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

Background: Antio-besity medications (OMs) are increasingly used in youth before and after metabolic and bariatric surgery (MBS), but their impact on surgical outcomes remains unclear.

Objectives: This study examined whether perioperative OM exposure affects early postoperative body mass index (BMI) reduction in youth undergoing sleeve gastrectomy (SG), and whether presurgery OM response influences outcomes.

Setting: Pediatric MBS program at a free-standing, tertiary care, safety-net children's hospital.

Methods: A retrospective review was conducted of youth (age 7-21) who underwent SG from November 2023 to March 2025. Youth were stratified based on perioperative OM use, defined as OM use for at least 3 months prior to surgery (n = 74). Among these 74 youth, 47 (64%) resumed OM use within 6 months postoperatively. This group was compared to youth with no OM exposure either before or after SG (n = 20). Primary outcomes were percent change in BMI (%BMI), percent excess BMI loss (% EBMIL), and percent total weight loss (% TWL) at 1-, 2-, and 3-months postsurgery. Secondary outcomes included 90-day postoperative safety and eating behavior changes. A secondary analysis compared "high responders" to OM (>5% BMI loss pre-SG, n = 23) versus "low responders" (≤5%, n = 51). Mixed-effects models adjusted for BMI at consult, age, and time between medical weight management and surgery date.

Results: Among 94 youth (mean age 16.5 ± 2.3 years; BMI 50.1 ± 9.7 kg/m²; 57% female; 80% Hispanic; 77% publicly insured), OM users had more comorbidities (type 2 diabetes [T2D] 20% versus 0%) and longer presurgical care (P < .05). Median OM duration was 10.2 mo (IQR 6.0-22.0); semaglutide was most common (51/74). Adjusted analyses demonstrated no significant effect of perioperative OM use on postoperative outcomes at 1-, 2-, 3-months. Compared to youth with no OM exposure (n = 20), there were no significant differences in %BMI, %TWL, or %EBMIL at 3 months. Specifically, the between-group differences at 3 months were as follows: %BMI change: -.4 (95% CI: -2.9, 2.2; P = .8), %TWL: -.1 (95% CI: -2.6, 2.5; P = .9), and %EBMIL: +1.4 (95% CI: -.8, 3.5; P = .2). High responders to preoperative OM (n = 23) had greater postoperative weight loss than low responders (n = 51): at 3 months, %BMI change was -19.3% [95% CI: -21.1, -17.6] versus -15.5% [95% CI: -16.7, -14.3]; P < .001. Safety outcomes were similar across groups.

Conclusions: Perioperative OM use alone did not predict short-term weight loss after SG, but high OM responders before surgery had greater benefit. Further research is needed to optimize OM-MBS integration in youth.

Background: The incidence of bariatric surgery in younger adults, and subsequently conversional surgery, is increasing.

Objectives: We aim to describe patients ≤40 requiring conversion, operative details, and complications associated with different procedures.

Setting: MBSAQIP centers (United States and Canada).

Methods: We included patients ≤40 years from 2020 to 2022 undergoing a conversion procedure to sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI-S), or biliopancreatic diversion-duodenal switch (BPD/DS). Baseline characteristics and bivariate complication rates were compared. Multivariate models were generated for 30-day complication for all patients undergoing conversion surgery from index adjustable gastric banding (AGB) or SG.

Results: Of 13,486 patients, 842 were converted to SG, 9812 to RYGB, 549 to SADI-S, and 2283 to BPD/DS. The most common reason for conversion to RYGB was gastroesophageal reflux disease (GERD) (48.7%) and to SADI-S and BPD/DS was insufficient weight loss/regain (89.6% and 88.1%, respectively). On multivariate analysis, conversion to RYGB (adjusted odds ratio [aOR] 2.14) and BPD/DS (aOR 2.30) were associated with increased risk compared to SG. After controlling for initial operation, conversion of AGB to RYGB had a higher likelihood of having 30-day serious complication compared to SG (aOR 2.18). For patients with an index SG, conversion to BPD/DS carried similar likelihood of 30-day complication to RYGB (aOR .78, P = .302), while conversion to SADI-S carried lower likelihood (aOR .47, P = .031).

