Comparison of Mid- and Long-term Outcomes of Antrum-Resecting Versus Antrum-Preserving Laparoscopic Sleeve Gastrectomy.

Background: Contemporary data characterizing the utilization of metabolic and bariatric surgery (MBS) by type 2 diabetes mellitus (T2DM) status are limited. Methods: In this study, we analyzed data from patients 18-88 years of age eligible for MBS seen in the OneFlorida (https://onefloridaconsortium.org/) between 1/1/ 2012 to 12/31/2018. MBS eligibility was defined by any of the following criteria: (1) an encounter with a body mass index (BMI) ≥ 40 kg/m2; or (2) BMI ≥ 35 kg/m2 with at least one obesity-related comorbidity, including T2DM, hypertension, or hyperlipidemia. We compared patients’ characteristics stratified by T2DM status and whether they underwent common bariatric procedures including Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB). We performed multivariable logistic regression to identify factors independently associated with receipt of MBS among diabetic patients. Results: Among 190,606 patients with T2DM, 4103 (2.2%) of them underwent BS. Patients with diabetes were more likely to receive RYGB than those without T2DM (47.6% vs. 37.7%). We also observed that patients without diabetes aged between 18-44 years had a higher rate of MBS utilization than patients in that age range with diabetes (58.7% vs. 37.4%). The logistic regression results showed that female, higher pre-surgical BMI, had pre-surgical hypertension were strong indicators associated with bariatric treatment among patients with diabetes. Conclusion: In this study, we observed that patients with obesity and T2DM still had relatively low rates of MBS. The observed differences in rates of MBS among different demographic subgroups could inform interventions that target reductions in these disparities. Disclosure G. Chen: None. W. T. Donahoo: None. M. Cardel: Consultant; Spouse/Partner; Weight Watchers International, Inc. A. Holgerson: None. A. L. Ayzengart: None. M. J. Gurka: None.

ABSTRACTIntroductionObesity is a chronic and relapsing disease and metabolic and bariatric surgery (MBS) provides the greatest weight loss efficacy to improve obesity related complications. However, weight recurrence and suboptimal weight loss occur in some patients leading to a recurrence of disease. Obesity management medications (OMM) to prevent and manage excess weight after MBS are now being recommended. The aim of the study was to determine the efficacy of OMM prescribed for recurrent weight gain (RWG) or suboptimal weight loss (SWL) after primary and conversional bariatric metabolic surgery.MethodsPatients were prescribed either a fixed‐dose extended‐release combination of naltrexone and bupropion (NB‐ER; 8 mg/90 mg), liraglutide (3.0 mg), or semaglutide (1.0 mg) for RWG and/or SWL following adjustable gastric banding (LAGB), sleeve gastrectomy (LSG), one anastomosis gastric bypass (OAGB), or conversional procedures. Data were reported as categorical values using either parametric or nonparametric statistics.ResultsFor the 121 patients analyzed, baseline characteristics were similar at initiation of OMM. Among these patients, 59.7% underwent LSG, 11.8% underwent OAGB, 6.7% underwent LAGB, and 21.8% underwent conversional procedures. Patients regained a median of 9.7 kg (IQR; 5–18.1) or 27.9% (IQR; 15.7–57.8) of total body weight previously lost following MBS. In total, 34 patients (28.1%) were prescribed NB‐ER, 23 patients (19.1%) were prescribed liraglutide, and 64 patients (52.8%) were prescribed semaglutide post MBS. Overall, patients prescribed OMM treatment lost 8.8% (IQR; 5.7–14.1; median follow‐up, 9 months [IQR; 5–12]) total body weight. Adverse effects were minor and reflected clinical trial nonsurgical cohorts.ConclusionAdjuvant OMM conferred additional significant weight loss in patients with RWG or SWL in both primary and conversional surgical procedures and all three OMM studied should be considered as part of MBS aftercare.

