Types Of Bariatric Surgery Research Articles

FEATURES OF MANIFESTATION OF NONALCOHOLIC STEATOHEPATITIS IN OBESE PATIENTS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY

The state of energy starvation is the main phenomenon of the early postoperative period of bariatric surgery. All organs and systems of the body undergo such changes. Under normal physiological conditions, with the development of energy hunger, there is an excitation of metabolic centres in the hypothalamic-pituitary system of the brain. Transmitted impulses from chemoreceptor cells increase lipolysis, which ultimately leads to the mobilisation of large amounts of fatty acids from the fat depot to the liver. Excessively high concentrations of ketone bodies due to rapid weight loss are accompanied by the development of ketonemia, the severity of which depends not only on the compensatory capabilities of the body but also on the condition of the liver. Ketonemia is one of the common side effects reported by patients after bariatric surgery. Despite this, the evidence for the incidence of ketonemia after various bariatric surgeries and the mechanism of the development of this phenomenon is very limited. In this regard, this scientific article is devoted to the features of the manifestation of ketonemic syndrome in obese patients after the most popular type of bariatric surgery - laparoscopic longitudinal resection of the stomach.

Clinical evidence of low-calorie and ketogenic nutrological therapy before, during and after bariatric surgery: a systematic review

Introduction: Obesity is a multifactorial disease that causes serious comorbidities. There are more than 2.2 billion overweight and obese people in the world. Obese patients tend to be predisposed to micronutrient deficiency even before bariatric surgery, therefore, it is imperative to supplement nutrients orally, enterally, or parenterally, according to the indications of each patient. Objective: It was highlighted the importance of low-calorie and ketogenic nutritional therapy before, during, and after bariatric surgery through the systematic analysis of clinical studies. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 119 articles were found. A total of 40 articles were fully evaluated and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with a high risk of bias and 27 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X2=76.5%>50%. It was concluded that nutrological therapy strategies could represent a possible alternative to other methodologies, especially when it is recommended to improve patient adherence to following the prescribed diet before bariatric surgery. Weight loss induced by the ketogenic diet before bariatric surgery has beneficial effects on reducing liver volume, metabolic profile, and intra- and postoperative complications. Knowledge of the type of bariatric surgery performed and an understanding of its anatomy and physiology are useful to provide optimal care to patients, especially in nutritional complications. Nutritional deficiencies and metabolic disorders result from “malabsorption” procedures such as RYGB. Immediate administration of thiamine is essential. Dextrose should be avoided in intravenous hydration until thiamine is adequately replaced. For all bariatric patients, a protein intake of 60-70 g/d and a multivitamin with iron and vitamin B12 supplementation is recommended. Daily calcium and vitamin D supplementation is also encouraged. In addition, serum micronutrient levels should be monitored regularly and additional supplementation should be prescribed as indicated.

The trend of atherogenic indices in patients with type 2 diabetes after bariatric surgery: a national cohort study

BackgroundBariatric surgery has profound effects on weight loss, metabolic regulation, and gut hormone modulation, which make it an efficient tool for managing obesity and improving diabetes outcomes. ObjectivesThe objective of this study is to evaluate the atherogenic indices, including atherogenic index of plasma (AIP), atherogenic coefficient (AC), Castelli’s risk index II (CRI-II), and lipoprotein combine index (LCI) in individuals with type 2 diabetes (T2D) living with excess weight, who have undergone bariatric surgery. SettingThree types of surgery including one-anastomosis gastric bypass/mini gastric bypass (OAGB/MGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) were performed on patients with obesity and T2D in the period of August 2009 to February 2021, and the patients were followed up for 2years in 5 different visits at baseline (preoperative), 3 months, 6 months, 12 months, and 24 months after the surgery. MethodsIn this retrospective cohort, 1246 individuals with obesity and T2D who underwent 3 types of bariatric surgery including RYGB, SG, and OAGB/MGB were studied for 2years after the surgery; the data were derived from the National Iranian Obesity Surgery Database. Afterward, the trend of biochemical parameters, total weight loss (TWL%), and atherogenesis-related indices were evaluated from baseline up to 2years in 5 follow-up visits. ResultsA total of 1246 patients with T2D and obesity who underwent bariatric surgery were included in this study. The trend of all atherogenesis-related indices, including AIP, LCI, CRI-II, and AC, showed a significant reduction (49.2%, 53.4%, 20.8%, 22%, respectively) 2years after the bariatric surgery (P < .05). In the 6-month follow-up, 1-year follow-up, and 2-year follow-up, 1023 (83.10%), 719 (57.70%), and 341 (27.36%) individuals participated, respectively. In addition, a significant increase in high-density lipoprotein cholesterol levels was observed 2years after the surgery in both sexes (P < .05). ConclusionsThe bariatric surgery significantly reduced the levels of atherogenic indices including AIP, CRI-II, LCI, and AC.

