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

Background: In patients with osteoarthritis, bariatric surgery is associated with diminished joint pain and improved functionality.

Objectives: To evaluate the relationship between the risk of total joint replacement (TJR) and the fact of having undergone bariatric surgery (yes or no) in people living with obesity.

Settings: Data from the French National Hospitals Database.

Methods: This case-control study was conducted to identify hospitalizations for TJR. The main exposure of interest was having undergone (or not) a bariatric surgery procedure between January 2017 and December 2021. After a 6-month run-in phase, data on hospitalizations for the first TJR (i.e., hip or knee) from July 2017 to December 2023 were classified by obesity class and surgical type.

Results: One hundred sixty thousand seven hundred seventy-three patients who had undergone bariatric surgery (mean age: 40.8 years, 79.5% females) and 160,773 matched controls were identified. The most frequent surgical technique was sleeve gastrectomy (72.2%), followed by gastric bypass (27.8%). The average follow-up was 4.7 years. An increase in the overall risk of TJR, with a hazard ratio (HR) of 1.09 (95% confidence interval [CI], 1.03-1.15), was observed. Depending on obesity class, patients with body mass index (BMI) < 40 kg/m² had a lower risk of TJR (HR: 5.85; 95% CI: .78-.93), whereas a higher risk was observed in patients with BMI ≥40 kg/m² (HR: 5 1.25; 95% CI: 1.16-1.34).

Conclusions: In France, hospitalizations for TJR following bariatric surgery were associated with an increase of 25% in patients with BMI ≥ 40 kg/m², whereas it was associated with a decrease of 15% in patients with BMI < 40 kg/m².

Background: Routine preoperative esophagogastroduodenoscopy (EGD) for patients undergoing bariatric surgery remains controversial. However, anatomopathologic findings during endoscopy can influence the choice of bariatric procedure. Gastric intestinal metaplasia (GIM) is increasingly recognized as a potential risk factor for gastric adenocarcinoma, with a prevalence of 2.7% in patients seeking bariatric surgery.

Objective: To establish the prevalence of GIM among patients undergoing bariatric surgery in our population and determine the impact of routine EGD on surgical management.

Setting: Canadian academic hospital.

Methods: We retrospectively reviewed the charts of 314 consecutive patients who underwent routine EGD with antral/corpus biopsies by a single endoscopist at our institution between March 2021 and November 2022. Data were collected on patient demographic characteristics and EGD and pathology reports.

Results: The population consisted of 234 (74.5%) female patients and 80 (25.5%) male patients with average age of 43.6 years and body mass index of 46.5 kg/m². GIM was present in 8.6% of endoscopies, high-risk GIM in 2.9%, and Helicobacter pylori in 16.6%. Esophagitis and Barrett esophagus (BE) were present in 19.4% and 1.6% of patients, respectively. Regression analysis independently associated previous H pylori infection, antral erosive gastritis, BE, and mucosal atrophy with GIM. Preoperative EGD altered surgical management for 14.3% of patients. Reasons for alteration included hiatal anatomy (9.6%), GIM (2.2%), BE (.6%), gastric and esophageal varices (.6%), achalasia (.3%), and gastric adenocarcinoma (.3%).

Conclusion: We demonstrated greater GIM and high-risk GIM prevalence than previously published in the literature. GIM is the second most frequent finding altering surgical decision making in our bariatric population.

Background: A small proportion of patients undergoing malabsorptive or maldigestive bariatric interventions experience excessive weight loss and/or side effects. Some patients with recurrent comorbidities or severe metabolic derangements require a reversal to normal anatomy or physiology.

Objectives: To analyze indications, surgical techniques, and outcomes of reversal after malabsorptive or maldigestive surgery.

Setting: Academic institution, United States.

Methods: Single-center retrospective analysis and systematic literature review of reversal after malabsorptive and maldigestive bariatric surgery.

Results: From January 2005 until November 2022, 19 patients underwent a reversal of malabsorptive or maldigestive surgery to normal anatomy (15 Roux-en-Y gastric bypass, 4 jejunoileal bypass). The median age was 52 years (21; 74), and 80% of patients were female. Median body mass index (BMI) was 23 kg/m2 (17; 38) before reversal and 28 kg/m2 (17; 39) after reversal. Indication for reversal was often multifactorial but the most common indications were malnutrition (53%) with intractable diarrhea (42%) or hypoglycemia/dumping syndrome (37%). The most common reversal technique was a single anastomosis gastric bypass reversal (SARR procedure). Postoperative morbidity was 53%, with one major complication requiring reoperation (5%). With the exception of 4 patients who were lost during follow-up, all patients had improvement/resolution of symptoms. Weight regain occurred in three patients (16%), and one patient required further weight loss intervention (sleeve gastrectomy [SG]). Median follow-up time was 6 months (1; 206).

Conclusion: Reversal of a malabsorptive or maldigestive procedure due to metabolic complications is an effective and safe treatment modality. Because of the surgical complexity and its related postoperative morbidity, careful patient selection is essential to ensure a favorable postoperative outcome.