Conclusion: Each conversion surgery is associated with differing rates of complications, and conversion from index AGB to SG versus RYGB and from index SG to SADI-S versus RYGB or BPD/DS may be associated with fewer complications.

Background: Same-day discharge (SDD) in sleeve gastrectomy (SG) is becoming increasingly common but requires careful patient selection.

Objectives: To evaluate the risk profile of patients undergoing primary SG with SDD and assess 30-day serious adverse events (SAEs) in SDD and next-day discharge (NDD).

Setting: MBSAQIP 2020-2023 (United States).

Methods: SDD and NDD patients were categorized as low-risk (LR) [age<65 years, body mass index [BMI] <50 kg/m², and no history of foregut surgery, diabetes, sleep apnea, cardiovascular disease, kidney disease, immunosuppression or thromboembolic events], and high-risk (HR) [patients with at least one of these conditions]. Logistic regression models assessed odds of SAE (i.e., Comprehensive Complication Index ≥26.2) between SDD and NDD based on risk categories and cumulative number of risk factors (RFs).

Results: Forty thousand three hundred eighty-seven SDDs (50.4% LR, 49.6% HR) and 281,718 NDD (41.2% LR, 58.8% HR) were identified. The odds of HR patients experiencing SAE were higher in the SDD versus NDD (odds ratio [OR]: 1.26, confidence interval [CI]: 1.09-1.45, P < .001). Among high-risk SDD, 66.9% patients had one RF, 25.7% had two and 7.4% had ≥ 3. Compared to patients with a single RF, those with 2 RFs and ≥3RFs were more likely to experience SAEs (OR = 1.40 and 2.10, respectively; P < .01).

Conclusions: This study demonstrates that 50% of the SDD SG patients were considered high-risk and 32% had multiple RFs. Performing SG with SDD in high-risk patients is associated with a greater likelihood of SAE. Results warrant implementation of risk stratification models to ensure patient safety while maximizing the benefits of SDD.

Background: Health care access is influenced by geographic, socioeconomic, and systemic factors. For patients undergoing metabolic and bariatric surgery (MBS), travel distance may reflect disparities in service availability, insurance limitations, and referral patterns to specialized centers.

Objective: To test for an association between travel distance and 30-day postoperative outcomes, focusing on potential geographic biases to determine if patients who travel further face greater postoperative complications.

Setting: Three Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project centers (2020-2023).

Methods: Retrospective data from 1461 patients were analyzed. Travel distance from operative hospital was calculated using geocoding Area Deprivation Index (API) and Spearman's rank correlation assessed its relationship with outcomes including prolonged length of stay (LOS), infectious and serious complications, major adverse cardiac events (MACE), mortality, emergency department (ED) visits, and 30-day readmissions and reoperations.

Results: No significant correlations were identified between travel distance and prolonged LOS > 5 days (P = .578), infectious complications (P = .703), serious complications (P = .190), MACE events (P = .159), or mortality (P = .073). Similarly, there was no significant association with the number of 30-day readmissions (P = .635) or reoperations (P = .094). However, a significant negative correlation between travel distance and emergency department visits (P < .0001) was observed.

Conclusion: While travel distance does not significantly impact postoperative complications or mortality, it may create logistical barriers that complicate follow-up care. Further research is needed to understand how travel-related challenges influence the management of postoperative complications.