The Effectiveness of Bariatric Surgery on Treating Infertility in Women-A Systematic Review and Meta-Analysis.

Background/Objectives: Obesity is a growing global health concern, which increases the risk of various diseases and has seen a rising prevalence over time. The global prevalence of obesity among adults has doubled over time. Obesity significantly impacts health by increasing the risk of a range of severe medical conditions. Cardiovascular diseases, such as heart attacks and strokes, are more prevalent in individuals with obesity due to factors like high blood pressure and abnormal cholesterol levels. This systematic review and meta-analysis sought to establish the effectiveness of bariatric surgery in treating infertility in women. Methods: This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A broad electronic search was conducted through PubMed, Web Science, and Medline databases for studies published between April 2017 and October 2023. The search strategy used the following terms: bariatric surgery, metabolic surgery, bariatric surgical procedures, stomach stapling, infertility, and fertility issues. The data were analyzed using the Revman version 5.1.2 software. Results: The results of the study show that despite the heterogeneity found in the studies, irregular menstrual cycles were found to reduce significantly in patients who underwent bariatric surgery (p = 0.01), with an RR of 0.22, at a 95% CI (0.06, 0.74). With regards to infertility, the results indicate that bariatric surgery reduced the level of infertility among the patients significantly (p = 0.00001), with an RR of 0.55, at a 95% CI (0.45, 0.68). Further, the results show bariatric surgery reduced rate of miscarriages among patients (p = 0.01), with an RR of 0.51, at a 95% CI (0.30, 0.86). Moreover, bariatric surgery reduced the level of congenital malfunction, but the effect was not statistically significant (p = 0.16), with an RR of 0.39, at a 95% CI (0.10, 1.45). However, the overall effect of bariatric surgery on treating infertility was found to be significantly effective (p = 0.0001), with an RR of 0.54, at a 95% CI (0.43, 0.68). This implies that bariatric surgery helps in weight loss, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. Conclusions: This study found that bariatric surgery helps infertile women of a reproductive age to lose weight, which improves ovulatory dysfunction and irregular menstruation while boosting spontaneous conception. On the other hand, the study noted that after bariatric surgery, spontaneous conception can occur because of a decreased rate of miscarriage, increased fertility, reduced levels of congenital malfunction, and the restoration of regular menstrual cycles. Therefore, this study highlights the need to offer adequate preconception care and counselling to women who are about to be pregnant, both before and after bariatric surgery. Further, based on the fact that this study focused on general bariatric surgery, future research should focus on specific types of bariatric surgery to establish the most effective type of bariatric surgery in treating infertility in women.

Routine Histopathology in Laparoscopic Sleeve Gastrectomy Over 10 Years.

Laparoscopic sleeve gastrectomy (LSG) is one of the world's most commonly performed types of bariatric surgery. Routine histopathology of the surgical specimen is undertaken at most institutions, regardless of the lack of clinical suspicion of any sinister pathology. We evaluated the histopathology reports of LSG cases done for morbid obesity at our hospital over 10 years to determine the distribution of gastric changes and the prevalence of Helicobacter pylori infection in these specimens. A retrospective study was conducted. All LSGs performed at Shifa International Hospital, Islamabad,Pakistan, from July 1, 2014, to June 30, 2024, were assessed. A total of 538 cases were included. Histopathology reports were reviewed for all these patients, and the histopathological diagnosis and the presence or absence of H. pylori infection were recorded. The mean age was 36.9 ± 11.4 years. There were 201 (37.4%) males. No abnormality was found in 105 (19.5%) cases. Gastritis was present in 433 (80.5%) cases. Intestinal metaplasia was present in eight (1.5%) cases in a background of gastritis. There were no cases of gastric atrophy or dysplasia. There was one case of submucosal lipoma (0.2%) and one case of gastrointestinal stromal tumor (GIST) (0.2%). Both cases were associated with gastritis. H. pylori infection was present in 140 (26.0%) cases. All of these were associated with gastritis. Among the gastritis cases, 319 (73.7%) had chronic gastritis, while 114 (26.3%) had both active and chronic gastritis. The severity of gastritis, as designated by the histopathologist in their report, was minimal in 24 (4.5%) cases, mild in 228 (42.4%), moderate in 176 (32.7%), and severe in five (0.9%). There was one case of granulomatous gastritis (non-caseating) (0.2%). There was no difference in the prevalence of gastritis or H. pylori infection based on age or gender. Histopathological examination of the LSG specimen revealed a very high prevalence of gastritis, with normal findings in less than a fifth of all cases. The prevalence of H. pylori infection (26.0%) is much higher in comparison to other studies. Routine histopathology of LSG specimens should continue to be performed in every case.