We still need to know more about adolescents with attention deficit hyperactivity disorder who undergo surgery for severe obesity

Obesity is recognised as a chronic, relapsing and progressive disease, and long-term weight maintenance remains one of the greatest challenges in obesity management. When treatment gets interrupted, recurrent weight gain might be expected. Funding structures for MBS in numerous health systems globally do not currently permit metabolic and bariatric surgery (MBS) to prevent recurrent weight gain in patients who are normal weight or overweight. Gastric band removal is frequently required due to long-term complications such as slippage, which raises an important question: should revisional MBS be considered for weight maintenance in patients who have successfully lost weight after gastric banding? With the increasing use of obesity management medications and the associated successful weight loss, we anticipate that more patients will discontinue pharmacological treatment after reaching a normal weight or overweight range. However, many of these patients may still seek MBS for long-term weight maintenance. We question whether weight maintenance should be considered an indication for MBS in patients who are currently normal weight or overweight but have a history of severe obesity and must discontinue their current obesity treatment.

BackgroundHiatus hernia (HH) is prevalent among patients with obesity. Concurrent repair is often performed during metabolic and bariatric surgery (MBS), but a consensus on the safety and effectiveness of concurrent HH repair (HHR) and MBS remains unclear. We performed a systematic review of the safety and effectiveness of concurrent HHR and MBS through the measurement of multiple postoperative outcomes.MethodSeventeen studies relating to concurrent MBS and HHR were identified. MBS procedures included laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), and adjustable gastric banding (LAGB). Studies with pre- and postoperative measurements and outcomes were extracted.ResultsFor LSG, 9 of 11 studies concluded concurrent procedures to be safe and effective with no increase in mortality. Reoperation and readmission rates however were increased with HHR, whilst GORD rates were seen to improve, therefore providing a solution to the predominant issue with LSG. For LRYGB, in all 5 studies, concurrent procedures were concluded to be safe and effective, with no increase in mortality, length of stay, readmission and reoperation rates. Higher complication rates were observed compared to LSG with HHR. Among LAGB studies, all 4 studies were concluded to be safe and effective with no adverse outcomes on mortality and length of stay. GORD rates were seen to decrease, and reoperation rates from pouch dilatation and gastric prolapse were observed to significantly decrease.ConclusionConcurrent HHR with MBS appears to be safe and effective. Assessment of MBS warrants the consideration of concurrent HHR depending on specific patient case and the surgeon’s preference.Graphical

We aimed to compare 1-year postoperative results of patients with obesity and type 2 diabetes mellitus (T2DM) who underwent laparoscopic sleeve gastrectomy with transit bipartition (LSG-TB) and transit loop bipartition (LSG-TLB) and mini gastric bypass (MGB). This is a retrospective comparison of 2 novel bariatric surgery techniques with MGB. Primary outcome measure of the study was a rate of T2DM remission. Secondary outcomes included excess body mass index (BMI) loss, improvement in hepatosteatosis, and duration of operation. Revision surgery needs were also assessed. Overall, 32 patients underwent the LSG-TLB, 15 underwent LSG-TB, and 50 underwent MGB. Mean age and sex distribution were comparable for all groups. Presurgical BMI was similar in MGB and LSG + TB groups, whereas LSG + TLB group had significantly lower BMI values compared with the MGB group. In both groups, BMI values reduced significantly compared with respective baseline values. Excess BMI loss was significantly higher in patients who underwent LSG-TLB compared with patients treated with LSG-TB and MGB. Bariatric surgery procedures lasted shorter in LSG-TLB than in LSG-TB. However, the shortest of all was MGB. The remission of T2DM rates were 71% and 73.3% in LSG-TLB and LSG-TB groups, respectively ( P > 9.999). The rate of revision surgeries was comparable in both groups. In conclusion, LSG-TLB took less time and provided significantly higher excess BMI loss compared with LSG-TB. T2DM remission and improvement rates were similar in both groups. LSG-TLB seemed like a promising bariatric surgery technique in patients with obesity and T2DM.

