Journal of metabolic and bariatric surgery最新文献

Purpose: This study aims to identify the most accurate and useful non-invasive method to replace liver biopsy for the diagnosis of non-alcoholic fatty liver disease (NAFLD) before bariatric surgery and postoperative follow-up in morbidly obese patients.

Materials and methods: This single-center study is a retrospective analysis of prospectively collected data from 68 morbidly obese patients who underwent laparoscopic sleeve gastrectomy with intraoperative liver biopsy. Preoperative non-invasive diagnostic methods, including fatty liver index, NAFLD fibrosis score, enhanced liver fibrosis score, FibroScan, magnetic resonance imaging-proton density fat fraction (MRI-PDFF), magnetic resonance spectroscopy (MRS)-PDFF, and magnetic resonance elastography (MRE) were compared against liver biopsy results. Diagnostic performance was assessed using Spearman's correlation and receiver operating characteristic (ROC) curve analysis.

Results: Liver biopsy confirmed the presence of steatosis in 92.7% of patients, Nonalcoholic Steatohepatitis (NASH) in 64.7%, and liver fibrosis (≥F1) in 72.0%. MRI-PDFF and MRS-PDFF demonstrated the highest diagnostic accuracy for NASH, with the strongest correlation with histological findings. For liver fibrosis, MRE showed the strongest correlation with histological fibrosis stage, while FibroScan-Liver Stiffness Measurement (LSM) demonstrated better diagnostic performance in ROC analysis. However, the overall diagnostic quality of non-invasive methods for fibrosis assessment remained modest, with no method achieving a quality value above 0.6.

Conclusion: MRI-PDFF and MRS-PDFF were the most accurate noninvasive methods for diagnosing NASH in morbidly obese patients. For liver fibrosis, FibroScan-LSM may be more suitable for detection, while MRE may better reflect fibrosis severity. Further studies are needed to assess the cost-effectiveness and clinical applicability of these methods.

Purpose: To know about the feasibility and effectiveness of metabolic/bariatric surgery (MBS) in Korean super obese patients.

Materials and methods: We reviewed the medical records of 18 super obese (body mass index [BMI] ≥50 kg/m²) patients among 131 morbidly obese patients who underwent MBS at Incheon St. Mary's Hospital, the Catholic University of Korea from May 2011 to July 2024 and investigated the early surgical outcomes of these patients.

Results: Male/female ratio was 10 to 8, the mean age was 35.4±10.6 year, the mean body weight was 161.6±35.2 (range 112.9-241) kg, and the mean BMI was 58.3±8.2 (range 50.0-78.7) kg/m². Sleeve gastrectomy (SG) was performed in 10 patients, SG plus procedure (SG+) in 5 patients, single anastomosis duodenoileal bypass with SG (SADI-S) in 2 patients and long biliopancreatic limb Roux-en-Y gastric bypass (LBPL RYGB) in 1 patient. The mean operation time was 170.3±64.5 minute and the mean postoperative hospital stay was 9±4.6 day. There was no postoperative morbidity and no mortality. The percentage of total weight loss at 1 year after surgery was 34.3±0.6% in SG, 23.1±3.2% in SG+, 45.8±4.5% in SADI-S and 47% in LBPL RYGB.

Conclusion: MBS was feasible and effective in Korean super obese patients. However, SG+ was less effective than expected in these patients.

Purpose: Obesity is a major risk factor for obstructive sleep apnea (OSA), associated with conditions like type 2 diabetes, hypertension, stroke, cancer, and premature death. OSA involves sleep-breathing interruptions, with over 60% of obese individuals diagnosed through polysomnography. This study explores sleep issues in individuals considering bariatric surgery.

Materials and methods: We retrospectively analyzed sleep study records and questionnaires of 137 obese patients undergoing metabolic surgery at Kosin University Gospel Hospital between January 1, 2019, and September 30, 2022. Statistical tests, including Student's t-test and logistic regression, assessed subjective and objective characteristics.

Results: Most subjects, predominantly female with comorbidities, exhibited poor sleep quality. Positive correlations between polysomnography and subjective evaluation indicated poor results. Logistic regression revealed increased OSA likelihood with higher Apnea-Hypopnea Index, with associations to sex, age, and body mass index (BMI).

