Journal of metabolic and bariatric surgery最新文献

Obesity affects about 39% of the global population, and bariatric surgery is a leading treatment option. As the number of primary bariatric procedures increases, so does the demand for revisional bariatric surgeries (RBSs), which are often more complex and associated with increased risks of complications. This case report details an unusual complication of RBS that surgeons should be aware of. A 41-year-old male patient with morbid obesity, after an initial sleeve gastrectomy, experienced weight regain due to gastric pouch dilatation and underwent conversion to mini-gastric bypass. Postoperatively however, he presented with recurrent left subhepatic abscess. Evaluation revealed left ductal leak from undersurface of liver as cause of recurrent liver abscess. Surgical intervention in the form of left lateral sectionectomy, resolved the symptoms. This case underscores the complexities and potential complications associated with RBS, highlighting the need for meticulous adhesiolysis between stomach and left liver during revisional gastric surgeries.

Obesity is a chronic inflammatory disease with an alarming number of cases recorded, becoming a global public health problem. Thus, an increasing number of eligible individuals choose to undergo metabolic and bariatric surgery (MBS), known for its effective results in weight reduction and improvement of metabolic conditions. Despite reversing the damage to the central nervous system caused by obesity, these procedures also present neuronal complications. Therefore, in this review, we explore the early impact of MBS on the brain of postoperative patients, with effects observed up to 6 months after surgery, covering hormonal changes, reward mechanisms, as well as influence on mood and mental health. Although improvements in mood and quality of life are reported, the early postoperative phases can be marked by emotional vulnerability, nutritional deficiencies, and psychiatric complications. These findings highlight the benefits and risks associated with MBS, underscoring the need for interventions to maintain quality of life in the postoperative period.

Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), constitutes a significant global health concern due to its substantial morbidity and mortality, especially among hospitalized and surgical individuals. DVT commonly presents in the lower extremities with symptoms such as calf pain, swelling potentially spreading to the ankle and foot, localized warmth, and skin discoloration. PTE, arising from acute pulmonary artery obstruction by a thrombus, frequently manifests as sudden dyspnea, chest pain, tachycardia, diaphoresis, hemoptysis, and lightheadedness, posing a life-threatening emergency demanding prompt medical intervention. Obesity stands out as a critical and modifiable risk factor for VTE, elevating its incidence in both the general population and during the perioperative period. Despite its efficacy in weight reduction, bariatric surgery markedly increases VTE risk, establishing it as a primary contributor to postoperative fatalities in surgical patients with obesity. The interplay between obesity and VTE involves a complex network of pathophysiological mechanisms and is further complicated by surgical and postoperative factors, necessitating comprehensive understanding and vigilant preventive strategies, especially within Asian populations, where specific anatomical and clinical factors may influence VTE risk profiles. This review comprehensively examines these pathophysiological links, clinical implications with a focus on bariatric surgery, and current prevention strategies, drawing insights from both Asian and Western guidelines and highlighting the evolving role of direct oral anticoagulants.

Metabolic and bariatric surgery induces metabolic benefits beyond weight loss, including improved insulin sensitivity, type 2 diabetes (T2D) remission, and reduced inflammation. Recent metabolomics research highlights amino acid metabolites-branched-chain amino acids, aromatic amino acids, and tryptophan-derived compounds-as key biomarkers for predicting surgical outcomes. Elevated preoperative levels of isoleucine, phenylalanine, levodopa, and 3-hydroxyanthranilic acid are associated with improved glycemic control and T2D remission. Gut microbiota-derived metabolites, including indole-3-propionic acid and indole-3-pyruvic acid, contribute to insulin sensitivity and lean mass preservation. Additionally, serotonin-related indicators predict postoperative weight loss rates. These metabolites reflect individual metabolic heterogeneity and may outperform conventional clinical models in predicting surgical responsiveness. Integration of metabolomics into preoperative assessment may enhance precision medicine approaches and identify new therapeutic targets.

