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

Since nearly 40% of metabolic and bariatric surgery (MBS) patients are individuals with the ability to bear children, many may seek to become pregnant or may be currently lactating when seeking surgery. While many patients plan to breastfeed, MBS patients are at high risk for premature cessation of breastfeeding. Limited literature exists on the impact of MBS on lactation and there are no established guidelines to help clinicians support and educate MBS patients about breastfeeding. Herein, we aim to fill that gap by providing a comprehensive guide for bariatric surgeons, obstetricians, women's health providers, lactation consultants, registered dietitians, bariatric nurse coordinators, and advanced practice providers to support breastfeeding in patients with a history of MBS or who are considering MBS. We review physician-patient discussion points on how MBS impacts lactation, the micronutrient and caloric needs for this unique population, and data to support successful breastfeeding in post-MBS patients who are lactating regarding practical, anesthetic, and imaging considerations.

Background: Bariatric surgery has been shown to cause a negative impact on oral health, as reflected by postsurgical increase of caries-related dental interventions.

Objectives: The aim of this study was to compare dental intervention rates after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Setting: Nationwide and register-based (Sweden).

Methods: This 2-staged matched cohort study included all adults who underwent RYGB (n = 26,594) or SG (n = 3416) between 2011 and 2015, registered in the Scandinavian Obesity Surgery Register. Propensity score matching was used to match SG patients to RYGB patients, based on several covariates. The follow-up time was 3 years after surgery. The dental variables were collected from the Dental Health Register, including tooth extractions, restorative interventions (dental fillings), and endodontic interventions (root canal treatment).

Results: In total, 3317 RYGB and 3317 SG patients were included. Both groups showed increased dental event rates postoperatively. RYGB patients had significantly higher event rates compared with SG postoperatively regarding all interventions, restorative and endodontic interventions.

Conclusions: The negative effect on dental outcomes in terms of dental fillings and tooth extractions were higher after RYGB than after SG. The reasons are not clear. More research is needed to replicate these findings, to understand the mechanisms, and further delineate the significance of the surgical method.

Background: Patients with body mass index (BMI) ≥50 have more obesity-associated medical problems and often require more aggressive surgical management. Few single-institution comparative studies have been published examining this specific population.

Objectives: The study aims to compare the weight loss and diabetes remission effects of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (BPD/DS).

Setting: Rural academic tertiary care center.

Methods: We conducted a retrospective cohort study using prospectively collected data. All patients with a BMI ≥50 who underwent an SG, RYGB, and BPD/DS were included. Comparative analysis was performed for complications, readmission rates, weight loss, and diabetes remission.

Results: Excess weight loss at 3 years was 40.1% for SG, 54.1% for RYGB, and 67.4% for BPD/DS, with BPD/DS performing significantly better (P < .001). Complete diabetes remission at 5 years was 29% for SG, 61% for RYGB, and 79% for BPD/DS. BPD/DS had significantly longer operative times (P < .001) and rates of minor complications (P = .02).

Conclusions: BPD/DS achieved superior sustained weight loss and diabetes remission compared with RYGB and SG.

Background: Little is known about the associations between changes in hepatic steatosis and changes in abdominal adiposity after metabolic bariatric surgery.

Objectives: To evaluate the serial changes in hepatic steatosis and abdominal adiposity following sleeve gastrectomy (SG).

Setting: University hospital, Taiwan.

Methods: In this prospective study, patients who underwent SG and intraoperative liver biopsy were enrolled. Magnetic resonance imaging (MRI) was performed to assess the liver fat fraction (LFF), visceral adipose tissue (VAT) area, and subcutaneous adipose tissue (SAT) area. Liver fibrosis was assessed preoperatively via biopsy and the fibrosis-4 index (FIB-4) and postoperatively with the FIB-4.