Conclusion: Regardless of BMI, most patients with a BMI ≥30 kg/m² undergoing bariatric surgery were diagnosed with OSA, experiencing poor subjective and objective sleep quality. Correlations between subjective and objective evaluations were significant, with sex, advanced age, and high BMI identified as significant OSA risk factors.

Sleeve gastrectomy with proximal jejunal bypass (SG with PJB) is often preferred for patients with higher body mass index (BMI) and inadequate glycemic control. This study aimed to compare the outcomes of SG and SG with PJB, focusing on glycemic control and BMI in prediabetic and diabetic patients. Preoperative analysis revealed differences in age and hemoglobin A1c (HbA1c) levels between groups: SG with PJB patients were older (38.72±9.75 vs. 34.93±10.90 years, P=0.002) and had higher HbA1c levels (7.25±1.76 vs. 5.86±0.78%, P<0.001). Patients were stratified into prediabetic and diabetic groups. In the prediabetic group, no preoperative differences were observed between the surgical groups. However, in the diabetic group, patients in the SG with PJB had lower BMI (37.77±5.83 vs. 41.08±8.5 kg/m², P=0.034) and higher HbA1c levels (7.88±1.72 vs. 6.51±1.37%, P<0.001) compared to the SG, despite stratification. Postoperatively, SG with PJB led to significantly lower BMI at 3 months compared to SG, but this difference was not sustained at 6 and 12 months in the prediabetic group. In diabetic patients, SG with PJB resulted in significantly greater reductions in HbA1c levels compared to SG, even when adjusted for BMI as a covariate. At the 12-month follow-up, although SG with PJB still showed higher HbA1c levels than SG (5.79±0.78 vs. 5.59±0.44%, P=0.031), the difference was smaller compared to the preoperative period, where SG with PJB had significantly higher levels (7.88±1.72 vs. 6.51±1.37%, P<0.001). These findings suggest that SG with PJB may offer superior glycemic control in morbidly obese diabetic patients.

Purpose: We aimed to assess outcomes in patients undergoing sequential intragastric balloon (IGB) treatment for obesity.

Materials and methods: Consecutive patients who underwent treatment between May 2014 and February 2023 were identified. We recorded outcomes including: weight at 3-monthly intervals, progression to definitive bariatric procedure and morbidity.

Results: Forty-five patients were identified. Median weight loss with first IGB was 15.2 kg (8.8%). 11 patients (26.7%) had a second IGB, with median weight loss of 3.3 kg (1.9%). Twenty-one patients (46.7%) were suitable for definitive surgery after first IGB treatment. One further patient (2.2%) was suitable for surgery after a second IGB. During first IGB, median weight loss was observed during the each of the first 3 quartiles (0-3 months: 10.1 kg; 3-6 months: 2.3 kg; 6-9 months: 4.2 kg). There was a median 2 kg weight gain during 9-12 months.

Conclusion: Greatest weight loss was achieved during first IGB treatment. Sequential IGB treatment did not lead to beneficial weight loss or progression to surgery. Weight loss with first IGB was not uniform across the 12-month period of treatment, with net weight gain during the last quartile.

Purpose: Metabolic and bariatric surgery (MBS) is an effective treatment for patients with body mass index (BMI) above 50.0 kg/m² but nutritional deficiencies (ND) may arise. This study aimed to assess if patients with BMI above 50.0 kg/m² have more ND and require more supplementation after MBS compared to patients in lower BMI groups.

Materials and methods: Retrospective single center study including all patients submitted to MBS from 2019-2020. Several parameters were collected. Statistical analysis was performed to compare ND between BMI groups (<40.0 kg/m²; 40.0 to 49.9 kg/m²; ≥50.0 kg/m²), and between surgeries (Roux-en-Y gastric bypass [RYGB] vs. sleeve gastrectomy [SG]) in the group with BMI ≥50.0 kg/m².

Results: We identified 951 patients, 85 (9.0%) with BMI ≥50.0 kg/m², with RYGB performed in 644 (68.4%) patients. Pre-operatively, vitamin D deficiency was observed in 80.0% of patients with BMI ≥50.0 kg/m², with significant differences between BMI groups. At follow-up there were no significant differences in ND according to BMI groups. In patients with BMI ≥50.0 kg/m², vitamin B12 deficiency was more frequent after RYGB. At 2-year follow-up, 95.4% patients were taking multivitamin supplementation, and 52.4% required additional supplements, namely vitamin D.

