Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery最新文献

Background: While bariatric surgery reduces short-term mortality and improves metabolic outcomes, less is known about the long-term causes of death in patients who undergo these procedures. Understanding these outcomes is critical for long-term care and risk counseling.

Objectives: To identify any shifts in the long-term causes of death among bariatric surgery patients in the United States and compare these to matched nonsurgical controls, as well as to obese and normal-weight individuals in the general population.

Setting: United States; National Health and Nutrition Examination Survey (NHANES) Linked Mortality Files.

Methods: We analyzed data from NHANES 2005 to 2018 linked to the National Death Index through 2019. Individuals with self-reported bariatric surgery were matched to controls by age, sex, and body mass index (BMI). We excluded deaths occurring within 1 year of survey participation. Causes of death were classified by International Classification of Diseases Version 10 (ICD-10) categories. Descriptive statistics and survival trends were analyzed.

Results: Among 435 bariatric patients and 1740 controls, there were 87 and 212 long-term deaths, respectively. The leading causes of death in the bariatric group were cardiovascular disease (30%), cancer (21%), and diabetes (9%). Compared to controls, bariatric patients had proportionally higher rates of suicide (6.6%) and liver disease (8.5%). In contrast, diabetes-related deaths occurred in 5.7% of bariatric patients compared to 9.8% in controls. Bariatric patients had a three times higher risk of death from suicide (standardized mortality ratios [SMRs] 3.33; 95% confidence interval (CI), 1.08-7.78) and a higher risk of death from liver disease (SMR 3.00; 95% CI, 1.10-6.53) compared to matched controls. Diabetes-related mortality was also markedly elevated (SMR 2.00; 95% CI, .86-3.94).

Conclusion: Long-term causes of death after bariatric surgery remain primarily cardiovascular and oncologic, but higher rates of suicide and liver-related mortality highlight the need for targeted follow-up and psychosocial care.

Background: Bariatric surgery (BS) and glucagon-like peptide-1- receptor agonists (GLP-1RAs) are established treatments for obesity and cardiovascular risk, but their comparative impact on clinical outcomes remains unclear.

Objectives: To compare long-term outcomes of BS versus GLP-1RA therapy in adults with obesity, focusing on mortality, major adverse cardiovascular events (MACE), and heart failure.

Setting: Multicenter observational studies using national and institutional databases.

Methods: PubMed, Embase, and Cochrane CENTRAL were searched for studies comparing bariatric surgery and GLP-1RAs reporting adjusted hazard ratios for mortality, MACE, or heart failure. Two reviewers independently performed screening and data extraction. Risk of bias was assessed with ROBINS-I, and random-effects meta-analysis was used. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessed certainty of evidence.

Results: Five cohort studies (N = 39,569) were included. BS was associated with a 43% lower risk of mortality (hazard ratio [HR] .57, 95% CI .34-.95), 35% lower MACE risk (HR .65, 95% CI .51-.83), and 55% lower risk of heart failure (HR .45, 95% CI .39-.51). Per 1000 patients treated, absolute reductions were 25 deaths, 25 cardiovascular events, and 23 heart failure cases. Certainty ranged from low (MACE) to moderate (heart failure).

Conclusions: In this meta-analysis of observational studies, bariatric surgery was associated with lower risks of mortality and cardiovascular outcomes compared to GLP-1RA therapy in adults with obesity. These findings suggest potential differences in long-term effectiveness between treatment strategies, warranting further investigation in randomized controlled trials. Residual confounding and selection bias cannot be fully eliminated given the observational design of the included cohorts.

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity. Prior research suggests a volume-outcome relationship, where higher hospital volumes correlate with improved patient safety. However, current accreditation standards may not reflect contemporary practice.

Objectives: To evaluate the impact of hospital volume on postoperative complications, as measured by Patient Safety Indicators (PSI-90), and mortality following bariatric surgery.

Setting: Nationwide Readmissions Database (NRD) from 2018 to 2020, representing 266,743 procedures across 1947 U S. hospitals.

Methods: Bariatric procedures (sleeve gastrectomy (SG), gastric bypass (GP), and duodenal switch (DS)) were categorized into low-, medium-, and high-volume hospitals based on tertiles of case volume. Risk-adjusted odds ratios (ORs) for PSI-90 complications and mortality were compared using high-volume centers as the reference.

Results: Medium-volume centers had significantly increased risk of PSI-90 complications for SG (OR 1.56, P < .001) and DS (OR 2.16, P = .035) compared to high-volume hospitals. No significant difference was found between low- and high-volume hospitals, suggesting patient selection bias at low-volume centers. GP outcomes did not significantly vary across volume tiers.

Conclusions: Higher hospital volume was associated with reduced postoperative complications for SG and DS. The increased complication risk in medium-volume centers suggests the need to reassess accreditation volume thresholds. Future policies should ensure standards align with evolving bariatric surgical practices to optimize patient outcomes.

