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

Background: Metabolic bariatric surgery (MBS) remains the optimal treatment for patients with severe obesity. However, concern is growing about the risk of suicide after MBS.

Objectives: To compare the risk of suicide in adult patients with obesity, treated with or without MBS.

Setting: University-affiliated hospital, China.

Methods: PubMed and Embase were searched through April 30, 2024. Eligible studies were matched cohort studies and population-based studies (PROSPERO ID: CRD42024561042). Effects were pooled using a random-effects model. Subgroup analysis was performed based on study type.

Results: A total of 3 matched cohort studies (4 matched cohorts) and 2 population-based studies, involving 114,615 adult patients with obesity treated with MBS (272 suicides) and 552,642 nonsurgery counterparts (622 suicides), met the selection criteria. Patients treated with MBS had a pooled hazard ratio (HR) of suicide of 2.12 (95% confidence interval [CI] 1.54-2.92, P < .01, I² = 24%) and a pooled risk ratio (RR) of suicide of 2.32 (95% CI 1.55-3.45, P < .01, I² = 58%) compared with those treated without MBS. In the subgroup analysis, relatively higher pooled HR (2.64 [1.84-3.77] versus 1.67 [1.32-2.12]) and RR (2.98 [2.02-4.41] versus 1.48 [.80-2.75]) were observed in the subgroup of matched cohort studies compared with the subgroup of population-based studies.

Conclusions: Adult patients treated with MBS are at more than double the risk of suicide than those treated without MBS in terms of both HR and RR. However, the absolute risk was low and did not warrant a general discouragement of MBS.

Bariatric surgeries are related to reduced food tolerance (FT), which may impact on nutritional status and weight loss treatment. The present study was conducted to compare the effects of gastric banding (GB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) on FT. A literature search was performed using Scopus, PubMed, Web of Science, and Google Scholar to find relevant studies published up to August 2023. The primary outcome was the postoperative overall FT score assessed by the Quality of Alimentation questionnaire. Overall, 27 studies containing 4366 adults were included in the review: 15 cohort studies, 5 interventional studies, and 7 cross-sectional studies. The quality of articles ranged between low and high. Thirteen studies evaluated the effect of SG on FT; however, 4 studies reported FT following RYGB. The postsurgery FT of GB patients was examined in 1 study. The mixture of bariatric techniques was evaluated in 9 papers. Selected studies assessed FT from 1 month to 5 years following obesity surgery. Taken together, GB patients showed the lowest level of FT. Although SG and RYGB patients had no difference in FT, RYGB ones had better tolerance to protein-rich foods such as red meat, white meat, and fish. Both SG and RYGB individuals tolerated vegetables and fish more than other food groups and could least tolerate red meat and grains. After the first postoperative year, a good level of FT was found among SG and RYGB patients.

Background: Marginal ulcers (MU) are a significant postoperative complication following anastomotic metabolic and bariatric surgeries including Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and biliopancreatic diversion with duodenal switch (BPD/DS). This review summarizes current knowledge on MU risk factors, screening, and prophylactic strategies.

Objectives: The goal of this review is to examine technical and patient-related risk factors for MU, assess screening strategies, and recommend prophylactic approaches to reduce MU incidence after anastomotic metabolic and bariatric surgery (MBS).

Setting: A comprehensive review was conducted by members of the American Society for Metabolic and Bariatric Surgery (ASMBS) Clinical Issues Committee, based on available literature from 2000 to the present.

Methods: A systematic search was performed using Ovid MEDLINE and PubMed databases. Relevant studies were screened for inclusion. Technical and patient-related factors were evaluated, and recommendations for MU prevention were formulated.

Results: Several risk factors for MU were identified, including large gastric pouch size, circular stapled anastomoses, use of nonabsorbable sutures, smoking, nonsteroidal anti-inflammatory drugs use, and immunosuppression. While prophylactic proton pump inhibitor (PPI) therapy is widely recommended, its optimal duration remains debated. The role of Helicobacter pylori in MU development is not clearly defined.

Conclusions: Prophylactic PPI therapy for at least 3 months postsurgery significantly reduces the risk of MU. Risk stratification and individualized treatment plans are essential to minimize postoperative complications. Further research is needed to clarify the role of H. pylori and optimize prophylactic strategies.

Background: Whether preoperative exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) remains unclear.

Objectives: To investigate the association between preoperative GLP-1RAs exposure and PONV after LSG.

Setting: University Hospital, China.

Methods: We reviewed a retrospective cohort of patients underwent LSG between January 1, 2017, and December 30, 2021 at Nanjing Drum Tower Hospital, dividing the patients into 2 groups on the basis of whether they were exposed to GLP-1RAs preoperatively. A 1:1 propensity score matching was performed to balance the characteristics between the groups. Associations between GLP-1RAs exposure and PONV were determined by logistic regressions.

