Results

Thirty-seven patients (median age 52 years, 75.7% female, median BMI of 49.1 kg/m²) were included. There were 9 distinct organs of origin of primary neoplasia, with the endometrium (43.2%) being the most common, followed by the pancreas, colon, kidney and breast. Sleeve gastrectomy (SG) was the most commonly performed MBS procedure (78.4%), with no MBS-related complications or mortalities reported over an average of 4.3 ± 3.9 years. Thirty-one patients (83.8%) eventually underwent neoplastic surgery, with a mean BMI decrease from 49.9 kg/m² to 39.7 kg/m² at surgery over an average of 5.8 ± 4.8 months. There were 2 (6.7%) documented mortalities associated with neoplastic surgical intervention.

Conclusions

This study highlights the potential feasibility of employing MBS prior to neoplastic therapy in patients with low-grade, less aggressive neoplasms in the context of obesity. This underscores the importance of providing a personalized, case-to-case multidisciplinary approach in the management of these patients.

Background

Sleeve gastrectomy (SG) is the most commonly performed weight loss operation, and its 2 most common complications are postoperative reflux and weight recurrence. There is limited evidence to guide decision-making in treating these conditions.

Objectives

To determine the efficacy of conversion of SG to Roux-en-Y gastric bypass (RYGB) for GERD management and weight loss.

Setting

Forty-one hospitals in Michigan.

Methods

We conducted a retrospective cohort study examining patients who underwent conversion of SG to RYGB from 2014 to 2022. The primary outcomes were changes in GERD-HRQL scores, anti-reflux medication use, and weight from baseline to 1 year after conversion. Secondary outcomes included 30-day postoperative complications and resource utilization.

Results

Among 2133 patients undergoing conversion, 279 (13%) patients had baseline and 1-year GERD-HRQL survey data and anti-reflux medication data. GERD-HRQL scores decreased significantly from 24.6 to 6.6 (P < .01). Among these, 207 patients (74%) required anti-reflux medication at baseline, with only 76 patients (27%) requiring anti-reflux medication at 1 year postoperatively (P < .01). Of the 380 patients (18%) with weight loss data, mean weight decreased by 68.4lbs, with a 24.3% decline in total body weight and 51.5% decline in excess body weight. In terms of 30-day complications, 308 (14%) patients experienced any complication and 89 (4%) experienced a serious complication, but there were no leaks, perforations, or deaths. Three-hundred and fifty-five (17%) patients presented to the emergency department and 64 (3%) patients underwent reoperation.

Conclusions

This study represents the largest reported experience with conversion from SG to RYGB. We found that conversion to RYGB is associated with significant improvement in GERD symptoms, reduction in anti-reflux medication use, and significant weight loss and is therefore an effective treatment for GERD and weight regain after SG. However, the risks and benefits of conversion surgery should be carefully considered, especially in patients with significant comorbidity burden.

Background

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) has been a game changer for metabolic and bariatric surgery (MBS), with continuous improvements in safety and outcomes throughout the years of its usage. It allows in-depth evaluations of MBS procedures, presenting practitioners and researchers with unparalleled opportunities for quality assessment, research and clinical advancement.

Objectives

To offer an updated overview of MBSAQIP-related publications.

Setting

United States.

Methods

PubMed was queried using keywords “MBSAQIP” and “Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.” Letters to editors, duplicates, commentaries, and retracted articles were excluded. Studies that mentioned MBSAQIP but did not use the data within were also excluded.

Results

A total of 400 search items were returned as of August 2023. After exclusions, 289 studies were reviewed. Articles were published in a total of 28 unique journals, the majority of which were featured in Surgery for Obesity and Related Diseases (SOARD), with 114 articles (39.4%). Sixty-one articles were focused on creating predictive models or risk calculators, 58 on investigating the safety of procedures, and 52 on exploring complications. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were the 2 most commonly discussed procedures, at 80.3% and 80% respectively. Forty-three studies included patients who underwent robotic-assisted MBS.

Conclusions

The MBSAQIP is a valuable resource that has generated a wealth of studies in the literature. It has allowed for intense analysis of clinical issues and fostered a culture of safety and quality improvement. Participating surgeons must pledge commitment to extended follow-up periods to maximize its effectiveness.

Background

Obesity and nonalcoholic fatty liver disease (NAFLD) are an increasing health care burden worldwide. Weight loss is currently the best option to alleviate NAFLD and is efficiently achieved by bariatric surgery. Presence of NAFLD seems to be predictive for postoperative weight loss. To date, only few predictive factors for postbariatric weight loss (age, diabetes, psychiatric disorders) are established.

Objectives

Since liver fibrosis is the pathogenic driver for the progression of liver disease, we investigated its role in predicting postoperative weight loss. This study focuses on the correlation between fibrosis stage and weight loss.

Setting

University and university-affiliated cooperation, Germany.

Methods

We used a prospective, single-center cohort study including 164 patients who underwent bariatric surgery with simultaneous liver biopsies. Liver fibrosis was determined histologically according to Kleiner score and noninvasively by APRI and FIB-4 score. Percentage of total body weight loss was calculated at 1-year follow up visit.

Results

Thirty-two patients were found without fibrosis, whereas 91 patients showed mild fibrosis (F1), 37 significant fibrosis (F2), and only 4 patients presented advanced fibrosis (F3) at the time of bariatric surgery. Weight loss was similar across different degrees of fibrosis stage. Accordingly, linear regression analysis did not identify predictors of weight loss among fibrosis scores. In multivariable analysis, age and presence of diabetes showed the strongest predictive value.

Conclusions

Baseline presence of fibrosis was not associated with postoperative weight loss, while age and diabetes were independent predictors of weight loss. Bariatric surgery should be applied independently of the fibrosis stage.