The gut microbiome is a critical mediator of metabolic health including obesity and type 2 diabetes. Microbial composition variation - driven by diet, genetics, environment, and host physiology - can influence insulin sensitivity, energy absorption, fat storage, and systemic inflammation. Metabolic and bariatric surgery (MBS) is associated with distinct shifts in gut microbiota that may contribute to weight loss and metabolic improvements. Changes in microbial diversity, bile acid metabolism, and enrichment of beneficial taxa have all been linked to favorable metabolic outcomes. Furthermore, the gut microbiome may interact with molecular signaling pathways including glucagon-like peptide-1 signaling. Despite probiotics and prebiotics showing potential modulation of the gut microbiota, their clinical impact on obesity management remains inconsistent. Understanding the complex interplay between MBS, the gut microbiome, and host metabolism may offer novel insights into future therapeutic targets. As the field advances, microbiome-based strategies may enhance procedure selection, improve patient outcomes after MBS, and contribute to more personalized, durable treatment approaches for obesity and its related diseases.

Roux-en-Y gastric bypass (RYGB) is a widely performed and well-established metabolic and bariatric surgery (MBS) procedure around the world based on its high efficacy and low complication profile when offered to appropriately selected candidates. However, it is still associated with chronic abdominal pain confounded by nonspecific symptoms and signs that many times lead to a delay in diagnosis or excessive and unnecessary testing that may put patients at risk for long-term complications and adverse events. Among the most important causes of chronic abdominal pain after RYGB are marginal ulcers, intussusception, internal hernias, bile reflux gastritis, dumping syndrome, small intestinal bacterial overgrowth (SIBO), candy cane syndrome, biliary pathology, vascular etiologies, and gastroesophageal reflux disease (GERD). A comprehensive literature review based on the highest-level available published manuscripts has been conducted with the goal of providing the readers and members from the American Society for Metabolic and Bariatric Surgery (ASMBS) with a practical algorithm to diagnose and treat chronic abdominal pain after RYGB. An organized approach that promotes early diagnosis and cause-specific management in a multidisciplinary team environment led by metabolic and bariatric surgeons is advised and encouraged. This literature review by the members of the Clinical Issues Committee (CIC) of ASMBS introduces available high-level evidence to allow our members to achieve early diagnosis of the etiologies of chronic abdominal pain and the expedited therapeutic maneuvers to address them and improve quality of life while increasing patient survival.

Background: Increasing obesity and metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis present challenges in liver transplantation.

Objectives: While simultaneous sleeve gastrectomy (SG) has been described in the deceased donor liver transplantation (DDLT) population, its role in living donor liver transplantation (LDLT) remains poorly unexplored.

Setting: Simultaneous SG and LDLT for obese patients with MASH cirrhosis.

Methods: This is a pilot study of LDLT recipients who underwent simultaneous sleeve gastrectomy (LDLT-SG) at this institution from December 2023 to May 2025. Short term postoperative outcomes, weight loss, graft function, and metabolic syndrome comorbidities were compared to a matched LDLT-only cohort at this institution along with a DDLT-SG cohort at another institution.

Results: Seven patients with a body mass index (BMI) of 42.1 (standard deviation [SD] 5.8) underwent simultaneous LDLT-SG. They had MASH cirrhosis with an average model for end-stage liver disease (MELD) score of 18.6 (SD 7.7). Patients experienced significant total body weight loss (TBWL%): 15.7% at 1 month, 26.5% at 6 months, and 31.3% at 12 months. Excess body weight loss (EBWL%) was 42.2%, 71.9%, and 81.3% at the respective intervals. No biliary or vascular complications noted post-operatively. Three patients were re-admitted - 2 for PO intolerance and 1 for a gastric sleeve leak. 57% of patients noted resolution of obesity-related comorbidities. Postop magnetic resonance imaging (MRI) assessments indicated healthy liver grafts.

Conclusion: Simultaneous LDLT-SG allows a semi-elective option for patients with obesity and MASH cirrhosis who have decreased access to DDLT. The combined procedure promotes substantial weight loss, improved metabolic comorbidities and likely decreased graft steatosis. Early outcomes are promising and suggest SG offers risk reduction in the setting of LDLT.

Background: Severe pediatric obesity disproportionately affects low-income and publicly insured youth, yet access to metabolic and bariatric surgery (MBS) remains limited despite clear national guidelines.

Objectives and setting: This manuscript describes the development of a pediatric MBS program within a safety-net children's hospital, using a structured framework grounded in interdisciplinary collaboration, stakeholder engagement, and a commitment to equitable access.

Methods: Real-world clinical vignettes are used to illustrate common barriers, including delayed care, medical complexity, and systemic inequities, and to demonstrate how an integrated, adaptive approach can address these challenges. Key components of the program include multidisciplinary team development, ethical review pathways, incorporation of antiobesity medication before and after surgery, and advocacy for financial sustainability.

Results: Early results suggest that this model improves access for historically excluded populations and supports safe, effective surgical care for youth with severe obesity.

Conclusions: This framework may serve as a replicable guide for other institutions (including those with diverse payor mixes) seeking to implement or expand pediatric MBS services in resource-limited or safety-net settings.