IntroductionThe long-term success of metabolic and bariatric surgery (MBS) depends largely on adherence to health-promoting behaviour following MBS. Especially, adherence to healthy dietary behaviour in line with guidelines appears to be of the utmost importance. The primary objective of the present study is to evaluate the effect of adherence to dietary behaviour recommendations and the percentage of total weight loss (%TWL) after MBS. Adherence is hypothesised to have a positive influence on the %TWL, 24 months after MBS. Furthermore, we investigate the association of various sociodemographic, organisational, psychological and behavioural factors prior to and after MBS and their effect on %TWL.Methods and analysisThe present study is a single-centre observational, prospective, longitudinal cohort study conducted in Germany. Data are collected at nine measurement points (T0: 4 weeks prior to MBS; T1: 2 weeks after MBS, T2: 5 weeks after MBS; T3: 3 months after MBS; T4: 6 months after MBS; T5: 12 months after MBS; T6: 18 months after MBS; T7: 24 months after MBS; and T8: 36 months after MBS). Adherence to dietary behaviour recommendations is assessed using the Dietary Behavior Inventory-Surgery (DBI-S). N=325 patients applying for MBS will be included in the study. A regression analysis approach is chosen to answer the primary research question. The primary outcome %TWL is regressed at T7 (24 months after MBS) in a causal analysis on dietary adherence (DBI-S score) at T3–T7, with the covariates age, gender, marital status, educational attainment, employment status, Patient Health Questionnaire-4 score and body mass index at T0 and MBS method at T1. Stepwise hierarchical regression analyses are performed and analysed for significant model differences using χ2 difference tests. Effect sizes are estimated by R2. Group differences are analysed using t-tests and Analyses of variance (ANOVAs). Bivariate correlations of continuous variables are examined using regression/correlation analyses.Ethics and disseminationThe Ethics Committee of the Medical Faculty of the University of Essen-Duisburg has approved the conduct of the study (24-11969-BO). Results will be disseminated through manuscripts in clinical/academic peer-reviewed journals, presentations at academic conferences and communications with partners, participants and other stakeholders. Key findings will also be published in lay language on a publicly accessible website and disseminated via various (social) media channels.Trial registration numberThe study has been prospectively registered on 8 October 2024 in the German Clinical Trials Register (DRKS00034888).

Introduction: Sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB) are two of the three most performed metabolic and bariatric surgery (MBS) procedures worldwide. Indication for the proper surgical procedure is based on the surgeon’s choice, and no validated score for procedure selection exists. The aim of this study was to develop and validate a clinical score, which standardizes procedure selection in MBS. Methods: Based on the importance of obesity complications and comorbidities, we created a Metabolic Surgery Indication Score (MetSIS), including ten clinical and laboratory parameters to categorize the complex disease obesity with its comorbidities: age, sex, body mass index (BMI), obstructive sleep apnea syndrome (OSAS), hypertension, dyslipidemia, type 2 diabetes mellitus (T2DM), HbA1c, insulin therapy, and metabolic dysfunction-associated steatotic liver disease (MASLD). Minimum score was 0 points, and maximum 12 points. Retrospectively, data from all patients who underwent primary SG or OAGB in a 4-year period in our center of excellence for MBS were analyzed. Exclusion criteria included reflux disease (esophagitis ≥C next to LA classification) and/or the presence of hiatal hernia (≥3 cm) (since these patients undergo RYGB next to the internal protocol) and revisional bariatric surgery. Results: From March 2019 to September 2023, 468 patients underwent SG (n = 363) or OAGB (n = 105) as primary bariatric procedure. Mean BMI was 42.1 kg/m2 (SG) and 48 kg/m2 (OAGB). Patients who underwent SG demonstrated lower MetSIS, while patients who underwent OAGB had a higher score (p < 0.001). The parameters BMI (p < 0.001), presence of OSAS associated with CPAP treatment (p < 0.001), hypertension (p < 0.001), T2DM (p < 0.001), insulin requirement (p = 0.001), and MASLD (p = 0.035) were found as statistically significant parameters which influenced procedure choice. Conclusion: The MetSIS is a simple and immediate score, which can be applied during decision-making of MBS procedure in routine clinical settings. Further studies are necessary to associate this score to the real metabolic outcome during long-term follow-up.