Conclusion: ND are common in patients with BMI ≥50.0 kg/m², even before MBS. After surgery, patients with BMI ≥50.0 kg/m² may not have increased risk for ND, compared to other BMI groups. In these patients, RYGB resulted in an increased risk for vitamin B12 deficiency. Adequate supplementation and clinical follow-up are essential to mitigate these complications.

Traumatic lower limb amputation has been identified as a major risk factor for obesity and metabolic diseases. Surgery in amputees with obesity poses significant complexities with physical and logistical issues of positioning and ergonomics. A 64-year-old gentleman with a history bilateral above knee amputation, obesity, type 2 diabetes mellitus, and obstructive sleep apnea was worked up for bariatric surgery. Due to his amputations, it was unknown whether this would be safe or feasible. In order to ensure this, the patient was brought to the operating room more than a week in advance to trial positioning. The patient was able to be positioned in reverse Trendelenburg with straps across his lower chest and his proximal thighs. Despite obesity being a prevalent and increasing issue facing lower limb amputees, there was relative paucity of literature on the topic. The successful use of this strategy to position a bilateral amputee could be mirrored in future cases.

Metabolic surgery is an effective treatment option for type 2 diabetes. However, the therapeutic scope has been limited by unexpected inconsistent outcomes. This study aims to overcome these obstacles by determining fundamental mechanisms from a novel perspective by analyzing and comparing the surgical anatomy, clinical characteristics, and outcomes of metabolic surgery, including duodenal-jejunal bypass, Roux-en-Y gastric bypass, biliopancreatic diversion, one anastomosis gastric bypass, and their modified procedures, predominantly focusing on nonobese patients to mitigate confounding effects from overweighted type 2 diabetes. Regional epithelial cell growth and unique villus formation along the anterior-posterior axis of the small intestine depend on crosstalk between the epithelium and the underlying mesenchyme. Due to altered crosstalk between the epithelium and the opposite mesenchyme at the anastomotic site, the enteroendocrine lineage of the distal intestine is replaced by the proximal epithelium after the bypass procedure. Subsequent intestinal compensatory proliferation accelerates the expansion of the replaced epithelium, including enteroendocrine cells. The primary reasons for unsatisfactory results are incomplete duodenal exclusion and insufficient biliopancreatic limb length. We anticipate that this novel mechanism will have a significant impact on metabolic surgery outcomes and provide valuable insight into optimizing its effectiveness in type 2 diabetes.

Purpose: The introduction of insurance coverage in Korea has led to a rise in the number of bariatric and metabolic surgeries. This study aims to provide a comprehensive report on the nationwide status of these surgeries from 2019 to 2022, utilizing data from the Korean Society of Metabolic and Bariatric Surgery (KSMBS) database registry.

Materials and methods: This study analyzed data from the KSMBS registry, collected from 68 certified surgeons across 58 institutions from January 2019 to December 2022. After excluding non-relevant cases, the final analysis included 7,377 patients.

Results: Annually, data for 1,869, 1,934, 1,782, and 1,792 patients were collected from 2019 to 2022, respectively. The rate of revisional operations accounted for 7.1%, 8.2%, 4.6%, and 4.5% of the total cases each year. The most common primary surgery was Sleeve Gastrectomy (SG, ranging from 71.1% to 78.9%), followed by Roux-en-Y Gastric Bypass (RYGB, ranging from 9.6% to 13.4%). The surgeries demonstrated a high safety profile, with a low morbidity rate (0.5% to 0.9%) and a zero mortality rate over the 4 years. Within 2 years post-operation, the Total Weight Loss Percentage was similar among patients who underwent SG, RYGB, and Sleeve Plus procedures.

Conclusion: The number of bariatric and metabolic surgeries in Korea has increased significantly since the introduction of national insurance coverage. SG was the most performed primary procedure. All surgical procedures showed safe short-term outcomes and yielded reasonable results upon follow-up, indicating a positive impact of insurance coverage on the accessibility and safety of surgeries.