Pregnancy and offspring outcomes after prepregnancy bariatric surgery

BackgroundBariatric surgery is internationally performed as a treatment option in obesity to achieve significant and sustained weight loss. There is an increasing number of women having pregnancies after bariatric surgery with mixed maternal and fetal outcomes, with a limited number of large, matched studies. ObjectiveThis study aimed to describe the type of pre-pregnancy bariatric surgery, to analyse maternal, pregnancy and offspring outcomes compared to matched women and to assess the impact of pre-pregnancy bariatric surgery on fetal growth, particularly proportions of small for gestational (SGA) and large for gestational age (LGA). Study DesignA statewide hospital and perinatal data register linked cross-sectional matched study was performed. In total, n=2,018 births in n=1,677 women with pre-pregnancy bariatric surgery were registered between 2013 and 2018, of those n=1,282 were included and analysed with 1:10 to age, parity, smoking status and Body Mass Index (BMI) matched women without bariatric surgery. The first singleton pregnancy following bariatric surgery for each woman was used for analysis. Pregnancy and neonatal outcomes from International Statistical Classification of Diseases Tenth revision codes (ICD-10AM) and neonatal birth records for outcomes of interest were analysed. Multivariable logistic regression was used to estimate the association between SGA and LGA and pre-pregnancy bariatric surgery. ResultsOf the n=1,282 women, 93% had undergone laparoscopic sleeve gastrectomy. Offspring had lower absolute birthweight (3223g ± 605g vs 3418g ± 595g; p<0.001), fewer LGA (8.6% vs 14.1%; p<0.001) and more SGA infants (10.7% vs 7.3%; p<0.001) than offspring born to matched women. Offspring were more likely to be born preterm (10.5% vs 7.8%; p=0.007) to mothers with pre-pregnancy bariatric surgery. Fewer women with previous bariatric surgery were diagnosed with GDM (15% vs 20%; p<0.001) or pregnancy induced hypertension (3.7% vs 5.4%; p=0.01). In the adjusted model, pre-pregnancy bariatric surgery was associated with a lower risk of LGA (OR 0.54, 95% CI 0.44-0.66) and higher risk of SGA (OR 1.78, 95% CI 1.46-2.17). ConclusionsThese data suggest that pre-pregnancy bariatric surgery was associated with a reduction in several obesity related pregnancy complications at the expense of more pre-term births and SGA offspring.

Changes in Fat Mass Index and Fat-Free Mass Index Vary Significantly by Age and Sex of the Patient, and by Type of Bariatric Surgery.

The loss of fat-free mass after rapid weight loss following bariatric surgery shows BMI is inadequate for reporting weight loss, emphasizing the need for a more accurate body composition metric. This study assessed changes in fat mass index (FMI), fat-free mass index (FFMI), and dietary intake over 6months after one-anastomosis gastric bypass (OAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) across age and sex groups. This prospective observational study included 151 bariatric surgery candidates. Data on demographics, anthropometric, body composition, and food intake data were collected before and 6months after surgery. SPSS version 22 was used for analysis, employing ANOVA and t-tests to assess group differences. Younger patients (≤ 35years) had higher percent total and excess weight loss (%TWL and %EWL) across all bariatric surgeries, and those undergoing SG experienced more favorable changes in fat-free mass (FFM) and visceral fat compared to other procedures (P = 0.002). Males had higher percent change in fat mass index (%∆ FMI) and visceral fat than females with OAGB and RYGB (P < 0.05). Women undergoing SG and RYGB had a more significant decrease in energy intake compared to OAGB (P < 0.001), and the ≤ 35 and 35-44 age groups demonstrated lower reductions in energy intake following OAGB. Age, sex, and surgery type significantly affect bariatric surgery outcomes. Younger patients achieved greater weight-related improvements, while men undergoing RYGB experienced more substantial fat mass changes than women.

Online Search Trends Related to Bariatric Surgery and Their Relationship with Utilization in Australia

PurposeThere is an abundance of online information related to bariatric surgery. Patients may prefer a specific type of bariatric surgery based on what they read online. The primary aim of this study was to determine online search trends in bariatric surgery over time in Australia and worldwide. The secondary aim was to establish a relationship between public online search activity and the types of bariatric surgery performed in Australia.Materials and MethodThe terms “adjustable gastric band,” “sleeve gastrectomy,” and “gastric bypass surgery” were submitted for search volume analysis in Australia and worldwide using the Google Trends “Topic” search function. This was compared alongside the numbers of gastric bandings, sleeve gastrectomies, and gastric bypass surgeries performed in Australia over time to determine if there was a relationship between the two.ResultsSearch trends for “adjustable gastric band” and “sleeve gastrectomy” in Australia were similar to trends seen worldwide. However, search trends for “gastric bypass surgery” differ between Australia and the rest of the world. It took at least a year for online searches to reflect the higher number of sleeve gastrectomies performed relative to gastric bandings. There was a lag time of over four years before online searches reflected the higher number of gastric bypass surgery performed compared to gastric banding.ConclusionSearch interests in Australia and worldwide were similar for gastric banding and sleeve gastrectomy but different for gastric bypass surgery. Online search activity did not have a significant association with the types of bariatric surgery being performed in Australia.Graphical

Bariatric Surgery in Patients with Previous Cardiac Revascularization: Review of Literature.

