Bariatric Treatment Research Articles

The Long-term Value of Bariatric Surgery Interventions for American Adults With Type 2 Diabetes Mellitus.

Bariatric surgery can cause type 2 diabetes (diabetes) remission for individuals with comorbid obesity, yet utilization is <1%. Surgery eligibility is currently limited to body mass index (BMI) ≥35kg/m 2 , though the American Diabetes Association recommends expansion to BMI ≥30kg/m 2 . We estimate the individual-level net social value benefits of diabetes remission through bariatric surgery and compare the population-level effects of expanding eligibility alone versus improving utilization for currently eligible individuals. Using microsimulation, we quantified the net social value (difference in lifetime health/economic benefits and costs) of bariatric surgery-related diabetes remission for Americans with obesity and diabetes. We compared projected lifetime surgical outcomes to conventional management at individual and population levels for current utilization (1%) and eligibility (BMI ≥35kg/m 2 ) and expansions of both (>1%, and BMI ≥30kg/m 2 ). The per capita net social value of bariatric surgery-related diabetes remission was $264,670 (95% confidence interval: $234,527-294,814) under current and $227,114 (95% confidence interval: $205,300-248,928) under expanded eligibility, an 11.1% and 9.16% improvement over conventional management. Quality-adjusted life expectancy represented the largest gains (current: $194,706; expanded: $169,002); followed by earnings ($51,395 and $46,466), and medical savings ($41,769 and $34,866) balanced against the surgery cost ($23,200). Doubling surgical utilization for currently eligible patients provides higher population gains ($34.9B) than only expanding eligibility at current utilization ($29.0B). Diabetes remission following bariatric surgery improves healthy life expectancy and provides net social benefit despite high procedural costs. Per capita benefits appear greater among currently eligible individuals. Therefore, policies that increase utilization may produce larger societal value than expanding eligibility criteria alone.

Higher Preoperative Weight loss Is Associated with Greater Weight Loss up to 12 Months After Bariatric Surgery

Prior research suggested presurgical weight loss is associated with greater total weight loss, resulting in amore effective bariatric intervention. We aimed to assess whether preoperative weight loss is a predictor for total weight loss, and which patient factors are associated with successful weight loss. All patients (N = 773) that underwent primary bariatric surgery between June 2017 and August 2019 were included in this single-center retrospective study. Outcome measures were preoperative weight loss (%preopWL) and total weight loss (%TWL) up to 1year postoperatively. Patients were divided into 4 groups based on quartiles of %preopWL. Total weight loss after 1, 6, and 12months for the upper quartile was 16.9%, 33.4%, and 37.8%, and for the lower quartile 11.8%, 28.9%, and 35.2%, respectively (p < 0.001). Seven hundred fourteen patients (92.4%) were available for the 1-year follow-up. Preoperative weight loss was not associated with the incidence of complications. Independent factors predicting increased %preopWL were mandated preoperative weight loss program (MWP) (p < 0.001), older age (p = 0.005), weight measurement in the week before surgery (p = 0.031), and non-diabetic status (p = 0.010). Predictors for superior %TWL were MWP (p = 0.014), younger age (p = 0.001), non-diabetic status (p = 0.005), female gender (p = 0.001), higher Body Mass Index (p = 0.006), and banded gastric bypass (p = 0.001). Higher preoperative weight loss is associated with persisting greater weight loss up to at least 12months post-surgery. In order to optimize preoperative weight loss, we recommend extra preoperative support to younger and diabetic patients. We advise nutritional counseling and additional weight measurement in the week before surgery.

