Journal of metabolic and bariatric surgery最新文献

Purpose: This study aimed to assess the association of dietary quality and surgical satisfaction with the amount of total weight loss (TWL) 1 year after laparoscopic sleeve gastrectomy (LSG) using the food tolerance score (FTS) and Bariatric Analysis and Reporting Outcome System (BAROS) questionnaires.

Materials and methods: This single-center retrospective study included patients who underwent LSG due to morbid obesity. Only those who have 1-year follow-up data were included and divided into 2 groups: suboptimal TWL (STWL) ≤20% and optimal TWL (OTWL) >20%. Clinical data and questionnaires recorded 1 year after surgery were collected. FTS was used to evaluate the degree of food tolerance, and BAROS assessed surgical outcomes, including weight loss, comorbidity changes, and quality of life (QoL). The total FTS and BAROS scores of the 2 groups were compared.

Results: Of 580 patients, 159 were included. Patients in STWL (n=17) were significantly older than those in OTWL (n=142) (42.24±9.28 vs. 35.92±8.71 years old, P=0.006). The total FTS (1-30 points) for STWL and OTWL were 24.88±3.43 and 25.04±3.14, respectively (P=0.845). Although the total BAROS scores (maximum: 9 points) were significantly lower in STWL than in OTWL (5.96±1.48 vs. 7.20±1.40, P<0.001). The only variable that made this difference was weight loss. There were no significant differences in other variables, such as medical conditions, QoL, and complications.

Conclusion: In terms of FTS and BAROS score, there is no difference in postoperative satisfaction and QoL between STWL and OTWL after LSG, except for the degree of weight loss.

Adjustable gastric banding was the most common type of bariatric surgery performed in Korea prior to 2019. Many patients that have undergone this procedure require revisional bariatric surgery while removing the gastric band, and it is important to select an appropriate revisional procedure. If reoperation is performed owing to insufficient weight loss or weight regain, a 1-step procedure can be considered. However, a 2-step procedure is preferred when complications such as band erosion or stomach perforation have occurred. Previous studies from Western countries have shown that revisional Roux-en-Y gastric bypass (RYGB) can achieve more effective postoperative weight loss than revisional sleeve gastrectomy, although this procedure may also carry a higher risk of morbidity, reoperation, and readmission to hospital. In Korea, the short-term outcomes of the 2 procedures may be similar. However, the potential risk of gastric cancer in the remnant stomach after RYGB must also be considered. The type of revisional surgery should be selected following discussions with the patient regarding the advantages and disadvantages associated with each procedure.

Bariatric surgery has been covered by medical insurance in Korea, since January 2019; and its number is steadily increasing. Representative bariatric surgeries include adjustable gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass. Each surgical method can be applied according to the patient's condition; however, there are other issues to consider in Korea. Because of the high incidence of gastric cancer in Korea, gastroscopy is recommended every two years after the age of 40. Therefore, it is difficult to perform conventional gastroscopy after Roux-en-Y gastric bypass. In this review, the incidence of gastric cancer after representative bariatric surgery was investigated through a literature review, so that it could be used as a reference for the selection of bariatric surgery in Korea.

Recently, metabolic surgery was recommended for patients with a BMI of 30 or higher and 27.5 or higher for Asians, as evidence level A. Until 2008, bariatric surgery was not introduced for the treatment of diabetes. Bariatric surgery was first recommended for adults with body mass index ≥35 kg/m² and type 2 diabetes in the American Diabetes Association (ADA) guidelines as evidence level B in 2009. In 2017, the terminology was changed from bariatric surgery to metabolic surgery. How such large changes could have occurred in the ADA guidelines? Because many patients have reached diabetes remission through metabolic surgery, and the long-term benefit and cost-effectiveness have been strongly proven by historical randomized controlled trials and high-quality studies. This review demonstrates how the recommendations for the treatment of obesity in patients with diabetes have changed in diabetes treatment guidelines and summarizes the evidence behind this change.

It has been proven that surgery is more effective than non-surgical treatment in obese patients. However, this approach has several disadvantages, especially long-term weight loss. Weight loss failures can be broadly classified into two categories; insufficient weight loss (poor responder) and weight regain. However, a unified definition has not been established yet for each category, and there is no clear standard for the post-surgery time point to be used to assess weight loss failure. In addition, analyzing factors that contribute to weight loss failure will lead to strategies for reducing it. Therefore, many researchers have been interested in this subject and have published conflicting results. This review presents a definition for and describes the mechanisms and predictors of weight loss failure after bariatric surgery.

Obesity by itself is a factor in the development of gallstone disease, and periods of weight loss after bariatric surgery further increase the risk of gallstone formation. In patients with obesity, hypersecretion of cholesterol may increase the risk of gallstone formation, which is approximately five-fold higher than that in the general population. The incidence of gallstone formation after bariatric surgery is 10-38% and often associated with a proportional increase in the risk of developing biliary complications. Routine postoperative administration of ursodeoxycholic acid (UDCA) is recommended to prevent gallstone formation. Several randomized trials have indicated that UDCA can effectively prevent gallstones and reduce the risk of cholecystectomy after bariatric procedures. The effective daily dose of UDCA in each study ranged from 500 to 1,200 mg, and it may be considered at least during the period of rapid weight loss (first 3-6 months postoperatively) to decrease the incidence of symptomatic gallstones.

Purpose: The number of Korean patients undergoing metabolic surgery for obesity is on the increase. Patients undergoing obesity and metabolic surgery have a body mass index (BMI) ≥30 kg/m². In this study, we investigated the prevalence of nonalcoholic fatty liver disease in Korean patients who had undergone bariatric surgery.

Materials and methods: Between January 2019 and December 2021, 147 patients who underwent bariatric surgery were studied. Of these, 133 patients underwent transient elastography, and the prevalence was analyzed after being classified using the World Health Organization (WHO) obesity classification system. The participants were divided into three groups as Class 1, BMI 30 to <35 kg/m²; Class 2, BMI 35 to <40 kg/m²; and Class 3, BMI ≥40 kg/m²).

Results: The average ages of three classes of patients according to the WHO obesity classification system were 42.4, 38.8, and 36.0 years with intergroup differences. Controlled attenuation parameter (CAP) and liver stiffness also showed differences in each group (307.6±59.3, 325.8±53.0, and 346.5±52.2, respectively, P=0.007; CAP, 5.5±2.1, 7.1±3.8, and 11.7±9.1, P<0.001; liver stiffness). The prevalence of type 2 diabetes mellitus also differed among the groups (61.3%, 42.2%, and 36.8%, respectively, P=0.036). The proportion of patients with liver fibrosis also showed differences in each group (16.1%, 42.2%, and 59.6%, respectively; P<0.001).

Conclusion: Our study shows that most Korean patients undergoing bariatric surgery were also diagnosed with hepatic steatosis. Furthermore, the rate of liver fibrosis was higher among patients with more severe obesity.