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

Background: With the rise of glucagon-like peptide-1 receptor agonists for obesity, rigorous long-term data on surgical outcomes are essential to establish benchmarks and inform future comparative effectiveness studies.

Objective: To evaluate long-term weight loss, safety, and survival following Roux-en-Y gastric bypass (RYGB).

Setting: Community Teaching Hospital.

Methods: This retrospective cohort included all primary RYGB procedures between 2006 and 2011. Outcomes assessed included complications, mortality, and weight loss before glucagon-like peptide 1 (GLP-1) initiation. Mortality was compared with a propensity-weighted national reference cohort to establish population-level benchmarks.

Results: One thousand three-hundred fourteen consecutive RYGB patients were identified with an average follow-up of 11.7 years; 82% had available data at 10 years. In weighted, adjusted models, RYGB was associated with a 67% mortality reduction in patients aged 55-64 (.33; P = .045) and 53% reduction for patients ≥65 (.47; P = .005), but no reduction in patients <55. Total body weight loss at 2 years was 35% ± .3%, and at 10 years, 28.5% ± .4%. Higher initial weight, younger age, and Caucasian race were associated with greater weight loss. At 10 years, 1.8% of patients weighed more than before surgery. At least 5% of RYGB patients developed "severe" alcohol use disorder, with younger patients at higher risk. Of the 137 deaths, we identified a cause in 99. Seven deaths were directly attributable to RYGB complications, and 22 (16%) to liver failure.

Conclusion: RYGB provides durable, meaningful long-term weight loss and a marked survival benefit in patients older than 55. These findings establish a benchmark for emerging medical therapies.

Background: Reoperative bariatric surgeries continue to increase every year, and indications and outcomes have changed over time.

Objective: The aim of this study is to assess trends and 30-day outcomes of elective reoperative metabolic and bariatric surgeries (MBS) between 2020 and 2023.

Setting: National database, United States.

Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2020 to 2023 was evaluated. Elective reoperations were included in the analysis while emergent and rare procedures were excluded. Comprehensive descriptive statistics were reported for pooled and stratified data. Preoperative variables and postoperative outcomes were compared.

Results: Of 828,481 surgeries, 90,410 elective reoperations occurred (10.9%) between 2020 and 2023. Sleeve gastrectomy (SG) reoperations were the most common. Of these, 39,265 (80.9%) were converted to Roux-en-Y gastric bypass (RYGB), and 5331 (11%) to duodenal switch (DS)/single anastomosis duodenal-ileal bypass (SADI). Common indications for reoperation were weight recurrence/non-responders (53.7%) and gastroesophageal reflux (32.2%). Laparoscopic adjustable gastric band (LAGB) conversion to RYGB had higher complication rates than LAGB to SG (5.9% vs 3.4%). Conversion from SG to RYGB had higher complication rates compared with conversion to SADI or DS (5.9% vs 4.6% and 3.6%); however, SG to RYGB had lower rates of major complication (leak, deep space surgical site infection (SSI), and gastrointestinal bleeding).

Conclusion: Reoperative bariatric surgery procedures have remained relatively stable over recent years. SG is the most common primary MBS procedure as well as the most frequent requiring re-operation. While complication rates continue to be low for elective re-operative bariatric surgeries, comprehensive evaluation and counseling are vital for informed decision-making with patients. Objective assessment of indication and patient factors are necessary when choosing reoperative procedures.

Background: Severe obesity is associated with impaired respiratory and lung mechanics, including increased airway resistance.

Objectives: This study aimed to evaluate changes in respiratory system impedance and airway mechanics after bariatric surgery in adults with severe obesity.

Methods: Adults with severe obesity (n = 12) were evaluated before and after bariatric surgery using impulse oscillometry. Anthropometric measures and respiratory system impedance parameters, including airway resistance (R5 and R20), reactance (X5), and resonant frequency (Fres), were assessed and compared between time points.

Results: Weight loss after bariatric surgery was associated with significant reductions in airway resistance (R5 and R20) and Fres, indicating improvements in respiratory system mechanics.

Conclusion: Bariatric surgery improved respiratory system impedance and airway mechanics in adults with severe obesity. Impulse oscillometry detected respiratory mechanical improvements after weight loss and may represent a sensitive tool for evaluating changes in lung mechanics in this population.

Background: The increasing prevalence of obesity has led to a rise in bariatric surgery as an effective intervention for weight loss and associated co-morbidities. However, concerns persist regarding increased alcohol consumption after surgery.

Objectives: To objectively assess long-term changes in alcohol use after bariatric surgery, we used the highly specific alcohol biomarker phosphatidylethanol (PEth).