Results: A total of 564 eligible patients underwent LSG, 351 (62.2%, 95% CI 58.2-66.1) of whom had PONV. In total cohort, PONV occurred in 72(84.7%) patients exposed to GLP-1RAs preoperatively and 279 (58.2%) patients not exposed to GLP-1RAs (adjusted odds ratio 6.782, 95% confidence interval 3.307-13.907, P < .001). In the 158 matched patients, PONV occurred in 66 (83.5%) patients exposed to GLP-1RAs preoperatively and 48 (60.8%) matched patients not exposed to GLP-1RAs (adjusted odds ratio 3.830, 95% confidence interval 1.461-10.036, P = .006). Subgroup analysis by dosage forms and doses revealed a positive association between greater doses and an increased risk of PONV after LSG for both once-daily and once-weekly formulations.

Conclusions: Preoperative exposure to GLP-1RAs is associated with an increased risk of PONV in patients undergoing LSG, particularly at higher doses of exposure.

Marginal ulcers (MUs) encompass a group of mucosal disruptions and subsequent inflammatory changes and their sequala found after Roux-en-Y gastric bypass (RYGB) oneanastomosis gastric bypass (OAGB), and, less commonly, after biliopancreatic diversion with duodenal switch (BPD/DS) or single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S). Prevalence of MU after RYGB ranges from .6%-16%. This review summarizes the current knowledge about the treatment options available for MU after MBS for providers who treat them.

Background: Besides its benefits for weight loss, current findings suggest that bariatric surgery can induce remission of hypertension. Limited data report the effect of bariatric surgery on this obesity-associated comorbidity.

Objective: Compare the short-term, mid-term, and long-term remission of hypertension after sleeve gastrectomy versus Roux-en-Y gastric bypass.

Setting: Meta-analysis of randomized controlled trials (RCTs).

Methods: Four databases (Embase, PubMed, Scopus, and Science Direct) were searched for RCTs that compared the effects of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) on hypertension remission at <1 year, 2-4 years, and ≥5 years. Patients with a history of hypertension and who had primary bariatric surgery were included.

Results: After reviewing 11,814 studies, only 11 RCTs were included. In total, the analysis included 2323 patients, with 1158 in the SG group (49.85%) and 1165 in the RYGB group (50.15%). It was found that SG and RYGB procedures had comparable hypertension remission at ≤1 year (Relative risk: 1.11, 95% CI .83-1.48, P = .49), and between 2 and 4 years (Relative risk: 1.11, 95% CI .90-1.37, P = .34). However, there was a significant difference in hypertension remission at ≥ 5 years, favoring RYGB (relative risk: 1.39, 95% CI 1.06-1.82, P = .02).

Conclusion: This systematic review and meta-analysis of RCTs demonstrates that RYGB is superior to SG in resolving hypertension beyond 5 years postoperatively. These findings highlight the long-term benefits of RYGB over SG in managing hypertension, providing valuable insights for surgical decision-making and patient counseling.

Background: Psychiatric diagnoses are common among adults with severe obesity (body mass index [BMI] ≥40 kg/m²) and may be associated with hypertension.

Objectives: To determine the association between lifetime and current psychiatric diagnoses, separately, with hypertension, uncontrolled blood pressure (BP), and systolic BP (SBP) among adults with severe obesity undergoing metabolic and bariatric surgery (MBS).

Setting: Academic medical center.

Methods: Outcomes were identified from electronic medical records. Psychiatric diagnoses were assessed by clinical interview and included any bipolar and related disorder or depressive disorders, anxiety, alcohol use disorder, substance use disorder, post-traumatic stress disorder, and eating disorders. Adjusted odds ratios for the association between psychiatric diagnoses and hypertension and uncontrolled BP, separately, were calculated using logistic regression. Linear regression was used to determine the association of psychiatric diagnoses with SBP. Models were adjusted for age, sex, race, and BMI.

Results: There were 281 participants with mean age of 40.5 years (standard deviation = 10.9) and BMI of 45.9 kg/m² (standard deviation = 6.2). Participants were predominantly women (86.5%) and Black (57.2%). Overall, 44.8% had hypertension and 32.5% of these individuals had uncontrolled BP. The adjusted odds ratios for hypertension was higher (2.95; 95% confidence interval 1.48-5.87) and SBP was greater (3.50 mm Hg; P = .048) among participants with a lifetime diagnosis of anxiety compared with those without. Participants with any current psychiatric diagnosis had a higher SBP compared to those who did not have a current psychiatric diagnosis (3.62 mm Hg; P = .029).

Conclusions: A diagnosis of anxiety during the lifetime of patients undergoing MBS was associated with almost three times increased odds of hypertension.