Bariatric Surgery Weight Loss Research Articles

Prevalence of adverse childhood experiences and effect on outcomes in bariatric surgery patients: a systematic review and meta-analysis.

Adverse childhood experiences (ACEs) are defined as childhood maltreatment (sexual, physical, and emotional abuse and neglect) and other childhood traumatic experiences. Published prevalence estimates for ACEs in bariatric samples vary greatly and evidence on the association between ACEs and bariatric surgery weight loss and psychosocial outcomes is inconclusive. A systematic literature search on PubMed/Medline, PsycInfo, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Open Grey for studies published until August 30, 2021, yielded 21 publications for qualitative synthesis: 20 reporting on prevalence of ACEs in bariatric surgery candidates and patients, and 10 on the association of ACEs with outcomes. In meta-analysis, overall moderate to high heterogeneity was observed for prevalence estimates and moderate heterogeneity was observed for associations. Prevalence estimate for at least 1 form of ACEs (6 studies, n = 1368 patients) was 51% (95% confidence interval [CI]: 32%-70%). Effect size (Hedge's g) for the difference between the groups of patients reporting any or a high number of ACEs versus no or a low number of ACEs was calculated from means, standard deviations and group size, or P values. Based on 7 studies (n = 946 patients), the association between ACEs and weight loss was not significant (Hedge's g = -.15 [95% CI: -.38 to .09]; I2 = 53%), regardless of short- or long-term follow-up (P = .413) and the proportion of patients in each study receiving Roux-en-Y gastric bypass (RYGB) (β = .0005, P = .868). Preliminary findings based on 3 short- and long-term studies (n = 414 patients) showed that ACEs were significantly (P = .001) associated with higher postoperative depressive symptoms (Hedge's g = .50 [95% CI: .22-.78]; I2 = 36%). Associations between ACEs and other psychosocial outcomes such as eating pathology were reported narratively. There is a need for additional long-term studies using validated assessment tools for ACEs to evaluate the effect of ACEs on weight and psychosocial outcomes after bariatric surgery.

Anterior Cervical Discectomy and Fusion Outcomes in Patients With and Without Bariatric Surgery-Weight Loss Does Make a Difference.

A retrospective comparative cohort study. To compare outcomes of elective non-obese anterior cervical discectomy and fusion (ACDF) patients with those that underwent bariatric surgery (BS). Morbid obesity (MO) has been associated with an increased risk of complications following procedures such as elective ACDF. While pre-emptive BS has been considered for those with MO (body mass index [BMI] ≥35kg/m 2 ), the impact of this intervention on BMI and its resultant correlation with surgical outcomes remains limited. The PearlDiver 2010-Q1 2020 MSpine database was used to identify patients undergoing elective isolated ACDF. Three sub-cohorts were defined as follows: (1) Non-obese controls without a history of BS, (2) patients with BS procedure within two years with a BMI <35kg/m 2 (BS+MO-), and (3) patients with BS procedure within the two years with a BMI ≥35kg/m 2 (BS+MO+). Univariate and multivariate regression analyses were performed to compare 90-day adverse event rates adjusting for age, sex, Elixhauser Comorbidity Index, and length of stay. Kaplan-Meier analysis was performed to assess five-year cervical reoperation rates. Of 160,166 elective ACDF patients, prior BS was identified for 479. Of these, 136 patients were BS+MO- and 343 were BS+MO+. On multivariate analysis, BS+MO- were not at increased odds of adverse events, but BS+MO+ were at greater odds of 90-day pulmonary embolism (odds ratio 3.28, P =0.043), wound dehiscence (5.02, P <0.001), hematomas (2.52, P =0.042), and overall minor adverse events (1.61, P =0.011) compared with controls. Five-year reoperation rates were not significantly different between the groups. Twenty-eight percent of those with BS before ACDF fell out of the categorization of MO. Among this group, the odds of adverse events were similar to non-obese patients. These findings suggest that the psychological preparation and BS alone are insufficient to reduce the risk of adverse events after ACDF. Weight reduction must be achieved as well, ideally moving patients out of the BMI range for morbid obesity.