Purpose: Combined lifestyle interventions (CLI) is a program designed to treat (morbid) obesity and can possibly be an adjunct to bariatric surgery. Bariatric surgery can lead to 25-50% total weight loss (TWL) and up to 71% excess weight loss, yet the longevity of the weight reduction remains variable, primarily attributed to a lack of lifestyle change. This pilot study aims to assess the effect of a 3-year structured CLI program, additional to a 5-year bariatric surgery program in a regional hospital, on the short-term outcome following bariatric surgery.

Materials and methods: A single-center prospective cohort study was performed on patients who underwent bariatric surgery between September 2021 and October 2022 (n=28). A structured CLI program was organized and offered by an official out-of-hospital CLI provider. CLI participants were matched with patients following regular follow-up. Primary outcome was quarterly measured excess weight loss (EWL). Secondary outcomes were TWL, fat measurements, sports participation and comorbidities.

Results: There were significant differences in sports participation after 1 year (92.9% vs. 62.5%; P=0.050), EWL at 21 months (18.3 kg; 95% confidence interval [CI], 0.14-36.4; P=0.049), fat mass at 18 months (-8.7 kg; 95% CI, -14.1, -3.3; P=0.008) and fat percentage at 18 months (-10.0%; 95% CI, -17.9, -2.0; P=0.017) in the CLI group compared to the control group.

Conclusion: Preliminary short-term results show that a structured additional CLI program to bariatric surgery could benefit in terms of weight loss, perhaps due to better sports participation, but long-term results have to be awaited for.

Purpose: To evaluate inflammatory and biochemical parameters in the serum of patients with obesity before and after bariatric surgery.

Materials and methods: An epidemiological study of the prospective cohort type was conducted to follow patients classified with grade II or III obesity undergoing bariatric surgery. Body mass index (BMI), lipid profile, C-reactive protein (CRP), reactive oxygen species production using dichlorofluorescein (DCF), and antioxidant defenses superoxide dismutase (SOD) and reduced glutathione (GSH) were analyzed before and 3 months after Roux-en-Y bariatric surgery.

Results: A paired analysis was conducted, evaluating 23 patients in the pre- and post-surgical period. A statistically significant reduction was observed after bariatric surgery in BMI (P value<0.001), total cholesterol (CT) (P value=0.0006), total triglycerides (P value=0.0025), high-density lipoprotein cholesterol (P value=0.0010), low-density lipoprotein cholesterol (P value=0.0189), CRP (P value=0.0130), DCF (P value=0.0069), and GSH (P value<0.0001), as well as an increase in SOD activity (P value=0.0005).

Conclusion: Bariatric surgery effectively reduced inflammatory and lipid markers and reversed oxidative stress, indicating that the procedure improves the health of bariatric patients across various parameters.

Obesity has emerged as a major global health issue. The ratio of male to female patients undergoing metabolic bariatric surgery (MBS) is 1:3.5. Although not as dramatic compared to the global trend, the rate of obesity in women of reproductive age in Korea has been steadily increasing over the past several decades. The impact of obesity on reproductive health and perinatal outcomes should be carefully considered when consulting female candidates of reproductive age for MBS. Obesity adversely affects reproductive health by causing menstrual irregularities, anovulation, subfertility, and increased miscarriage risk, as well as impairing the success of assisted reproductive technologies. Maternal obesity also heightens the risk of adverse perinatal outcomes, including childhood obesity and metabolic disorders. MBS has been shown to improve fertility outcomes and reduce obesity-related pregnancy complications, although concerns remain regarding potential risks such as small-for-gestational-age infants due to rapid weight loss and nutritional deficiencies. Despite these implications, current MBS guidelines rarely address the unique needs of reproductive-age women. In response, the Korean Society for Metabolic and Bariatric Surgery convened a task force to develop evidence-based recommendations tailored to this population. This position statement aims to guide the management of obesity in women of reproductive age to optimize reproductive and perinatal outcomes.