Spinal Epidural Lipomatosis Causing Lumbar Canal Stenosis: A Pictorial Essay on Radiological Grading and the Role of Bariatric Surgery Versus Laminectomy

Spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of adipose tissue in the spinal canal that can have a compressive effect on intraspinal neuroanatomical structures, leading to clinical symptoms. Several different conservative and surgical treatment strategies have been proposed but the treatment and outcomes remain controversial. There is a lack of severity-based evidence documenting the success of decompressive laminectomy in SEL and there are only anecdotal reports of clinico-radiological success with weight loss from bariatric surgery. This article demonstrates the resolution of SEL in two patients with bariatric surgery with the help of pre and postoperative MR imaging. The authors also highlight the classic “types” of spinal epidural lipomatosis with a surgically relevant grading system and elucidate the existence of concurrent extraspinal lipomatosis (i.e. mediastinal and intra-abdominal lipomatosis), drawing parallels with the natural history of SEL. The controversial question remains whether a symptomatic SEL patient needs a multilevel laminectomy for spinal decompression or bariatric surgery that can indirectly help the spinal condition. We propose that bariatric intervention could be better frontline management in patients with multifocal/multisystem lipomatosis (i.e., combined spinal and extraspinal) and spinal decompression would be ideal for those SEL patients with coexisting bony and/or ligamentous spinal canal or foraminal stenosis. This manuscript serves as a comprehensive and contemporary update on the radiological profile and two plausible treatment paths and will look toward further verification by a randomized clinical trial.

Metabolisches Syndrom und Adipositas bei Nierentransplantation

BackgroundObesity and the metabolic syndrome (MS) are risk factors for chronic kidney disease (CKD) and are associated with challenges before, during and after kidney transplantation.ObjectiveThe significance of obesity and the MS in CKD and recommendations for the management at various stages of kidney transplantation.Material and methodsSearch of the literature and screening of selected guidelines on kidney transplantation.ResultsAlthough the negative impact of obesity and MS on the outcome of kidney transplantation is well known, there are few specific recommendations in the current guidelines. The lack of comparative studies and meta-analyses on the best risk stratification of obesity in the context of CKD as well as the inconsistent definition of the MS, complicate the ability to draw conclusions.ConclusionThe body mass index (BMI) serves as a measure of obesity in all guidelines, although its validity is controversial. The standardized collation of measures of central obesity, weight reduction through multidisciplinary programs and accurate screening of obesity-associated cardiovascular risk factors before transplantation appear to be meaningful. Consideration of bariatric interventions is recommended only on a case by case basis and with a careful risk-benefit analysis. The effects of immunosuppressive agents on absorption should particularly be considered.

The problem of identification and correction of micro- and macronutrients deficiency after bariatric surgery: A review

Surgical treatment of obesity is one of the most effective ways to reduce and maintain body weight for a long time. Depending on the type of operation, patients with different frequency develop malabsorption syndrome. As a result, in individuals who have received this type of medical care, at different times after bariatric surgery, micro and macronutrient deficiencies may be detected. Therefore, the long-term safety of this treatment method is associated with the correction of vitamin and trace element deficiencies both before and after bariatric intervention. This review highlights the most common deficiencies that are found in obese patients, as well as methods for their diagnosis and treatment.

Endoscopic Bariatric Treatment with Duodenal-Jejunal Bypass Liner Improves Non-invasive Markers of Non-alcoholic Steatohepatitis

PurposePeople with obesity often develop non-alcoholic fatty liver disease (NAFLD) and are at high risk of progression to non-alcoholic steatohepatitis (NASH). Few therapies are effective other than bariatric surgery. We therefore analyzed data from duodenal-jejunal bypass liner (DJBL) patients regarding steatosis, fibrosis, and NASH.MethodsConsecutive DJBL patients with type 2 diabetes underwent standardized assessments up to device removal at 48 weeks. These included aspartate and alanine transaminase (AST, ALT), controlled attenuation parameter (CAP, for steatosis), and liver stiffness measurement (LSM, for fibrosis). The NAFLD fibrosis score (NFS), fibrosis-4 score (FIB4), and enhanced liver fibrosis (ELF) test were also used to assess fibrosis and the Fibroscan-AST (FAST) score to assess NASH. Mixed models were used and missing data were accounted for with multiple imputation.ResultsThirty-two patients (18 female, mean age 55.1, mean BMI 40.2 kg/m2) were included. After 48 weeks, the change compared to baseline with 95% CI was a factor 0.74 (0.65 to 0.84) for AST, 0.63 (0.53 to 0.75) for ALT, and a difference of − 0.21 (− 0.28 to − 0.13) for FAST, all with p < 0.001. Fibrosis based on LSM, NFS, and ELF did not change whereas FIB4 exhibited slight improvement. Eight DJBL were explanted early due to device-related complications and eight complications led to hospitalization.ConclusionsOne year of DJBL therapy is associated with relevant improvements in non-invasive markers of steatosis and NASH, but not fibrosis, and is accompanied by a substantial number of complications. Given the lack of alternatives, DJBL deserves further attention.Graphical abstract

Quality of life after surgical operations

The aim of the work is to study the quality of life in patients who underwent gastric plication for morbid obesity. A prospective study of 37 patients aged 28 to 59 years, who underwent gastroplication according to the original technique, was conducted on the basis of the Clinic of the Bashkir State Medical University. The indication for surgery was morbid obesity (body mass index 40 kg/m² or more). The quality of life of patients who underwent laparoscopic gastric plication for morbid obesity was studied by comparing the results of questionnaires and special research methods. Weight loss achieved as a result of laparoscopic gastric plication, correction of concomitant disorders in organs and systems, and normalization of metabolic parameters allow us to consider the intervention effective, and the results obtained good. Long-term results of treatment were monitored for up to 2 years. The assessment of the parameters of the quality of life of patients indicates that after bariatric interventions, positive changes are more related to the physical indicators of the quality of life and health status in general. At the same time, changes in mental health indicators, such as vitality, social and emotional functioning, were not statistically significant. In addition to the ongoing surgical correction, obviously essential in achieving stabilization of the psycho-emotional sphere of patients should be given a multidisciplinary approach using developed diets snd psychotherapeutic techniques. The study highlights the features of the regimen and structure of nutrition in patients after bariatric surgery, which can improve long-term results and improve the quality of life in patients with morbid obesity.

Attention-deficit/hyperactivity disorder (ADHD) in adult obese patients referred to bariatric surgery

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by symptoms of inattention, hyperactivity, and impulsivity, which only rarely remits in adulthood[1]. A positive association between ADHD and obesity has been repeatedly observed, especially in adult samples[2]. However, only a few studies investigated the prevalence and correlates of ADHD in obese patients seeking bariatric treatment[3,4].ObjectivesOur study was aimed to examine the prevalence of probable ADHD comorbidity in a sample of obese patients referred for bariatric surgery. Secondly, we sought to characterize differences in eating behaviour between obese subjects with and without probable ADHD.MethodsThe study sample was composed of 110 adult obese patients (BMI ≥ 30 kg/m2) consecutively referred for bariatric surgery to the Obesity Center of the Endocrinology Unit in Pisa University Hospital between November 2010 and May 2012. Probable ADHD was identified using a recently developed screening scale based on items selected from Symptom Check‐List‐90‐R (SCL-90-R)[5]. The extent of binge-eating/purging and night-eating behaviours were respectively estimated using the Bulimic Investigatory Test, Edinburgh (BITE)[6] and the Night-eating Questionnaire (NEQ)[7]. Wilcoxon test was used for statistical comparisons, with a significance level of p&lt;0.05 set for all tests.ResultsProbable ADHD was found in 14 subjects (12.7%, 95%CI=7.1-20.4%). Patients with probable ADHD showed significantly higher BITE symptom score (20.4±9.3 vs. 12.1±7.5, r=0.31, p=0.001) and NEQ total score (16.1±9.2 vs. 9.5±3.9, r=0.27, p=0.005).ConclusionsADHD is a relatively common comorbidity in obese patients seeking bariatric treatment, which is positively associated with disordered eating habits, such as binge-eating/purging and night-eating behaviours.DisclosureNo significant relationships.

Patient rehabilitation after bariatric surgery

Due to steady increase in the prevalence of obesity, there is a growing demand for bariatric surgery. The question of active dynamic postoperative monitoring and long-term management of these patients arises. The issue of long-term rehabilitation of bariatric patients is a serious interdisciplinary problem. This article provides a review of the literature both on rehabilitation in the early postoperative period and long-term rehabilitation after a bariatric procedure, including the methodology of patient monitoring, metabolic control, replenishment of nutrient deficiencies, vitamin and microelement support, physical activity, and behavior modification under constant interdisciplinary control. In preparing this review, articles were searched in the Medline (PubMed), RSCI (eLibrary), and Google Scholar databases using the relevant key words (“bariatric surgery”, “rehabilitation”). A ketonemic syndrome and late dumping syndrome (hypoglycemia after eating) are described as conditions that occur after bariatric interventions.

Bariatric Surgery Induced Changes in Blood Cholesterol Are Modulated by Vitamin D Status.

The effect of metabolically active bariatric surgery treatment on lipid metabolism is inconclusive. The authors of this study presume that initial vitamin D status may play a regulating role in influencing the beneficial post-effects of bariatric surgery, especially the lipid profile. The biochemical data obtained from 24 patients who had undergone laparoscopic one-anastomosis gastric bypass (OAGB) at baseline, 3 months before the surgery, at the time of surgery, and 6 months later, demonstrate that vitamin D status influenced the postoperative lipid profile. The baseline established the partition line which divided patients into two groups according to the stated calcidiol initial concentration level of 32 ng/mL. The data shows that OAGB induces a decrease in TG and hsCRP while increasing HDL. Conversely, in patients whose 25(OH)D3 was below 32 ng/mL TC significantly increased while those above this concentration remained in the normal physiological range. The changes induced by OAGB in TG, glucose, and hsCRP were similar in both groups. Unexpectedly, the surgery did not affect vitamin D metabolites. In conclusion, the results of the study suggest that a higher concentration of serum 25(OH)D3 may enhance the protective effects of OAGB.

Effects of bariatric surgery and dietary intervention on changes in insulin resistance and appetite hormones over the period of 3 years

Effects of bariatric surgery and dietary intervention on changes in insulin resistance and appetite hormones over the period of 3 years

Gastric fluid-induced double network hydrogel with high swelling ratio and long-term mechanical stability

Hydrogels have been widely investigated as gastric retention systems for drug delivery and bariatric intervention due to their good biocompatibility , degradability, and similarity with human tissues or organs. To realize long-term retention, hydrogels need to swell considerably on contact with gastric fluid to prevent passing through the pylorus and simultaneously maintain their mechanical stability after swelling to resist the damage of gastric pressure. However, high swelling ratio often results in the reduction of mechanical strength. Here, a swelling hydrogel with long-term mechanical stability for gastric retention is proposed. The hydrogel is designed as double networks, namely, the polyacrylamide as the first network and chitosan/sodium alginate as the second network. The hydrogel can reside in the stomach by the swelling of first network and maintain mechanical stability through the gradual formation of second network under the action of gastric fluid. The animal model test proves that the hydrogel can reside in the stomach with intact shape for 16 days, and then is biologically degraded in the gastric environment. • The hydrogel possesses both high swelling ratio and long-term mechanical stability. • The hydrogel forms a new network in gastric juice to maintain mechanical stability. • The hydrogel can reside in the stomach of rabbit for 16 days.

The effects of bariatric surgery procedures on the gut microbiota, features of genetically mediated predisposition to obesity, forecasting algorithms for surgical treatment outcomes. Literature review

Obesity is one of the major challenges facing modern medicine in the 21st century. Medically complicated obesity cases lead to a significant deterioration in quality of life and are associated with excess morbidity and increased mortality. According to the WHO, more than 24 % of the world's population over 18 years of age is overweight. About 3.9 million people of working age died in 2018 due to obesity and its complications. Today, bariatric surgery is the most effective in treating obesity, as it allows achieving optimal metabolic outcomes. After bariatric surgery, the desired effect can be produced by the response of the intestinal microbiome to postoperative anatomical and physiological changes in the gastrointestinal tract.&#x0D; The aim of this study was to conduct a comprehensive literature review and evaluate the effects of bariatric surgery on the human intestinal microbiome.&#x0D; The literature review revealed a stable correlation between quantitative and qualitative characteristics of the intestinal microbiota and bariatric surgery, regardless of the type of a bariatric surgical operation. Roux‑en‑Y Gastric Bypass, Mini‑Gastric Bypass and Sleeve Gastrectomy are the most commonly used bariatric operations in the world. The outcomes of these procedures show a sharp change in the proportion of different microbial phyla, including Firmicutes, Bacterioides and Escherichia, as well as changes in the gene expression parameters of these groups at different time periods after surgery.&#x0D; An increasing number of the reported bariatric interventions worldwide necessitates the study of pathophysiological mechanisms of intermicrobial relationships, which can contribute to better outcomes of surgical treatment of obesity and the development of algorithms for predicting them.&#x0D;

Nutritional support for patients in general surgery

The modern stage of development of surgery, especially minimal invasive technologies, has significantly changed the surgeons' thoughts about the perioperative period. Until the end of the twentieth century, pre‑ and postoperative fasting was the most important requirement in planned surgery. It was believed that it could help to avoid complications both during surgery and in the early postoperative period. H. Kehlet in his fundamental work outlined the factors that allowed to accelerate the patient's recovery after surgery, namely: the absence of preoperative fasting.&#x0D; Objective — to evaluate the effectiveness of nutritional support for surgical patients within ERAS (Enhanced Recovery After Surgery) and ESPEN (European Society for Clinical Nutrition and Metabolism) protocols.&#x0D; Materials and methods. This research included both traditional laparoscopic cholecystectomy (177 cases) and single‑port transumbilical cholecystectomy (8); among laparoscopic bariatric interventions, the major part was represented by classical Roux‑Y gastric shunting (28), as well as sleeve gastrectomy (5) and mini‑gastric shunting (4); among 123 different laparoscopic hernioplasties, in 64 cases transabdominal preperitoneal (TAPP) was performed for bubonocele, intraperitoneal onlay mesh (IPOM) for postoperative ventral and umbilical hernias (59), laparoscopic crurography and fundoplication with and without alloplasty (33). For each type of surgery two groups we identified: control and experimental. Both groups were followed by ERAS protocols in addition to nutritional support. With the prior consent of patients before surgery: the experimental group received full perioperative nutritional support according to our local protocols using protein‑enriched sip feeding formula Nutridrink Protein, the control group followed the traditional scheme of fasting during 12 hours before surgery and received regular drinking water instead of protein mixtures at the first postoperative day.&#x0D; Results. We found statistically significant difference between control and experimental groups in assessing of two important parameters as hunger and weakness. The hunger after laparoscopic cholecystectomy was 1.5 times (p &lt; 0.001), after laparoscopic hernia repair — 1.7 times (p &lt; 0.001), after laparoscopic crurography and fundoplication — 1.26 times (p &lt; 0.001), after laparoscopic bariatric intervention — 1.43 times, and after laparoscopic colon intervention — 1.9 times lower in the experimental group. The weakness after laparoscopic cholecystectomy was 1.8 times (p &lt; 0.001), after laparoscopic hernia repair — 1.31 times (p &lt; 0.001), after laparoscopic crurography and fundoplication — 1.68 times (p &lt; 0.001), after laparoscopic bariatric intervention — 1.67 times (p &lt; 0.001), and after laparoscopic colon intervention — 1.38 times (p = 0.006) stronger in the control group.&#x0D; Conclusions. Traditional long‑term preoperative fasting is inappropriate. Combined with other ERAS postulates, perioperative nutritional support for surgical patients has a great chance of success. In our research, early restoration of oral nutrition significantly decreases hunger and general weakness in the early postoperative period, which allows the patient quickly return to full life.&#x0D;

Does Time Matter in Deficit of Calcium after Total Thyroidectomy in Subjects with Previous Bariatric Surgery?

Background: Hypoparathyroidism-related hypocalcemia is a common complication after total thyroidectomy (TT), particularly if there is a history of prior bariatric surgery. However, it is still unknown if it is the surgery timing or the type of bariatric intervention that increases the risk of developing this complication. Methods: We compared the risk of hypocalcemia (serum calcium levels < 8 mg/dL) and hypoparathyroidism (both transient and permanent) between patients with restrictive procedures (LSG and GB) and patients without a history of obesity surgery in the immediate post-operative period and after 12 months. Hypoparathyroidism was considered permanent if the plasma parathyroid hormone (PTH) levels at 6 months were less than 15 pg/mL and the patient still required oral calcium (calcium carbonate) and vitamin D supplementation, in addition to the supplements that were taken routinely before thyroidectomy. Results: From the 96 patients who underwent TT, 50% had a history of bariatric surgery: 36 LSG and 12 GB. The risk of hypocalcemia was similar in patients with a history of restrictive procedures (31.35%) and in controls (25%) (p = 0.49). Furthermore, hypocalcemia risk was similar between patients with a history of LSG (30.5%) and GB (33%) (p = 0.85). The prevalences of transient and permanent hypoparathyroidism were similar between patients with a history of restrictive procedures and in controls; similarly, no differences were detected between subjects undergoing LSG and GB. Conclusions: Restrictive bariatric surgery (LSG and GB) is not a risk factor for post-thyroidectomy hypocalcemia and hypoparathyroidism and thus did not require a different perioperative supplementation protocol compared to subjects without history of bariatric surgery undergoing TT.

Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy—An Unusual but Effective Surgical Approach to Achieve Full Recovery

Sleeve gastrectomy is at present the most practiced bariatric intervention for patients suffering from severe obesity. Although rare, post-operative complications such as leakages and strictures may represent a challenging issue for bariatric surgeons and cause impaired quality of life for patients. Gastric twist is even more rare. This complication is a functional obstruction rather than a stricture of the gastric remnant most likely due to technical mistakes at index surgery. If endoscopy usually allows diagnosis and constitutes the first-line treatment for this condition, surgery is mandatory when endoscopy is not successful. The conversion of the sleeve to a Roux-en-Y gastric bypass is the usually chosen intervention but a wide range of reconstruction has been proposed. In this report, we discuss the surgical technique we employed to achieve a full resolution of a gastric twist.

ASSESSMENT OF THE ACID-BASE STATE OF ARTERIAL BLOOD DEPENDING ON THE DEGREE OF MORBID OBESITY IN PATIENTS IN BARIATRIC SURGERY

Abstract. The work is devoted to the study of indicators of the acid-base state of arterial blood depending on the degree of morbid obesity in patients who were to undergo surgical bariatric interventions in 2012-2021. The study included 61 patients, whose age ranged from 22 to 69 years, body mass index from 40 to 91 kg/m2. The patients were divided into 3 groups depending on the degree of morbid obesity: group 1 - 20 patients with body mass index ≥ 40 (grade 3); group 2 - 25 patients with body mass index ≥ 50 (grade 4); group 3 - 16 patients with body mass index ≥ 60 (grade 5). Based on the data obtained, it was found that the acid-base state of arterial blood indicates the presence in patients with morbid obesity of pronounced changes in the direction of respiratory and metabolic acidosis with an increase in lactate, glucose, which significantly reduce the compensatory capabilities of the body. All studied indicators of the acid-base state of arterial blood in patients of group 1 tended to worsen. In patients of groups 2 and 3, the parameters of the acid-base state of arterial blood significantly worsen with an increase in the degree of morbid obesity. The maximum disruption of the acid-base state of arterial blood was found in patients with a body mass index ≥ 60.