Descriptive analysis of TikTok videos posted under the hashtag #Ozempic

Current discourse regarding weight loss on social media includes the discussion of Ozempic, a drug which facilitates weight loss, although approved for enhancing metabolic control among people with diabetes. The surge in public interest and the subsequent increase in demand for Ozempic has led to medication shortages for people with diabetes, as highlighted in news reports and publications. This cross-sectional study aimed to describe the content of the first 100 video results under the hashtag #Ozempic on TikTok. Videos extracted from TikTok were primarily uploaded by consumers and viewed ∼ 70 million times. The coding sheet encompassed basic information (including the URL identifier, date of upload, view count, number of likes, number of shares, and indication of whether the video was uploaded by consumers or professionals), and 19 content categories. Only two of the 19 content characteristics were covered in the majority (>50%) of the videos, “mentions being on/taking Ozempic or others taking/using/planning to use Ozempic” (n = 69), garnering over 43 million views) and “mentions being used for weight loss” (n = 57), garnering over 44 million views). Over one-third (n = 35), garnering over 31 million views, included content that “encourages/entices other people to try Ozempic/presents Ozempic as a coveted drug/portrays Ozempic positively.” Less than 5% of the sample mentioned “off label prescription use” (n = 3), “bariatric surgery for weight loss” (n = 3), or “medication shortage” that may result from off label use (n = 1). Healthcare professionals, regulatory bodies, and social media platforms should collaborate to address the challenges posed by viral trends resulting in medication shortages with potentially consequential outcomes for people with diabetes.

African American Patients Experience Worse Outcomes than Hispanic Patients Following Bariatric Surgery: an Analysis Using the MBSAQIP Data Registry.

Obesity rates in Hispanics and African Americans (AAs) are higher than in Caucasians in the USA, yet the rate of metabolic and bariatric surgery (MBS) for weight loss remains lower for both Hispanics and AAs. Patient demographics and outcomes of adult AA and Hispanic patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) procedures were analyzed using the MBSAQIP dataset [2015-2018] using unmatched and propensity-matched data. In total, 173,157 patients were included, of whom 98,185 were AA [56.7%] [21,163-RYGB; 77,022-SG] and 74,972 were Hispanic [43.3%] [20,282-RYGB; 54,690-SG]). Preoperatively, the AA cohort was older, had more females, and higher BMIs with higher rates of all tracked obesity-related medical conditions except for diabetes, venous stasis, and prior foregut surgery. Intra- and postoperatively, AAs were more likely to experience major complications including unplanned ICU admission, 30-day readmission/reintervention, and mortality. After propensity matching, the differences in ED visits, treatment for dehydration, 30-day readmission, 30-day intervention, and pulmonary embolism remained for both SG and RYGB cohorts. Progressive renal insufficiency and ventilator use lost statistical significance in both cohorts. Conversely, 30-day reoperation, postoperative ventilator requirement, unplanned intubation, unplanned ICU admission, and mortality lost significance in the RYGB cohort, but not SG patients. Outcomes for AA patients were worse than for Hispanic patients, even after propensity matching. After matching, differences in major complications and mortality lost significance for RYGB, but not SG. These data suggest that outcomes for RYGB may be driven by the presence and severity of pre-existing patient-related factors.

The relationship between weight loss and cognitive function in bariatric surgery.

Previously, we reported short-term improvements in auditory attention, oromotor processing speed, and executive function during the active weight loss phase following bariatric surgery that persisted out to 3months. In this study, our aims were to investigate the relationship between weight loss and cognitive performance in these patients 1 year following vertical sleeve gastrectomy (VSG) and Roux-en Y gastric bypass (RYGB) surgery and to determine whether preoperative cognitive performance predicted weight loss. Adult women ages 18-55 approved for bariatric surgery completed a cognitive battery prior to and at 2, 12, 24, and 52weeks following VSG (N = 17) or RYGB (N = 18). Scores from each task were assigned to one of the following cognitive domains: auditory attention, processing speed, memory, and executive functioning. Weight loss and cognitive scores for each domain were calculated and compared between cohorts. RYGB surgery resulted in greater weight loss at 1-year follow-up relative to VSG. Both VSG and RYGB procedures resulted in improved performance on different measures of auditory attention and both surgery groups improved across all processing speed tasks. Within the executive function domain, both groups showed improvements, but only the RYGB procedure resulted in improved performance in the Trail Making Test. Baseline auditory attention and memory performance predicted weight loss at 1 year following RYGB but not VSG surgery. Controlling for baseline cognitiveperformance, percent total weight loss predicted auditory attention at 1 year following RYGB but not VSG surgery. Bariatric surgery type may result in selective improvements in cognition during the first year following surgery. Presurgical cognitive performance as well as surgery type appears to influence weight loss outcomes.