Background: The effect of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on postoperative esophageal motility and its clinical significance is poorly understood.

Objectives: To investigate the effect of SG and RYGB on esophageal motility and distal esophageal acid exposure time at least 5 years after surgery.

Setting: Prospective clinical study conducted in 2 academic hospitals in Switzerland.

Methods: Patients who underwent SG and RYGB were invited at least 5 years after surgery to undergo upper endoscopy, high-resolution manometry (HRM) and wireless pH measurement. Primary outcome was presence of esophageal motility disorders. Exploratory outcomes included presence of esophagitis, Barrett's esophagus, esophageal acid exposure, and validated symptom questionnaires.

Results: A total of 113 patients (49 SG and 64 RYGB) underwent HRM and pH monitoring 7 ± 1.6 years after bariatric-metabolic surgery. Integrated-relaxation-pressure was 4.3 ± 3.9 mm Hg after SG and 4.2 ± 3.8 mm Hg after RYGB (P = .89). Average distal contractile integral was 2931 ± 2102 mm Hg-cm-s after SG and 3530 ± 3454 mm Hg-cm-s after RYGB (P = .29). After 100-mL rapid drinking challenge, a hypercontractile or spastic contraction was seen in 37.5% after RYGB and 16.3% after SG (P = .01). Mean esophageal acid exposure time was 11.4 ± 7.9% after SG and 1.3 ± 2.1 after RYGB (P < .0001). Esophagitis was present in 67.3% after SG and 28.1% after RYGB (P < .0001).

Conclusions: Esophageal motility is similar for patients after SG and RYGB and clinically significant motility disorders of the esophagus are rare at long term follow-up. SG leads to significantly more reflux esophagitis, acid reflux and symptoms than RYGB and therefore, endoscopic surveillance should be considered.

Background: Although bariatric surgery (BaS) is an important treatment option to treat obesity in general, the safety and efficacy of BaS in patients with advanced heart failure (HF) are not well known.

Objectives: To describe the trajectory of patients with advanced HF who underwent BaS and cardiac replacement therapy.

Setting: Single-tertiary academic hospital.

Methods: We conducted a retrospective study of patients with advanced HF with obesity (body mass index [BMI] >35 kg/m²) between January 2010 and August 2022. Among them, 15 patients underwent BaS, and their clinical trajectories were compared with 62 patients with advanced HF who received orthotopic heart transplant (OHT) or durable mechanical circulatory support without BaS (non-BaS group) during the same period. Key outcomes included BMI reduction, OHT eligibility, and post-OHT survival.

Results: Among 15 patients who underwent BaS, 12 underwent sleeve gastrectomy and 3 underwent gastric bypass surgery. After a median duration of 11 (6-14) months from BaS, the mean value of BMI was significantly reduced (39.8 [39.0-42.2] kg/m² versus 31.6 [27.7-35.3] kg/m², P < .001) with no BaS related mortality. In subgroup of OHT patients, post-OHT survival was comparable between the 2 groups.

Conclusions: BaS is a safe and effective intervention for BMI reduction in patients with advanced HF. BaS may enhance OHT eligibility without compromising posttransplantation outcomes.

Background: The Middle Eastern and North African (MENA) population of the United States consists of 3.8 million citizens. This study compares health care outcomes for MENA patients undergoing metabolic and bariatric surgery (MBS) in Michigan to those of non-MENA patients statewide.

Objectives: To compare outcomes of MBS between MENA and non-MENA patients in Michigan and identify disparities in surgery rates.

Setting: Michigan Bariatric Surgery Collaborative (MBSC), Ann Arbor, MI.

Methods: This retrospective cohort study used data from the MBSC database from 2017 to 2024. The cohort consisted of self-identified MENA patients (n = 799), approximately 1.5% of the MBSC total patient cohort. Data collected included demographic information, co-morbidities, type of bariatric procedure performed, adverse events at 30 days and at 1-year postoperative, including weight loss and changes in co-morbid status.

Results: Compared to non-MENA patients, MENA patients were more likely to be males (25.8% vs. 18.5%; P < .0001), present at younger ages (age < 30 years: 21.8% vs. 11.0%, P < .0001), have lower initial body mass index (BMI) (45.1 vs 47.4, P < .001), be active smokers (12.6% vs 8.5%; P < .0001), and undergo sleeve gastrectomy (84.7% vs 80.1%; P = .0011). There were no differences in 30-day complications (5.9% vs. 5.7%, P = .5056), although MENA patients had lower rates of emergency department visits (6.3% vs 7.1%, P = .0139) and healthcare utilization (8.6% vs 10.0%, P = .0117). Overall, there were no differences in weight loss outcomes or rates of comorbidity improvement at 1 year following MBS among MENA patients undergoing gastric bypass specifically, the percent total weight loss at 1 year was lower than non-MENA patients (30.2% vs 33.4%, P = .0168).

Conclusion: MENA individuals tend to pursue MBS at a younger age and with a lower BMI. Bariatric surgery appears equally safe and similarly effective in this patient population.