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

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.

With the prevalence of obesity alarmingly increasing, it is of primary interest to identify those factors predicting the success of anti-obesity therapeutic strategies currently adopted in clinical practice, and in particular, those of bariatric procedures showing the greatest success in terms of weight loss and maintenance in both the short and long term. Given sex-related differences in psychosocial status, hormonal homeostasis, and body fat distribution, it is likely that the response to different weight management strategies differs by sex. The objective was to elucidate the effect of sex on different bariatric procedures' efficacy and safety outcomes. Searches of PubMed, Cochrane, and Embase databases were performed, followed by hand-searching of reference lists from all relevant articles. We included all the studies evaluating the effect of bariatric procedures on body mass index loss (BMIL), and/or percentage excess weight loss (%EWL), and/or percentage excess body mass index loss, and/or percentage of responders, and/or short-/long-term complications and co-morbidity resolution, broken down by sex. Twenty-seven studies with a total of 114,919 patients were included. Men were more likely to achieve greater BMIL, consistent with higher male baseline BMI, and women were 2.87 times more likely to be classified as weight responders (95% confidence interval [CI]: 1.90-4.34), as well as to perform better in terms of %EWL (95% CI: .13-.54). Upon subgroup analysis based on bariatric procedure, women were more likely to be successful in terms of %EWL upon bioenteric intragastric balloon (BIB) placement (.72, 95% CI: .42-1.02). There was no sex difference regarding investigated co-morbidity resolution (hypertension, diabetes, and obstructive sleep apnea syndrome) or occurrence of short-term complications, whereas women were more likely to develop long-term complications, with an odds ratio of 1.97 (95% CI: 1.57-2.49). Sex does not have a clear effect on efficacy outcomes of bariatric procedures. Differentiating by procedure, BIB may be more effective in women, although results are discordant based on the weight loss outcome considered. If the short-term postoperative complication rate is similar across both sexes, long-term complications occur more frequently in women. To clarify the real effect of sex on bariatric procedure-derived health benefits, it is crucial to report sex-stratified results in future studies, as well as evaluate body composition changes that go beyond simple body weight reduction.