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) demonstrates a high safety profile and consistent weight loss efficiency, increasingly used as a revisional procedure. However, while mid- and long-term outcomes for primary SADI-S are established, evidence on its effectiveness as a revisional technique remains limited. This study aims to address that gap by assessing the efficacy and safety of revisional SADI-S after failed primary adjustable gastric banding (AGB) or sleeve gastrectomy (SG) procedures. A systematic search was conducted in PubMed, Embase, Web of Science, and Scopus to identify articles on the efficacy and safety of SADI-S as a revisional surgery after failed primary AGB or SG. A meta-analysis was conducted, coupled with subgroup analyses on comparing revisional SADI-S, Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), and duodenal switch (DS). Eighteen articles with 1641 revisional cases were included in the current study. BMI change after SADI-S was 11.01 (1.51), 9.57 (1.75), and 11.04 (.86) kg/m2 after 12, 36, and 60 months, respectively. Furthermore, total weight loss (TWL) after SADI-S was 23.78% (2.50), 21.03% (4.95), and 22.11% (8.69) after 12, 36, and 60 months, respectively. SADI-S was associated with 69%, 41%, 47%, and 69% rates of diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea remission, respectively. Leak (2.9%), gastroesophageal reflux disease (GERD) (5.1%), anemia (5.7%), diarrhea (8.7%), nutritional deficiency (4.2%), and steatorrhea (11.2%) were the most common reported complications after revisional SADI-S. In subgroup analysis, revisional SADI-S, OAGB, and RYGB had comparable weight loss, obesity related comorbidity resolution, and complications, except for a higher rate of stenosis/obstruction in RYGB and bile reflux in OAGB. Revisional SADI-S is a safe and effective option for patients with failed primary AGB or SG.

Background: Prior research has shown higher rates of complications across a broad spectrum of surgeries in pediatric patients with higher Social Vulnerability Index (SVI).

Objective: This study aims to compare how SVI impacts outcomes in adolescents undergoing metabolic and bariatric surgery (MBS).

Setting: Academic Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-adolescent accredited care center METHODS: We performed a retrospective cohort study of 126 adolescents and young adults undergoing laparoscopic sleeve gastrectomy between September 2014 and April 2021. Comparative analysis was performed for demographics, percent total body weight loss (%TBWL), and complications between those with high (≥ .75) and low (<.75) SVI.

Results: There were 47 patients in the high SVI group and 79 in the low SVI group. Age at surgery, gender, primary language, and insurance type were similar between groups. Preoperative weight and body mass index (BMI) were higher in the high SVI group compared to the low SVI group (145 kg vs 136 kg, P = .033, BMI 52 vs 46, P < .001). Average distance to the hospital was similar (82 miles in high SVI group vs 100 miles in low SVI group, P = .079). The high SVI group had a trend towards a higher percentage of patients who identified as Hispanic/Latino (64% vs 47%, P = .064) and less patients who identified as white (28% vs 51%, P = .054). There was no significant difference in mean %TBWL at 3 months, 6 months, or 12 months (23% in high SVI group (N = 40) compared to 22% in low SVI group (N = 66), P = .4). Complication rates were low in both groups, with no difference between SVI groups (6.5% vs 5.1%, P = .707). While the number of patients with long-term data decreased over time, there was no difference in %TBWL at 2, 3, or 4 years after surgery.

Conclusions: Despite a diverse patient population and significant geographic barriers, the outcomes between high and low SVI in this cohort were comparable. Continued efforts need to be made to expand access to MBS for socioeconomic disadvantaged adolescent patients with obesity.

Background: While new medications are transforming the management of obesity, their association with outcomes in adolescents undergoing metabolic and bariatric surgery (MBS) is not clear.

Objectives: The objective was to determine how preoperative prescription of antiobesity medications (AOMs) is associated with postoperative weight loss after MBS.

Setting: The study was conducted using data from 3 academic children's hospitals, spanning the period from March 2013 to September 2024.

Methods: This is a retrospective review in which demographics, obesity-related diseases, preoperative and postoperative weight and body mass index (BMI) were compared between patients who were treated preoperatively with topiramate or glucagon-like peptide-1 receptor agonists (GLP-1RAs) and those who were not. Statistical analyses included Wilcoxon rank-sum, Pearson's χ², and Fisher's exact tests, plus 1:1 propensity score matching and multivariable linear regression sensitivity models adjusting for time-to-surgery.