Setting: Kalmar County Hospital, Sweden.

Methods: This longitudinal cohort study included 1238 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy at Kalmar County Hospital from 2010 to 2020. Patients were divided into 2 cohorts based on preoperative PEth sampling (n = 327 with, n = 911 without). PEth levels were measured before surgery and at intervals up to 10 years postoperatively, using .30 μmol/L (approximately 210 ng/mL) as the threshold for heavy alcohol use.

Results: Mean PEth concentrations increased from .07 to .38 μmol/L (P < .001) in men and from .06 to .11 μmol/L nonsignificantly in women. The proportion of patients that postoperatively exceeded the heavy drinking threshold rose significantly over time. At 5 years, 37.5% of men and 4.8% of women had PEth values above .30 μmol/L (both P < .001). Men were at significantly higher risk (odds ratio: 7.89, 95% confidence interval: 3.76-16.57; P < .001). This pattern remained consistent at the 10-year follow-up.

Conclusions: Alcohol consumption, as measured by PEth, increased significantly after bariatric surgery, particularly in men. These findings support routine postoperative alcohol screening and suggest incorporating PEth testing into long-term follow-up protocols.

Background: Abdominal Wall Hernias (AWHs) are common in patients with obesity, yet the optimal management approach and outcomes of concurrent bariatric surgery and hernia repair remain unclear.

Objectives: To compare outcomes of patients who underwent concurrent AWH repair and bariatric surgery with those who had bariatric surgery alone.

Setting: National deidentified database.

Methods: We conducted a retrospective analysis of the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, which recently incorporated new Current Procedural Terminology codes capturing detailed hernia characteristics.

Results: Of 180,544 patients undergoing bariatric surgery, 1.3% (2292) of patients underwent concurrent AWH. These patients were older (47.6 ± 11.4 vs. 42.9 ± 11.9 years; P < .001), had higher body mass index (46.1 ± 11.4 vs. 45.1 ± 7.7 kg/m²; P < .001), and more comorbidities. Most repaired hernias were primary (90.1%), reducible (71.4%), and small-to-medium sized (<3 cm) (94.9%). Concurrent procedures had longer operative times (122.2 ± 64.5 vs. 84.1 ± 48.4 min) and hospital stays (1.5 ± 1.8 vs. 1.2 ± 1.1 days). Reoperation (2.1% vs. .8%), readmission (4.8% vs. 2.9%), serious complications (4.1% vs. 2.5%), and mortality (.3% vs. .07%) were significantly higher with concurrent repair (all P < .001). Multivariable logistic regression analysis identified medium hernia size (3-10 cm) (odds ratio [OR] 1.87), increased age (OR 1.10), history of venous thromboembolism (OR 1.49), and Roux-en-Y gastric bypass (RYGB) (OR 1.72) as independent predictors of serious complications.

Conclusion: This large-scale national analysis demonstrates that concurrent AWH repair during bariatric surgery is uncommon and might be associated with higher short-term morbidity. These findings should be interpreted as descriptive and hypothesis-generating, highlighting patient- and hernia-specific factors that may inform perioperative risk stratification and shared decision-making, particularly in patients with medium-sized hernias (3-10 cm) or those undergoing RYGB.

Background: Food addiction symptoms and binge eating symptoms both include the experience of loss of control eating and emotional dysregulation and are prevalent among adult metabolic and bariatric surgery (MBS) candidates.

Objectives: To examine whether food insecurity elucidates the relationship between food addiction symptoms and binge eating symptoms. We hypothesized an indirect effect through food insecurity on the relationship between food addiction symptoms and binge eating symptoms. We also hypothesized that food insecurity moderates the relationship between food addiction symptoms and binge eating symptoms.

Setting: Academic medical center, United States METHODS: Participants were 866 consecutive adult MBS candidates who completed a battery of self-report questionnaires assessing demographic information, food addiction symptoms, food insecurity, and binge eating symptoms prior to MBS during a routine clinic visit.

Results: In both statistical models, a strong relationship between food addiction symptoms and binge eating symptoms emerged; however, overall food insecurity did not mediate or moderate this relationship. Exploratory analyses indicated that use of food assistance from family or friends moderated the relationship between food addiction symptoms and binge eating symptoms.

Conclusions: Food insecurity may not be relevant in understanding the relationship food addiction symptoms and binge eating symptoms in presurgical bariatric populations. Food addiction symptoms and binge eating symptoms continue to demonstrate a strong relationship; however, the extent to which they have unique differences requires additional examination.