Epilepsy Risk Following Bariatric Surgery for Weight Loss.

A previous study reported finding that epilepsy risk is elevated after bariatric surgery for weight loss; however, this association has not been adequately explored. Our objectives were to (1) estimate the risk of epilepsy after bariatric surgery for weight loss relative to a nonsurgical cohort of patients with an obesity diagnosis and (2) identify epilepsy risk factors among bariatric surgery recipients. We conducted a population-based retrospective cohort study using linked health administrative databases in Ontario, Canada. Participants were accrued between July 1, 2010, and December 31, 2016, and followed until December 31, 2019. All Ontario residents aged 18 years and older who had bariatric surgery during the accrual period were eligible for inclusion in our exposed cohort. Patients hospitalized with a diagnosis of obesity and who did not have bariatric surgery during the accrual period were eligible for inclusion in our unexposed cohort. We excluded patients with a history of seizures, epilepsy, various seizure or epilepsy risk factors, psychiatric disorders, or drug or alcohol abuse/dependence. In our primary analysis, we used inverse probability of treatment weighting to control for confounding. A marginal Cox proportional hazards model was then used to estimate the risk of epilepsy associated with bariatric surgery. A Cox model was also used to identify epilepsy risk factors among exposed participants. The final sample included 16,958 exposed participants and 622,514 unexposed participants. After inverse probability of treatment weighting, the estimated rates of epilepsy were 50.1 and 34.1 per 100,000 person-years among those who did and did not have bariatric surgery, respectively. The hazard ratio for developing epilepsy after bariatric surgery was 1.45 (95% CI = 1.35, 1.56). Among participants who received bariatric surgery, stroke during follow-up increased epilepsy risk (HR = 14.03, 95% CI = 4.26, 46.25). In this study, we found that patients with a history of bariatric surgery were at increased risk of developing epilepsy. These findings suggest that epilepsy is a long-term risk associated with bariatric surgery for weight loss.

THE EFFECT OF STATIC MAGNETIC FIELD EXPOSURE ON BODY WEIGHT AND ADIPOSE CELLS DENSITY OF OBESE MICE

Obesity is a mojar public health problem in worldwide, especially in Indonesia. Obesity in addition to affecting productivity, is also trigger for other chronic disease such as diabetes and cardiac disease. Body mass index is an assessment tool used to assess degree of individual adiposity to define overweight, obesity, and severe obesity.The determination of obesity is based on the calculation of Body Mass Index (BMI), which devide body weight (kg) by height (cm2). In addition to the method of regulating diet, exercise, and bariatric surgery for weight loss, it was reported that the biophysical therapy tool, that is static magnetic field (SMF) became a modality for weight loss. Based on research reports, it proves that the static magnetic field affects weight loss in the group of obese mice after 30 days of exposure. Therefore, in this study, we carried out static magnetic field exposure to obese mice with a field intensity of 2 mT for 1 hour/day. Mice were exposed gradually to SMF on 2, 7, 14, and 21 days to determine the effectiveness of SMF to obesity in mice in terms of weight loss and cellular adipose cell density. The results showed that the weight of mice decreased significantly on 2nd and 7th days of exposure, the trend showed a decrease in body weight until the 14th day. The density of adipose tissue is increased after exposure to SMF on the 14th and 21st days of exposure. It showed that early exposure to SMF (2 and 7 days) could induce weight loss in mice, while cellularly SMF increased adipose cell density on late exposure (14 and 21 days).