Results: Seventy-six metabolic dysfunction-associated steatotic liver disease (MASLD) patients, including 67 pure MASLD patients and 9 MASLD patients with combined etiologies, were enrolled. LFF and visceral-to-subcutaneous fat ratio were associated with metabolic dysfunction-associated steatohepatitis, and VAT area was associated with significant fibrosis (≥F2). Twelve months after SG, all MRI measurements significantly improved. The median LFF of pure MASLD patients decreased from 17.4% at baseline to 4.2% and 3.7% at the 6th and 12th postoperative months, respectively. Complete resolution of steatosis was achieved in 97.5% of patients at the 12th postoperative months. Using %VAT and %SAT reductions at the sixth postoperative month as references, LFF decreased more rapidly, with fold ratios of 1.3 and 1.8, respectively.

Conclusions: SG resulted in a significant decrease in hepatic steatosis and abdominal adiposity in patients with severe obesity, but hepatic steatosis improved faster than abdominal adiposity. Hepatic steatosis resolved in almost all patients 12 months after SG.

Background: Candy cane (CC) syndrome is a complication that occurs following Roux-en-Y bypass (RYGB), implicated as a long, small-bowel blind limb at gastrojejunostomy possibly caused using circular staplers.

Objectives: We aimed to report our experience with CC resection and improving outcomes following RYGB.

Setting: University hospital.

Methods: We performed a retrospective analysis of patients who underwent CC resection at our institution from 2017 to 2023. Patient's charts were then reviewed to evaluate for symptoms, operative, and weight data. Only patients with an afferent blind limb in the most direct outlet from the gastroesophageal junction (GJ) visualized in upper gastrointestinal (GI) study and endoscopy were included.

Results: Twenty-nine patients had presented with symptoms of and underwent surgery of resection of the CC (83% female; 50.3 ± 12.9 years) within 11 ± 6 years after initial RYGB. In addition, 58.6% underwent a concomitant procedure (10 hiatal hernia repair, 4 revision gastrojejunostomy, and 3 internal hernia reduction and defect closure). The mean length of the CC was 7.5 ± 3.9 cm. Resection of CC was performed in 62.1% as stapling only, 34.5% as stapling and oversewing, and 3.4% as oversewing only. The 30-day hospital readmission rate was 7.4% (n = 2). At 8.5-month follow-up, there was a significant reduction (P < .005) of bloating, nausea or vomiting, and dysphagia; however, abdominal pain and diarrhea slightly decreased. The estimated weight loss percentage was 29.4% ± 5.6%, and body mass index decreased from 32.1 ± 7.3 kg/m² to 29.1 ± 4.7 kg/m².

Conclusions: Resection of blind afferent limb can be managed safely with excellent outcomes and resolution of symptoms, even if major procedures are performed concomitantly. Surgeons should resect excess Roux limb in the initial RYGB to decrease the likelihood of this syndrome.

Patients undergoing metabolic and bariatric surgery (MBS) can improve outcomes through a physically active lifestyle. Despite ongoing research, clinical recommendations for physical activity (PA) are not fully developed. For this review, 39 articles representing 24 randomized clinical trials satisfied inclusion criteria. The PA interventions utilized in these trials, the expertise of the multidisciplinary research team, and the general principles of strength and conditioning were considered in the creation of the following 12 PA recommendations: 1) Begin PA intervention pre-MBS; 2) Unless contraindicated, walk short distances the day of the surgery; 3) Progressively increase movement through activities of daily living during the first month postoperatively; 4) Avoid prolonged sitting and adopt lifestyle routines that decrease sedentary time; 5) Slowly progress to 150-300 minutes of accumulated moderate-intensity cardiovascular exercise/week; 6) In addition to walking, gradually increase structured PA through a variety of activities; 7) Delay water exercise until surgical wounds have healed, around 4 weeks postoperatively; 8) Begin full body resistance training (RT) 4-6 weeks post-MBS on 2 noncontinuous d/wk; 9) Delay high-intensity PA and abdominal exercises for 8-12 weeks; 10) Have periodic assessments of strength and cardiovascular fitness to evaluate progress; 11) Continue long-term monitoring with exercise professionals in the context of health; and 12) Consult with a registered dietitian to optimize nutrition alongside changes in PA.