Background: Patients with type 2 diabetes (T2D) and obesity are prone to gastroesophageal reflux disease (GERD) due not only to obesity itself but also to gastroparesis, digestive neuropathy, and antidiabetic treatment. Nissen sleeve gastrectomy (NSG) achieves satisfactory long-term weight loss and significantly reduces GERD incidence. However, its results in this population remain to be compared with those of standard sleeve gastrectomy (SG) given the potential impact of the Nissen wrap on GERD outcomes.

Objectives: To compare the 5-year results of NSG on patients with T2D and obesity in terms of weight loss, T2D remission, and GERD incidence, with those of SG.

Setting: Montpellier University Hospital, France.

Methods: This is a comparative, nonrandomized, single-center cohort study analyzing prospectively collected data from patients who underwent SG or NSG between January 2017 and December 2019.

Results: A total of 105 patients with T2D and obesity underwent either an SG (N = 61) or an NSG (N = 44), with 82 (SG: 44; NSG: 36) completing 5-year follow-up. The groups were comparable for sex, age, and T2D severity. At 5 years, total weight loss was 19.1% versus 19.6% (effect size: -.77, P = .86), mean hemoglobin A1C 6.5% versus 6.3% (effect size: -.43, P = .12), and clinical GERD incidence 57.9% versus 18.8% (effect size: .23 [.07; .73], P = .01) for the SG and NSG groups, respectively.

Conclusions: NSG could be a valuable alternative to SG for patients with T2D and obesity, providing comparable weight loss and diabetes remission at 5 years, with the added benefit of significantly reducing the incidence of GERD.

Background: Heart failure (HF) has been associated with postoperative cardiac events and mortality after bariatric surgery. However, recent data remain scarce.

Objectives: To compare 30-day outcomes after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in patients with versus without HF and to assess HF as a predictor for adverse outcomes after SG and RYGB.

Setting: 2023-2024 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.

Methods: We analyzed patients with HF who underwent SG and RYGB. A 4:1 propensity score matching analysis was performed, matching 24 preoperative characteristics. We compared 30-day postoperative outcomes in patients with and without HF for both SG and RYGB. Then, 7 multivariate logistic regression analyses were conducted to identify independent predictors for postoperative complications after SG and RYGB.

Results: We analyzed 231,243 SG and 96,546 RYGB patients. Outcomes in patients who underwent SG showed that patients with HF had higher rates of mortality, cardiac complications, pulmonary complications, unplanned intensive care unit admissions, readmissions, interventions, nonhome discharge, and postoperative bleeding (P < .05). Outcomes in patients who underwent RYGB had higher rates of mortality, pulmonary complications, renal complications, unplanned intensive care unit admissions, emergency visits, readmissions, and interventions (P < .05). HF was the most significant predictor for 30-day mortality (odds ratio: 4.88; 95% confidence interval: 2.88-8.27; P < .001) following SG and the second most significant predictor (odds ratio: 2.90; 95% confidence interval: 1.37-6.14; P = .005) following RYGB.

Conclusions: Patients with HF have a higher rate of mortality and overall complications compared to patients without HF after either SG or RYGB. HF is the strongest independent predictor for 30-day mortality after SG and the second strongest independent predictor after RYGB. Preoperative cardiac optimization is strongly advised in this population.

Background: Patients who undergo metabolic and bariatric surgery (MBS) are at an increased risk for an alcohol use disorder. Preoperative alcohol use is associated with increased postoperative risk, yet patients under-report their alcohol use during the routine psychosocial evaluation. This results in challenges to accurately identify individuals at risk for postoperative alcohol use disorder.

Objective: This study investigated whether there are clinical characteristics associated with objective measurement of alcohol use to help guide preoperative assessment.

Setting: Single healthcare system.

Methods: Retrospective medical record reviews were conducted on 85 patients who completed a preoperative psychosocial evaluation and phosphatidylethanol (PEth) testing prior to MBS. Patient demographic and clinical characteristics were collected from the preoperative psychosocial evaluation.

Results: Black individuals (37.7%) were more likely to have a positive PEth test compared to White individuals (13.8%, P = .02). Individuals with a positive PEth test had significantly lower depressive symptoms than those with a negative PEth test (P = .03). No other demographic or clinical characteristics were associated with PEth test results.

Conclusions: Few variables were associated with a positive PEth test, and the value of the statistical differences may not be clinically meaningful. As such, it is difficult to use clinical characteristics to assist with identification of individuals with regular alcohol use at the preoperative assessment. There may be benefits to routine use of objective alcohol measurement, such as PEth testing, for patients pursuing MBS to identify individuals who are engaging in regular or heavy alcohol use at the time of the preoperative evaluation.