Introduction: While invasive and associated with risks, metabolic and bariatric surgery (MBS) can promote sustained weight loss and substantial health benefits in youths with extreme obesity. The path toward informed decision making for or against MBS is poorly characterized and postoperative follow-up to assess risks and benefits is inconsistent. In youths with extreme obesity, we aimed to evaluate decision making toward MBS, as well as MBS outcomes and adherence with follow-up and recommendations in the setting of a structured pre- and post-MBS program. Methods: Participants were recruited in the setting of the multicenter “Youth with Extreme Obesity Study” (YES). YES is a cohort study in adolescents and young adults aged 14–24 years with obesity (BMI ≥30.0 kg/m²) who were recruited at four medical centers and one job center in Germany between 2012 and 2018. Participants at two medical centers with BMI ≥35 kg/m², aged 14–24 years, and interested in pursuing MBS were included in the subproject 3 “Safety and effectiveness of weight loss surgery in adolescents with severe obesity within a structured pre- and post-surgery treatment program – an observational study” that comprised a 2-months pre- and 12-months post-MBS program. Results: Twenty-eight of 169 youths (17%) with BMI ≥35 kg/m² were interested in MBS. Twenty-six fulfilled published eligibility criteria for MBS and participated in the structured pre-MBS preparation program. Of these, 9 participants (2 females) decided against, and 17 (n = 11 females) decided for MBS (sleeve gastrectomy). The 12-month follow-up rate was high (16/17 [94%]) and all participants achieved significant weight reduction (ΔBMI: −16.1 ± 5.6 kg/m²). Eleven of 16 participants (69%) reported taking the prescribed dietary supplements in the first year after MBS, but only five of them (31%) did so daily. In contrast to the high 12-month retention rate, follow-up after completion of the structured program was low at 24-months (9/16 [56%]) and at 36-months (5/15 [36%]), respectively. Conclusion: Participants demonstrated active decision making for or against MBS and high adherence with the structured pre- and 12 months post-MBS program, but participation was low thereafter. These findings endorse the need for longer term structured post-MBS programs to capture long-term outcomes and provide adequate care in this vulnerable group at the transition to adulthood.

Background and Objectives: Religious fasting in patients after Metabolic and Bariatric Surgery (MBS) remains a topic with limited clarity. This study aims to present the results of a survey on religious fasting in patients after MBS in Israel. The questionnaire was sent to members of the Israeli Society for Metabolic and Bariatric Surgery (ISMBS). Materials and Methods: An online questionnaire survey was designed and distributed to members of the ISMBS. The survey consisted of 23 questions addressing religious fasting in patients after MBS and was divided into three sections: (1) MBS surgeon clinical experience, (2) clinical considerations regarding religious fasting in MBS patients, and (3) fasting-related complications in MBS patients. Responses were recorded and presented as numbers (percentages), with results analyzed descriptively and/or graphically. Results: The ISMBS has 63 active members, and 37 members (59%) responded to the survey. Most respondents have more than 10 years of MBS experience and perform more than 100 MBS procedures annually (67.5% and 54%, respectively). In general, 81.1% of respondents permit religious fasting in patients after MBS, and 73% think that fasting could be safe at least 12 months after MBS. Most (62.2%) agree that a clinical evaluation should be undertaken prior to permitting religious fasting; 40% of respondents note that there is increased patient admission to emergency rooms during religious fasting, mostly due to dehydration. When asked about fasting risks, most noted hypoglycemia (40.5%) and the evolution of marginal ulcers (16.2%). Conclusions: In conclusion, these national survey results emphasize the variations in MBS surgeons' opinions regarding religious fasting after MBS. Despite these differences, there were still many similarities in responses such as timing and fasting permission, and this study could aid clinicians in the future when consulted on religious fasting by MBS patients.