Results: Of 324 patients, 22 were treated with topiramate and 30 with a GLP-1RA. Rates of obesity-related diseases were similar. Patients on GLP-1RA lost weight from first consultation to surgery (-2% BMI), while those on no medication gained (+1% BMI) and those on topiramate remained stable (0%, P = .023). There was no difference in weight/BMI at the time of surgery; however, patients pretreated with medications lost less weight than those not taking medications at 6 months (no medications: -20% BMI reduction; GLP-1RA: -18%; topiramate: -17%, P = .017) and 12 months (no medications -23% BMI reduction, GLP-1RA -15%, topiramate -17%, P = .015). From initial consultation to 12 months after surgery, the differences in weight loss between groups were not significant (P = .072).

Conclusion: Preoperative exposure to topiramate or GLP-1RA was associated with less postoperative weight loss, despite similar starting weights/BMIs. Total weight loss from consultation through 12 months did not differ significantly between groups. These findings raise important questions regarding the use and timing of obesity management medications in relation to surgery for adolescents.

Metabolic and Bariatric surgery (MBS) has become an essential treatment for severe obesity and associated comorbidities, particularly type 2 diabetes mellitus (T2DM), with substantial benefits in weight loss, improved glycemic control, and cardiovascular risk reduction. The International Diabetes Federation (IDF) recognizes MBS as an effective option for individuals with obesity with T2DM due to its ability to improve insulin sensitivity and lower inflammation. These surgeries induce metabolic improvements through distinct mechanisms that affect gut hormone secretion, nutrient absorption, and energy balance. These interventions modulate key gut hormones like glucagon-like peptide-1 (GLP-1), ghrelin, and leptin, which influence appetite, glucose metabolism, and fat storage. Moreover, MBS alters the gut microbiome, contributing to enhanced metabolic function and the resolution of obesity-related conditions. Theories such as the Foregut-Hindgut Hypothesis, Ileal Brake Mechanism, and Gastric Center Hypothesis further try explain these metabolic changes. Understanding these theories and the physiological alterations they provoke is crucial for optimizing patient care and advancing the future of obesity treatments, offering insights into mechanisms that go beyond simple weight loss to address complex metabolic disorders.

Background: Resleeve gastrectomy (ReSG) is a surgical option for patients experiencing insufficient weight loss or weight regain after primary sleeve gastrectomy (P-SG). However, national-level data on the comparative perioperative safety of ReSG versus P-SG remain limited.

Objectives: To evaluate 30-day perioperative outcomes between ReSG and P-SG.

Setting: Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database across accredited bariatric surgical centers.

Methods: An analysis of the 2020-2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was conducted to evaluate 30-day outcomes following ReSG. Univariate analysis and multivariable logistic regression identified independent predictors of serious postoperative complications.

Results: Among 496,405 patients, 493,187 underwent P-SG and 3218 underwent ReSG. ReSG patients were older, more likely female, and had a higher prevalence of gastroesophageal reflux disease but lower body mass index and comorbidity burden. ReSG was associated with significantly higher rates of serious complications (5.13% versus 2.03%, P < .0001), including anastomotic leak, deep surgical site infection, and the need for reintervention. Multivariable analysis identified ReSG as the strongest independent predictor of serious complications (odds ratio: 2.26), followed by anticoagulant use, history of venous thromboembolism, insulin-dependent diabetes, hypertension, gastroesophageal reflux disease, and Black race. Mortality was low and comparable between groups (P = .360).

Conclusions: ReSG is associated with significantly higher rates of serious perioperative complications compared to P-SG despite similar short-term mortality. These findings underscore the importance of revisional strategy selection and alternative procedures may offer superior safety, more durable weight loss, and improved metabolic outcomes for revision after sleeve gastrectomy.