ASSESSMENT OF ARTERIAL BLOOD GAS COMPOSITION DEPENDING ON THE DEGREE OF MORBID OBESITY IN PATIENTS IN BARIATRIC SURGERY

Abstract. The work is devoted to the study of arterial blood gas parameters and comparison of capnographic determination of carbon dioxide at the end of exhalation (EtCO2) and the real pressure of carbon dioxide in arterial blood (paCO2) depending on the degree of morbid obesity in patients who were to undergo surgical bariatric interventions in 2012-2021. The study included 61 patients, whose age ranged from 22 to 69 years, body mass index from 40 to 91 kg/m2. The patients were divided into 3 groups depending on the degree of morbid obesity: group 1 - 20 patients with body mass index ≥ 40 (grade 3); group 2 - 25 patients with body mass index ≥ 50 (grade 4); group 3 - 16 patients with body mass index ≥ 60 (grade 5). Based on the data obtained, it was found that the state of the arterial blood gas composition indicates the presence of respiratory function disorders in patients with morbid obesity, which significantly reduce the compensatory capabilities of the body. Arterial hemoglobin saturation with oxygen (SaO2) tended to decrease, reaching a minimum in patients of the 1st group. The studied parameters of the arterial blood gas composition in patients of group 1 tended to worsen, and in patients of groups 2 and 3 they significantly worsened with an increase in the degree of morbid obesity. The maximum disruption of arterial blood gases was found in patients with a body mass index ≥ 60. The partial pressure of carbon dioxide at the end of exhalation (EtCO2) in patients with morbid obesity does not correspond to the partial pressure of carbon dioxide in arterial blood (paCO2).

Photodynamic Methylene Blue-Embedded Intragastric Satiety-Inducing Device to Treat Obesity.

Bariatric surgery is the most effective treatment for weight recidivism, and endoscopic bariatric treatment has been developed for a similar effect without anatomical modification. An intragastric satiety-inducing device (ISD) is a minimally invasive approach to induce satiety by continuously pressing the stomach and stimulating ghrelin-producing cells. To enhance the therapeutic effects of ISD, photodynamic therapy (PDT) can be combined by generating singlet oxygen under laser irradiation. Methylene blue (MB), as a photosensitizer (PS), was coated on the ISD surface for singlet oxygen production to stimulate or destroy cells. Ghrelin-producing cells effectively inhibited ghrelin secretion and induced gastrointestinal satiety signals compared with the MB-uncoated device via PDT. Herein, MB-embedded ISDs were developed, and their photoresponsive abilities were demonstrated in the device itself and in vitro. PDT with an MB-embedded ISD was successfully performed in a porcine model, which had 2-fold reduced body weight gain (12% in PDT vs 24% in control) and 2-fold reduced ghrelin levels (21.2 pg/mL in PDT vs 45.1 pg/mL in control) at the first week postprocedure. The simple and unique operation extends the point of view in PDT and is expected to be a novel endoscopic bariatric therapy.

Influence de l’indice de masse corporelle sur les complications des chirurgies de séquelles d’amaigrissement

The generalization of bariatric surgery interventions has led in recent years to an explosion in demand for body contouring surgeries. These operations can be followed by postoperative complications; and residual obesity, defined by a BMI≥30, is traditionally considered as a relative contraindication. The objective is to study the influence of a BMI≥30 on the risk of postoperative complications. A retrospective study was conducted on all patients who underwent body contouring surgery between 2014 and 2020 at the Arras Hospital Center. Major complication rates were compared in obese and non-obese patients. Two hundred twenty-three patients were included, representing a total of 247 surgeries: 124 in the BMI<30 group and 123 in the BMI≥30 group. Sixteen surgeries were followed by at least one major complication, 6 in group I versus 10 in group II (RR=1.7 (0.6-4.5), NS, P=0.29). Therefore there were not significantly more major complications in obese patients. The incidence of major complications following body contouring surgeries is not modified by the presence of a BMI greater than 30, subject to a precautionary procedure adapted to each patient. BMI is therefore not a sufficient criterion to contraindicate this type of surgery.