Although metabolic and bariatric surgery (MBS) is a safe and effective procedure to reduce severe obesity and is covered by most health insurance plans, utilization of MBS is significantly lower among men compared to women. This study identifies unique factors that explain men's attitude towards MBS. The study survey (paper/online) included 129 Black and White men with severe obesity from metropolitan communities in Western New York. Bivariate and multivariate analyses were used to evaluate participants' personal and community factors influencing their consideration of MBS. Men willing to undergo MBS had lower education (38% vs. 21% ≤ high school, p < 0.05), were less likely to be satisfied with their body weight (27% vs. 48%, p < 0.05), more likely to have a physician supporting their weight loss efforts (55% vs. 32%, p = 0.03) and discussing MBS treatment (39% vs. 19%, p = 0.02), believed that community role models who underwent MBS "lost weight and looked great" (66% vs. 40%, p = 0.02) and that MBS was safe and effective (40% vs. 13%, p < 0.01), compared to men unwilling to undergo MBS. When adjusted for education level, dissatisfaction with body size (odds ratio, OR = 4.56, 95% confidence interval, CI: 1.16, 18.01) and physician support (OR = 3.71, 95% CI: 1.17, 11.78) remained significantly associated with men's willingness to undergo MBS. Race and BMI were not associated with willingness to undergo MBS. Positive attitude toward MBS among men is influenced by self-perception of excess weight, strong physician support and community role models. Improving patient-provider communication about MBS and awareness from community role models may improve MBS utilization among men.

With the increasing number of obese patients worldwide, metabolic and bariatric surgery (MBS) has quickly become an effective way to treat obesity and related metabolic diseases such as type 2 diabetes, hypertension, lipid abnormalities, etc. Although MBS has become an important part of general surgery, there is still controversy regarding the indications for MBS. In 1991, the National Institutes of Health (NIH) issued a statement on the surgical treatment of severe obesity and other related issues, which continues to be the standard for insurance companies, health care systems, and hospital selection of patients. The standard no longer reflects the best practice data and lacks relevance to today's modern surgeries and patient populations. After 31 years, in October 2022, the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), the world's leading authorities on weight loss and metabolic surgery, jointly released new guidelines for MBS indications, based on increasing awareness of obesity and its comorbidities and the accumulation of evidence of obesity metabolic diseases. In a series of recommendations, the eligibility of patients for bariatric surgery has been expanded. Specific key updates include the following: (1) MBS is recommended for individuals with BMI≥35 kg/m2, regardless of the presence, absence, or severity of co-morbidities; (2) MBS should be considered for individuals with metabolic diseases and BMI 30.0-34.9 kg/m2; (3) the BMI threshold should be adjusted for the Asian population:: BMI≥25 kg/m2 suggest clinical obesity, and BMI ≥ 27.5 kg/m2 population should consider MBS; (4) Appropriately selected children and adolescents should be considered for MBS.

SummaryBackgroundRecurrent weight gain (RWG) is a major post‐operative challenge among metabolic and bariatric surgery (MBS) patients. Binge eating behaviours (BEB) and food addiction (FA) have been identified as significant predictors of post‐MBS RWG. However, limited research has investigated their independent associations with post‐MBS RWG.MethodsThis cross‐sectional study collected data via a self‐reported questionnaire of post‐MBS patient demographics and eating behaviours from a single‐site academic obesity medicine program. The Binge Eating Scale and Yale Food Addiction Scale 2.0 collected data on BEB and FA exposure variables, respectively. ANOVA/chi‐square tests determined bivariate associations with BEB and FA, while multivariable logistic regression models examined independent adjusted associations of BEB and FA with RWG% cut‐offs.ResultsOf the 294 MBS patients (90.48% female, and 51.71% non‐Hispanic white), 42.3% had BEB, 12.55% had severe FA, 7.36% moderate FA, and 7.36% mild FA. After adjustment, BEB was significantly associated with all magnitudes of post‐MBS RWG, with the highest odds observed at 50% RWG [OR = 3.07; 95% CI: 1.45, 6.49; p = 0.003]. FA was not significantly associated with post‐MBS RWG.ConclusionResults showed that BEB, but not FA, was associated with post‐MBS RWG. MBS patient support teams should consider screening for BEB at post‐MBS visits.

Nomogram for predicting type 2 diabetes remission after bariatric metabolic surgery in women: a multicenter cohort study.

Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients' management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits.