Journal of metabolic and bariatric surgery最新文献

Purpose: The prevalence of individuals with obesity classes 4 and 5 is increasing, with no optimal surgical approach identified. With the rising popularity of one anastomosis gastric bypass (OAGB), we conducted a single-arm meta-analysis to assess its outcomes in this population.

Materials and methods: A comprehensive search of PubMed, Scopus, EMBASE, and Cochrane identified studies on OAGB reporting weight loss, comorbidity remission, and complications. Statistical analysis was performed using RStudio 4.4.1. Heterogeneity was assessed using the Cochrane Q test and I² statistics.

Results: Seventeen studies including 2,274 patients (mean age, 40.44 years), were identified. The analysis revealed a rising trend up to 24 months, with a pooled excess weight loss (%) of 68.08% (95% confidence interval [CI], 63.64-72.52; I²=95.6%), and total weight loss (%) of 36.63% (95% CI, 35.34-37.92; I²=84.6%) at 12 months. Diabetes and hypertension remission rates were 82.02% (95% CI, 70.36-89.77; I²=59.5%) and 78.06% (95% CI, 59.05-89.77; I²=84.9%), respectively. The incidence of de novo gastroesophageal reflux disease was 4.38% (95% CI, 0.61-25.59; I²=91.9%).

Conclusion: OAGB can be a valuable option for this population, awaiting long-term data.

Bariatric and metabolic surgery (BMS) is the most effective treatment for severe obesity and its related comorbidities. Rapid metabolic improvement following surgery frequently leads to the reduction or discontinuation of medications for obesity-related comorbidities. However, there are no established guidelines regarding timing or criteria for dose adjustment. A narrative review examined major clinical trials, meta-analyses, and society guidelines relevant to BMS. Evidence from previous and recent studies was synthesized to summarize pharmacokinetic alterations, disease-specific medication adjustments, and long-term deprescription patterns following BMS. Postoperative anatomical changes-including reduced gastric surface area, intestinal bypass, and altered acidity-affect the absorption of many oral drugs, requiring early dose adjustment. For type 2 diabetes mellitus, patients using <30 units/day of basal insulin can discontinue insulin after surgery, whereas those using ≥30 units/day typically require a 50-80% dose reduction. Most patients taking a single oral hypoglycemic agent may stop medication, while metformin monotherapy is recommended when glycated hemoglobin (HbA1c) <9% and dual therapy when HbA1c ≥9%. In hypertension, discontinuation of one antihypertensive drug usually results in approximate 10 mmHg reduction in systolic blood pressure. Diuretics should be withheld for the first 2 weeks postoperatively to prevent dehydration and excessive volume loss. For dyslipidemia, lipid-lowering agents are adjusted according to postoperative lipid profile changes and restarted if necessary. In psychiatric disorders, early resumption of preoperative medications is recommended to prevent withdrawal symptoms or relapse. BMS enables early medication reduction across comorbidities, yet individualized pharmacologic management remains essential to sustain metabolic improvement and long-term disease control.

Class I obesity (body mass index [BMI]: 30-34.9 kg/m²) constitutes a considerable portion of the global obesity burden; however, traditional guidelines for metabolic bariatric surgery (MBS) have historically excluded this population. Recent updates in clinical consensus have expanded surgical eligibility, particularly for patients with obesity-related comorbidities refractory to medical treatment. To synthesize evidence from clinical studies, international guidelines, and expert consensus to assess the efficacy, safety, and long-term outcomes of MBS in patients with class I obesity. A comprehensive literature review was conducted, incorporating major clinical trials, observational cohorts, and meta-analyses published between 2006 and 2024. Weight loss, metabolic outcomes, and major surgical complication rates were examined. Recent studies demonstrate that MBS in patients with class I obesity achieves a total weight loss of 15.8-33.7%, and excess weight loss up to 102.7%, with type 2 diabetes mellitus remission rates frequently exceeding 60%. Complication rates remain low and are comparable to those observed in cohorts with higher BMI. Indirect comparisons suggest that the metabolic benefits and safety profiles in class I obesity are comparable to those in patients with higher BMI. Updated guidelines from international bariatric societies support MBS in class I obesity. MBS is an effective and safe treatment for weight loss and remission of comorbidities in class I obesity. Supported by recent guidelines and expert consensus, it should be considered as a valid treatment option for appropriately selected patients, with the potential to reduce their long-term healthcare burden.

Purpose: Obesity remains a significant public health issue in the Western world, affecting millions of Americans and contributing to chronic conditions such as diabetes and hypertension. In June 2021, the Food and Drug Administration approved semaglutide for long-term weight management. While its effectiveness in promoting weight loss has been well-documented, its impact on the field of bariatric surgery remains uncertain.

Materials and methods: A retrospective analysis was conducted on 515 bariatric patients from January 2022 to November 2023. Patients on semaglutide in the preoperative period were compared to those not using the medication, with outcomes including time to surgery, cancellation rates, weight loss at different time points, and secondary outcomes such as side effects.

Results: Thirteen percent of patients were on semaglutide. Semaglutide users had higher rates of diabetes (P<0.001). Starting and preoperative weights were comparable between both groups. Patients on semaglutide were less likely to proceed with surgery (P=0.001). For patients who had surgery, those on semaglutide experienced longer times from evaluation to surgery, compared to patients not taking this medication (8.8 months vs. 7.4 months, P=0.152). Weight loss outcomes at 2- and 6-month post-surgery were similar between groups. Notably, 22% of semaglutide patients no longer qualified for surgery due to successful weight loss.

Conclusion: The use of semaglutide has the potential to reduce the number of bariatric surgeries and delay surgical intervention for some patients. However, the long-term effects of semaglutide on weight maintenance and its broader implications for clinical practice require further investigation.

Purpose: Enhanced recovery after bariatric surgery is important for decreasing morbidity, enhancing functional recovery and shortening the length of stay. Ultrasound-guided transversus abdominis plane (TAP) block has been known to decrease pain scores and opioid requirement after bariatric surgery. We aimed to investigate the efficacy of continuous TAP block in 50 consecutive cases of laparoscopic sleeve gastrectomy (LSG).

Materials and methods: From February 2022 to April 2022, 50 cases of LSG were performed with ultrasound-guided TAP blocks. The data was compared to that of 157 cases of primary LSG that had been performed from January to December of 2021. Ultrasound guided TAP block was performed from the epigastric port site 3 to 5 mm in size that was placed for liver retraction during LSG. The lateral border of the rectus abdominis muscle was identified. A 17-gauge T-peel inducer and sheath (On-Q^® Pain Buster^®) were inserted in a medial to lateral direction towards the TAP. Fifteen to 20 mL of normal saline was injected for plane dissection and the catheter was inserted through the sheath after removal of the inducer. The same was performed for the other side in the same order. The elastomeric pump was injected with 100 mg of 0.5% bupivacaine and connected to the 2 catheters.

Results: There was no significant difference in mean age, initial body weight, preoperative body mass index (BMI), incidence of diabetes, hypertension, obstructive sleep apnea, and length of postoperative hospital stay between the TAP group and the non-TAP group. The TAP group had a higher incidence of dyslipidemia. There were statistically significant differences in the clinical outcomes regarding the numerical rating scale (NRS) score at postoperative 12, 24 and 48 hours, opioid injection within 24 hours (non-TAP group 36.82% vs. TAP group 20%, P value=0.037) and ramosetron injection within 24 hours (non-TAP group 9.45% vs. TAP group 0%, P value=0.017). There was no significant difference between the 2 groups in postoperative NRS scores at 1 and 6 hours, incidence of nausea or vomiting, injection of acetaminophen, non-steroidal anti-inflammatory drugs, or metoclopramide within 24 or 48 hours, injection of opioid or ramosetron within 48 hours. There were 2 cases of complications related to continuous TAP block where there was difficulty in removing the catheters and needed to be removed under local anesthesia.

Conclusion: Although continuous TAP block did not reduce cumulative opioid consumption, the need for additional opioid and antiemetic injection can be reduced within the postoperative 24 hours.

Purpose: Anaemia and micronutrient deficiencies are common complications following bariatric surgery. This study aimed to determine the prevalence of anaemia after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), and to identify anaemia associated risk factors.

Materials and methods: A cross-sectional study was conducted among 100 adults who underwent RYGB or SG between 2016 and 2022 at Hospital Raja Permaisuri Bainun, Ipoh. Demographics, biochemical parameters, and multivitamin (MVT) adherence data were analysed according to the type of surgery.

Results: Among the participants, 44 underwent RYGB and 56 underwent SG, with a mean follow-up of 3 years. Most were female and over half were still menstruating. The overall prevalence of anaemia increased from 14% pre-surgery to 47% post-surgery. Anaemia increased from 9.1% to 47.7% in the RYGB group and from 17.9% to 46.4% in the SG group, with no significant difference in severity of anaemia (P=0.897). Postoperatively iron, folate and vitamin B12 deficiencies were observed in 44%, 14%, and 9% of patients, respectively. Folate deficiency was higher after SG (23.2% vs. 2.3%, P=0.003), while vitamin B12 deficiency occurred only after RYGB (20.5% vs. 0%, P<0.001). Iron deficiency was slightly higher in the RYGB group but not statistically significant (P=0.547). Menstruating females had higher risk of iron deficiency (P=0.001). Only 46% showed good adherence to MVT intake.

Conclusion: Anaemia affected nearly half of post-bariatric surgery patients, with menstruating women at highest risk. Lifelong monitoring and prophylactic iron supplementation are essential to prevent anaemia and related micronutrient deficiencies.

Obesity represents a major global health challenge, requiring interventions that are both effective and economically sustainable. This review examines the cost-effectiveness of commonly discussed treatment options: glucagon-like peptide-1 receptor agonists (GLP-1 RAs), endoscopic sleeve gastroplasty (ESG), and metabolic/bariatric surgery (MBS). We synthesized evidence from published clinical studies and economic analyses, comparing incremental cost-effectiveness ratios (ICERs) and cost per quality-adjusted life year across obesity severity classes, with particular consideration of implications for Korea's healthcare context. Clinical trial data indicate that GLP-1 RAs can achieve approximately 15-20% weight reduction, but high cost often places ICERs above conventional willingness-to-pay benchmarks. ESG, a less invasive endoscopic procedure, yields around 15% weight loss and has demonstrated favorable cost-effectiveness, particularly in class I obesity. MBS offers the most durable weight loss, generally 25-30%, along with improvements in survival and quality of life. Economic evaluations consistently report MBS as highly cost-effective-and in some cases cost-saving-especially for class II and III obesity. Comparative findings suggest that ESG is generally more economically favorable than GLP-1 RAs in class I obesity, whereas head-to-head comparisons with MBS are limited. At current pricing, GLP-1 RAs rarely meet accepted cost-effectiveness thresholds. MBS is the most cost-effective intervention for moderate-to-severe obesity globally, while ESG is promising in lower body mass index groups. Despite their efficacy, GLP-1 RAs are limited by cost. As ESG is not yet available in Korea and evidence supporting MBS in class I obesity continues to accumulate, reassessment of cost-effectiveness in the Korean context is warranted.

Prader-Willi Syndrome (PWS) is a genetic disorder characterized by insatiable hyperphagia, resulting in severe, early-onset obesity that is often refractory to conventional management. The associated comorbidities and reduced life expectancy in PWS present a significant therapeutic challenge. This review synthesizes the existing literature on the controversial role, outcomes, and complexities of bariatric surgery in patients with PWS. In recent decades, bariatric surgical techniques have evolved from malabsorptive or restrictive operations to modern procedures such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). We present a 21-year-old male's SG case to illustrate key themes. Published series from specialized, high-volume centers demonstrate that SG and RYGB yield significant short- to mid-term weight loss and metabolic improvement with an acceptable perioperative risk profile. However, the fundamental challenge in PWS remains the persistent, inherent hyperphagia. As exemplified by the presented case and supported by the broader literature, this insatiable hunger severely limits long-term surgical success and frequently leads to substantial weight regain. Maintaining durable success requires rigorous, lifelong external dietary supervision and intensive multidisciplinary support. Moreover, ethical considerations, particularly regarding informed consent and procedural choice, complicate the application of bariatric surgery in this population. Bariatric surgery should therefore be considered an adjunctive tool rather than a definitive cure for PWS-related obesity. Its use must be reserved for carefully selected individuals who have severe comorbidities and robust, long-term support structures in place. This perspective highlights the critical need for ongoing research into optimal patient selection, procedural approaches, and adjuvant therapies to improve durable outcomes.

Purpose: This study aimed to compare the efficacy and safety of Classic and Hard laparoscopic sleeve gastrectomy (LSG) techniques, with a focus on long-term weight loss outcomes and complication rates over a 3-year follow-up period.

Materials and methods: A retrospective cohort study was conducted on 785 patients who underwent LSG between January 2019 and December 2022, with follow-up completed by 2023. Patients were divided into 2 groups according to surgical technique: Classic LSG (n=372), involving standard resection along the lesser curvature using a 36-French bougie; and Hard LSG (n=413), characterized by more extensive fundal mobilization and creation of a narrower gastric tube using a 32-French bougie.

Results: Both techniques resulted in significant body mass index (BMI) reductions; however, Hard LSG demonstrated superior weight loss. At 12 months, 70.7% of Hard LSG patients achieved a normal BMI (<25 kg/m²), compared to 42.2% in the Classic group. At 3 years, 59.3% and 20.4% maintained normal BMI, respectively (P<0.001). However, Hard LSG was associated with higher complication rates: early metabolic complications occurred in 64.3% vs. 25.7% (P<0.001), and late surgical complications in 10.4% vs. 2.4% (P<0.001).

Conclusion: While Hard LSG provides greater and more durable weight loss, it is associated with increased risks of complications. These findings support the need for individualized surgical decision-making to balance efficacy and safety in the management of obesity.

Early postoperative weight loss (EWL) after bariatric surgery is a critical as a powerful predictor of long-term weight loss and metabolic outcomes. This narrative review shows evidence from recent studies examining the biological, behavioral, and clinical implications of EWL in patients undergoing various bariatric procedures. We discuss the hormonal and metabolic adaptations that occur in the first months after surgery, the psychosocial and behavioral factors influencing postoperative outcomes, and how early weight loss can guide individualized management. We further conduct the clinical pathways that integrate EWL monitoring into routine postoperative care. The goal is to encourage standardization in EWL measurement and its integration into multidisciplinary bariatric management to improve patient postoperative outcomes.