Association between bariatric surgery and anemia

ObjectivesSeveral studies have recently conducted to investigate the link between anemia and bariatric surgery (BS). The results from these studies, however, were inconsistent. Therefore, a meta-analysis was conducted to determine whether BS for weight loss is a risk factor for anemia. MethodsStudies were identified relevant papers published a cutoff date of May 2022 for meta-analysis by searching four electronic databases (PubMed, EMBASE, Web of Science and Cochrane Library). Pairs of authors conducted title and abstract, full-text assessment, data extraction and risk of bias assessment, and quality of articles. Random-effects models were used to estimate the pooled effect size and evaluated the overall quality of evidence. The sources of heterogeneity were assessed with I2. The Newcastle-Ottawa scale (NOS) was used to assess the methodologic quality of selected studies. The publication bias was assessed using funnel plots and Egger's test statistics. ResultsIn all, eight studies comprising 3150 patients were finally included in the final study analysis. Of these, pooled analysis of eight studies detecting association between anemia and BS for weight loss yield a statistically significant correlation (SMD −1.12 (−1.46—−0.78, I2=93%). Subgroup analyses were performed according to postoperative follow-up time and operation method. Before 24 months postoperatively, no patient had a significant decrease in hemoglobin. More than 24 months after BS, patients show a significant reduction in hemoglobin. In addition, the hemoglobin level was not changed after sleeve gastrectomy (SG) and adjustable gastric banding (AGB) (SMD −0.19 (−1.04—0.67, I2=0% for SG; SMD −0.30 (−0.82—0.22 for AGB), but the hemoglobin level was significantly reduced after Roux-en-Y gastric bypass (RYGB) (SMD −1.19 (−1.52—−0.87, I2=94.2%). ConclusionThis current meta-analysis found that at 24 months after RYGB, the patient's hemoglobin level was significantly reduced, increasing the risk of anemia. Therefore, attention should be paid to the occurrence of anemia after BS. A large, placebo-controlled, multi-center study is needed to clarify the role of BS for weight loss in this patient anemia.

Clinical interventions to break the obesity and cancer link: a narrative review.

Excess body weight is a significant risk factor for the development and recurrence of many types of cancer. Patients with a history or current diagnosis of cancer who are overweight or have obesity have an increased risk of cancer treatment-related morbidity, recurrence, and decreased quality of life. Weight loss and maintenance of a healthy body weight may reduce cancer morbidity and recurrence in cancer survivors. While guidelines for cancer survivorship elaborate sufficiently on lifestyle interventions, little guidance is provided when considering additional therapies like anti-obesity pharmacotherapy or bariatric surgery for weight loss. This review will highlight and address current recommendations and feasible interventions that clinicians may consider to further reduce the incidence and recurrence of cancer in patients with obesity.

How effective is bariatric surgery for long-term weight loss?

How effective is bariatric surgery for long-term weight loss?

A151 COVID-19 Pandemic, Sleep, Eating Behaviors and Bariatric Surgery Weight Loss Outcomes

A151 COVID-19 Pandemic, Sleep, Eating Behaviors and Bariatric Surgery Weight Loss Outcomes

A084 Pre-surgical psychological evaluation allows identification and correction of psychopathology that may affect post bariatric surgery weight loss

A084 Pre-surgical psychological evaluation allows identification and correction of psychopathology that may affect post bariatric surgery weight loss

“Abdominal panniculectomy: Identifying complications and potential risk factors”

The abdominal panniculectomy is a common procedure that patients choose to undergo for the purpose of restoring hygiene, reducing infection, and improving personal esthetic. A panniculectomy is often indicated after bariatric surgery, which defines a high-risk patient population. This study sought to better establish the association of known risk factors that can complicate the postoperative care of the panniculectomy patient, and whether or not bariatric surgery plays a role in the development of these complications. Patients that underwent a panniculectomy between 2010 and 2018 were identified in PearlDiver, a national insurance-claims database, and identified by CPT code 15,380. Patient demographics and associated medical problems were elucidated, and various complications were then identified. Descriptive statistics as well as a multivariate analysis were used to evaluate the association of risk factors and complications. A total of 8,282 panniculectomy patients were identified. Of these, 1,420 underwent bariatric weight loss surgery prior to their panniculectomy, whereas the remaining 6,869 underwent a panniculectomy alone. Obesity, tobacco use, and diabetes were significant in developing a surgical site infection, wound disruption, and the need to undergo reoperation. Charlson Comorbidity Index greater than one (CCI>1), male gender, age greater than 60, COPD, and HTN identified as potential risk factors in developing various complications. Although patients with prior weight loss surgery had a history significant for prior comorbidities, the overall postoperative complication rate was decreased compared to those who did not undergo preoperative bariatric surgery. In the face of the obesity epidemic, the incidence of undergoing a panniculectomy has increased significantly, particularly following bariatric surgery. Identifying potential risk factors in this patient population could better help identify postoperative complications following a panniculectomy and perhaps allow for targeted intervention and medical optimization prior to surgery.

Successful Robotic Sleeve Gastrectomy in a Patient with Left Ventricular Assist Device

<h3>Introduction</h3> Severe obesity is an absolute contra-indication to heart transplantation in patients with end stage heart failure. Left Ventricular Assist Devices (LVAD) can be used as a bridge to transplant, recovery or destination therapy. There is limited data in the literature evaluating sleeve gastrectomy in severely obese patients with LVADs. We present a patient who underwent successful bariatric surgery while on LVAD support. <h3>Case Report</h3> We present a 28-year-old female with history of class III Obesity (Body Mass Index of 55 kg/m²⁾, Heart Failure with reduced Ejection Fraction secondary to Postpartum Cardiomyopathy, who underwent HeartMate 3 left ventricular assist device implantation as destination therapy with the goal of bariatric surgery for weight loss and eventual bridge to transplant. Of note Patient post LVAD course was complicated by chronic re-current drive line infections, sternal wound infection, menorrhea, spontaneous subdural hematoma. Two years post LVAD patient was at a BMI of 44 kg/m². A multidisciplinary team was formed to formulate protocols and algorithms for Pre-Op, intra-Op and post Op care for LVAD patients undergoing bariatric surgery. The team was composed of Advanced Heart Failure, Bariatric and Cardio-thoracic surgery transplant ID, and Anesthesia. Guided by our multidisciplinary protocols, patient subsequently underwent successful robotic sleeve gastrectomy without any complications. <h3>Summary</h3> LVAD and robotic sleeve gastrectomy are both technically reasonable options for Advanced Heart Failure patients with severe obesity. LVAD permits cardiac support as bariatric surgery assists in efficacious weight loss. Together, they are a safe and effective treatment option that can bridge Advanced Heart Failure patients to heart Transplant candidacy. Decision to pursue LVAD and sleeve gastrectomy should incorporate a multidisciplinary team approach. Given the high prevalence of Obesity, this joint therapy has the potential to bridge many heart failure patients to transplant.

Trends in the Utilization of Intragastric Balloons: a 5-Year Analysis of the MBSAQIP Registry.

The use of intragastric balloons (IGBs) for the treatment of obesity was approved by the US Food and Drug Administration in 2015. This study aims to characterize preoperative factors and outcomes of patients undergoing IGB therapy compared to bariatric surgery (non-IGB) and evaluate 5-year trends in IGB use. A retrospective cohort study was performed by extracting data from the MBSAQIP registry between 2015 and 2019. All non-IGB and IGB procedures were included while revisional and emergency surgeries were excluded. Multivariable logistic regression analysis was used to determine independent predictors of patient selection for IGB therapy. Of 652,927 patients identified, only 2910 (0.4%) underwent IGB therapy. Patients who underwent IGB therapy were older (46.7 ± 11.4years vs 44.4 ± 12.0years; p < 0.0001), had lower BMI at baseline (37.0 ± 6.2kg/m2 vs 45.3 ± 7.8kg/m2; p < 0.0001), and were overall healthier with fewer comorbidities and better functional status. The rate of early nonoperative reintervention was higher in the IGB cohort (7.7% vs 1.1%; p < 0.0001). Age was the only significant predictor of selection for IGB therapy (OR 1.32; 95% CI 1.24-1.37; p < 0.0001). The number of IGB procedures reported between 2016 and 2019 declined significantly (953 (0.62%) vs 418 (0.25%); p < 0.0001). Appropriate indications for IGBs appear to be increasingly limited. The ongoing role of IGBs in the treatment of obesity is unclear given the safety and efficacy of modern bariatric surgery and new pharmacological agents for weight loss.

Recent Technical Developments in the Field of Laparoscopic Surgery: A Literature Review.

The benefits of laparoscopic surgery (LS) include a speedy recovery, shorter duration of hospital stay, minimal postoperative pain, discomfort and disabilities, and better cosmetic outcomes (less scarring) that help an individual to resume normal daily activities and return to work. A comprehensive literature search on laparoscopic surgeries was conducted using different Internet-based search engines and databases from August 2021 to October 2021. The search was limited to articles published in the English language and those published between years 2005 and 2021. A total of 126 articles were initially identified. Two independent reviewers thoroughly examined the quality and content of the articles. Articles with duplicate data were excluded, and the remaining articles were screened and assessed by the titles and abstracts. After a vigorous assessment, we included data from 49 articles for this review process. Bibliographic management was done using the software “EndNote” (Thomson Reuters, New York, NY, USA).It was concluded that LS has become the technique of choice for virtually every kind of abdominal surgery, evident by numerous scholarly publications in this field. Level I evidence demonstrating the advantage of LS over open surgery has been reported for numerous operations, including fundoplication for gastroesophageal regurgitation disease, bariatric surgery for weight loss, and cancer resection. Advanced LS has subsequently been expanded to include hepatectomy, pancreatectomy, urology, and gynecology. Patients who are at risk of having elevated abdominal pressure during LS, however, should proceed with care. Recent advances in natural orifice transluminal endoscopic surgery, single-incision laparoscopic surgery, and robot-assisted laparoscopic surgery are promising.

P-B03 Gastric Band Tubing Causing Small Bowel Obstruction

Abstract Background Laparoscopically adjustable gastric bands (LAGB) have been widely employed as a means of weight loss in bariatric surgery over the past two decades. Although now largely superseded by other bariatric surgical techniques, complications from gastric bands continue to be encountered in surgical practice. We report an unusual case of small bowel obstruction due to an internal hernia caused by gastric band tubing resulting in closed loop small bowel obstruction. This is not commonly encountered and emergency general surgeons need to have a high index of suspicion for this condition as a possible cause for small bowel obstruction. Methods A 40 year old male presented with abdominal pain, vomiting and failure to open bowels or pass flatus for nine days. Twelve years previously (2008) he had had Roux n Y gastric bypass (RYGB), followed by by laparoscopic gastric banding of the RYGB about two years later (2010) also in the private sector. He had a soft but distended abdomen, and empty rectum on rectal examination. CT scan abdomen reported as: Multiple loops of distended small bowel demonstrated. No air seen in rectum, indicative of small bowel obstruction. No pneumoperitoneum. There is dilatation of the mid and distal small bowel seen to an apparent transition point in the mid abdomen where a loop is noted associated with the tubing for the inflation device for the gastric band. This appears to be centred on the cause of obstruction and appears tied around the base of mesentery and may be creating a closed loop obstruction, by having created an internal hernia. This patient had an internal hernia around loop of the gastric band tubing with resultant closed loop small bowel obstruction. The patient underwent diagnostic laparoscopy with ileo-caecal resection and primary anastomosis. He made successful recovery. Deflated gastric band remains in-situ. Results While small bowel obstruction is most commonly due to adhesions in individuals who have had previous laparotomy, it is important to bear in mind other causes such as internal hernias particularly in cases of those with history of previous gastric banding or Roux n Y gastric bypass. Early intervention may be necessary to reduce the likelihood of bowel ischaemia and bowel resection. Laparoscopy is a useful tool in the management of small bowel obstruction. Keywords: gastric band, small bowel obstruction, closed loop, emergency surgery, laparoscopy Conclusions Connection tubing causing small bowel obstruction and colonic erosion as a rare complication after laparoscopic gastric banding: a case report. Liza BK Tan, Jimmy BY So, and Asim Shabbir - J Med Case Reports. 2012; 6: 9. Acute small bowel obstruction due to the connecting tube of a gastric band. Federico Oppliger, M.D. Gonzalo Wiedmaier, M.D. Juan. Published April 07 2017. https://doi.org/10.1016/j.soard.2014.03.021 An unusual complication of gastric banding: recurrent small bowel obstruction caused by the connecting tube. M A Zappa, E Lattuada, E Mozzi, M Francese, I Antonini, S Radaelli, G Roviaro. Obes Surg . 2006 Jul;16(7):939-41. doi: 10.1381/096089206777822250 Total small bowel herniation through the space between the connecting tube of gastric band and abdominal wall: A case report of a surgical emergency. Tarek Hashem, Soliman M Soliman, Sherif Wagih 2. Int J Surg Case Rep. 2017;30:66-68. doi: 10.1016/j.ijscr.2016.11.021. Epub 2016 Nov 17

O-B03 Bariatric Surgery in Patients Awaiting a Kidney Transplant - Systematic Review and Personal Experience from a High Volume Bariatric Centre

Abstract Background Morbid obesity in end stage renal disease (ESRD) is a barrier to kidney transplantation due to potential suboptimal post-transplant outcomes. Bariatric surgery is the most effective treatment for morbid obesity and has been shown to improve transplant eligibility through weight loss. There is no national UK guidance with regards to the role of bariatric surgery in patients requiring a kidney transplant. We present a decade of experience from a large NHS tertiary referral bariatric centre of performing bariatric surgery for weight loss in a cohort of high BMI ESRD patients. Methods A retrospective review was conducted of all patients undergoing bariatric surgery between 2007-2017. All patients with chronic kidney disease (CKD) at the time of bariatric surgery were identified. Patient records for those with CKD stage 4 and Stage 5 (or ESRD) were reviewed and data extracted for analysis. A systematic review was also conducted of reported experiences of bariatric surgery in CKD patients as a bridge to kidney transplantation. Results Of 3119 patients operated on in the identified period 22 were identified as having CKD at the time of surgery. Sleeve gastrectomy was the most commonly performed procedure. There was no recorded post-operative complications or 30-day mortalities. Median LOS was 4 days (range:2-6), pre-operative BMI 45 (Range:37-69), 12m post-op excess weight loss 17.3±14.4%, final EWL 22.3±14.8% at 32 months follow-up (Range: 6-52). 57% were subsequently transplant wait listed, 28% proceeded to transplantation 18.5months after listing (Range:7-30months). Systematic review of 15 studies suggests bariatric surgery in these patients is safe and facilitates 1/4 of patients being listed and transplanted. Conclusions Experience from a large UK NHS bariatric centre shows weight-loss surgery in high BMI patients with CKD4/5 is safe, with minimal peri-operative morbidity and mortality. 1 in 2 patients proceeded to being listed for transplantation, and 1 in 3 progressed to transplantation. We should consider formalising the role of bariatric surgery in the pre-listing workup of high BMI ESRD patients in the UK to give all patients equal chances for transplantation.

Postprandial hypoglycemia after upper gastrointestinal tract surgery: prevalence and pathophysiology (part 1)

Nowadays obesity is a major health problem worldwide. Surgery is the most promising treatment for morbid obesity. There are two types of bariatric procedures, one to reduce the food intake volume and the other to limit the absorption of nutrients. Despite the indisputable advantages of bariatric surgery for weight loss, it is necessary to remember the potential risk of severe complications, such as hypoglycemic syndrome at 2 to 3 hours after ingestion of rapidly absorbable carbohydrates manifested by adrenergic and neuroglycopenic symptoms. According to the literature, the prevalence of post-bariatric postprandial hyperinsulinemic hypoglycemia (PHH) varies from 10% to 75%. PHH in post-bariatric patients should be differentiated from the syndrome of non-insulinoma pancreatogenic hypoglycemia and from insulinoma; however, these diseases are described also in patients after bariatric surgery.The mechanisms of PHH as an outcome of shunting bariatric procedures are currently not fully clear. According to the recent studies, incretin hypersecretion in response to the accelerated flow of carbohydrates into the small intestine plays a leading role in the inappropriate excess production of insulin by the pancreas. In addition, there are hypotheses on a slower normalization of insulin production during more rapid bodyweight decrease and regression of insulin resistance, the role of alpha-cell dysfunction, disturbed negative feedback between insulin and ghrelin, compensatory hyperplasia and hypertrophy of the remaining enterocytes (including L-cells), changes in gut microflora, bile acids level and composition. A number of other mechanisms have also been proposed that require further studies.

Percutaneous gastrostomy tube placement in a patient with prior sleeve gastrectomy

Sleeve gastrectomies have quickly become the most common bariatric weight loss surgery performed in the United States (U.S.). Given that hundreds of thousands of gastrostomy tubes (G tubes) are also placed each year, the number of patients with prior sleeve gastrectomies requiring a G tube will surely rise in the coming years. The case presented herein is a patient with prior sleeve gastrectomy who underwent percutaneous G tube placement.