Myosin heavy chain 9-related disorders (MYH9RD) are rare autosomal dominant genetic conditions caused by MYH9 mutations, leading to macrothrombocytopenia, renal complications such as focal segmental glomerulosclerosis (FSGS), and other systemic manifestations. We report a case of 28-year-old male with MYH9RD and body mass index exceeding 47 kg/m², who successfully underwent laparoscopic sleeve gastrectomy. Despite challenges from bleeding tendency caused by macrothrombocytopenia and renal impairment caused by FSGS, thorough preoperative evaluation and management, including platelet transfusion, enabled surgery to proceed without complications. The patient achieved significant weight loss, from 147.6 kg preoperatively to 90.15 kg at 1 year postoperatively, with improvements in hypertension and metabolic parameters, including aspartate aminotransferase/alanine aminotransferase, hemoglobin A1c, triglycerides, and low-density lipoprotein levels. While MYH9RD is not directly associated with morbid obesity, this case highlights that comprehensive preoperative evaluation and risk management can lead to successful outcomes in bariatric surgery for MYH9RD patients.

Purpose: The aim of this study was to compare postoperative course of laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG) and laparoscopic Roux-en-Y gastric bypass (RYGB) during a 1-year follow-up period.

Materials and methods: Electronic medical records of all patients who underwent SADJB-SG and RYGB between March 2019 and June 2021 at a single institution were retrospectively reviewed. Surgical outcomes, weight loss, resolution of co-morbidities, episode of dumping syndrome, and marginal ulcer at endoscopy were assessed.

Results: Eighty-four patients who underwent SADJB-SG and RYGB were enrolled. One-year follow-up rate was 78.6%. There were no significant differences in operative time, estimated blood loss, length of postoperative stay, postoperative complications, readmission, or reoperation rate between SADJB-SG and RYGB. Percent of total weight loss (%TWL) was 26.9±9.3% in SADJB-SG and 29.6±7.6% in RYGB (P=0.209). Remission rates of T2DM, hypertension, dyslipidemia, and GERD were 78.3%, 63.6%, 44.4%, and 40% in SADJB-SG and 71.4%, 52.9%, 56.2%, and 12.5% in RYGB (P=0.318, P=0.480, P=0.417, and P=0.561), respectively. Episodes of dumping syndrome and marginal ulcer at endoscopy showed rates of 0% and 0% in SADJB-SG and 33.4% and 15.8% in RYGB (P=0.002 and P=0.043), respectively.

Conclusion: SADJB-SG is comparable to RYGB in terms of perioperative outcomes, weight loss, and resolution of co-morbidities. It is advantageous in terms of dumping syndrome and marginal ulcer during 1-year follow-up.

Purpose: Non-alcoholic fatty liver disease (NAFLD) is becoming increasingly common, especially among obese individuals. This study evaluated the liver/spleen Hounsfield unit (HU) ratio (L/S ratio) as an indicator of steatosis and related metabolic diseases using contrast-enhanced computed tomography (CT).

Materials and methods: A retrospective analysis was conducted on 34 patients who underwent bariatric surgery at Eunpyeong St. Mary's Hospital between March 2019 and July 2023. All patients underwent CT scans before and 6 months after surgery. The L/S ratio was calculated by dividing the average value of 3 HU of the liver by that of the spleen. The ratio correlated with pre- and post-surgery weight changes, comorbidities, and laboratory findings.

Results: The mean preoperative body mass index (BMI) was 40.5. Post-surgery, BMI significantly decreased to 31.5, and the number of patients with diabetes reduced from 18 (52.9%) to 4 (11.8%). Significant reductions were observed in hemoglobin A1c (HbA1c), aspartate transaminase (AST), and alanine transaminase (ALT) levels after surgery. The L/S ratio increased from 0.7±0.2 to 0.9±0.1, correlating with liver function improvements and weight loss (all with P<0.001). Patients with a larger change in L/S ratio demonstrated more significant improvements in AST, ALT, and HbA1c levels and a higher total weight loss percentage.

Conclusion: This study demonstrated a strong correlation between changes in the L/S ratio and metabolic improvements, including diabetes remission, following bariatric surgery. The L/S ratio could serve as a valuable index for assessing NAFLD severity and monitoring the outcomes in patients undergoing bariatric surgery.