Background: The diet and physical activity of the world's population determine the increase in the number of bariatric surgeries. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy (LSG) and Roux-Y gastric bypass (RYGB). Surgical interventions are carried out in patients with numerous comorbidities, among which the most common are cardiovascular diseases. The aim of the present study was to review the literature regarding the safety and results of surgical treatment in patients with cardiac revascularization prior to surgery. Methods: We performed an online search in Pubmed in September 2023 to identify articles that reported cardiac revascularization prior to bariatric surgery. The extracted information included details of the working method, number of patients, types of cardiovascular disease-heart failure (HF) and cardiac artery disease (CAD), types of revascularization-coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or both CABG + PCI, demographic data (age, gender, race), clinical characteristics (body mass index-BMI, smoking status), comorbidities (diabetes mellitus, hypertension, prior myocardial infarction), postoperative complications, and postoperative results. Results: A total of 171 records were identified by the initial search, and 165 papers were excluded after applying the exclusion criteria (types of cardiovascular disease, types of revascularization, and demographic data). We evaluated a group of 9479 patients of which 730 had HF, 2621 CAD, and 1426 underwent prior cardiac revascularization. The analysis of the demographic data showed an average age of 55.5 years and a fluctuation of the male gender between 39% and 71.1%, and the female gender between 28.9% and 61%. The main types of bariatric interventions were RYGB (3659 cases) and LSG (659 cases), to which adjustable gastric band (AGB) and bilio-pancreatic diversion-duodenal switch (BPD-DS) were added. Among the most postprocedural complications were ST-segment elevation myocardial infarction (2 patients), gastro-intestinal bleeding (51 cases), pulmonary embolism (1 patient), arrhythmia (3 patients) and pacemaker insertion (1 patient). The recorded postoperative mortality rate was 0.42% (6 cases). Conclusions: Bariatric surgery remains safe in patients with cardiac revascularization. These finding need to be confirmed in more large-scale randomized trials.

Precise nutrition in the metabolic and nutritional management of bariatric surgery: a systematic review

Introduction: Obesity is a chronic relapsing disease characterized by abnormal or excessive adiposity with health risks. Any nutritional intervention in patients who are candidates for or have already undergone bariatric surgery must be based on a detailed nutritional assessment, including an assessment of personal values, preferences, and social determinants of eating habits. Objective: It was to carry out a systematic review to explore and present nutritional importance before, during, and after bariatric surgery. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 122 articles were found. A total of 43 articles were evaluated in full and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=64.5%&gt;50%. It was concluded that enteral nutrition strategies could represent a possible alternative to other methodologies, especially when it is recommended to improve patient adherence to the diet prescribed before bariatric surgery. Weight loss induced by the ketogenic diet before bariatric surgery has beneficial effects in reducing liver volume, metabolic profile, and intra- and postoperative complications. Knowledge of the type of bariatric surgery performed and an understanding of its anatomy and physiology help provide optimal care to patients, especially nutritional complications. Nutritional deficiencies and metabolic disorders result from “malabsorption” procedures, such as RYGB. It is essential to immediately administer thiamine. Dextrose should be avoided in intravenous hydration until thiamine is adequately replaced. For all bariatric patients, a protein intake of 60-70 g/d and multivitamin with iron and vitamin B12 supplementation is recommended. Daily calcium and vitamin D supplementation is also encouraged. Additionally, serum micronutrient levels should be monitored regularly and additional supplemental measures prescribed as indicated.

The association of bariatric surgery and carpal tunnel syndrome: A propensity score-matched cohort study

ObjectivesTo test the hypothesis that weight loss following bariatric surgery is associated with a reduced risk of developing carpal tunnel syndrome (CTS) when compared to obese patients who do not undergo bariatric surgery. MethodsWe performed a cohort study using data from Swedish nationwide healthcare registries. Patients aged 18-79 years who underwent bariatric surgery 2006-2019 were propensity score (PS)-matched to up to 2 obese bariatric surgery-free patients (“unexposed patients”). Cox proportional hazard regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CIs) to compare the incidence of CTS among bariatric surgery patients to obese unexposed patients both overall and divided by subgroups of age, sex, bariatric surgery type, and duration of follow-up. Results40,619 bariatric surgery patients were PS-matched to 63,540 obese unexposed patients who did not undergo surgery. Bariatric surgery was not associated overall with CTS (HR 0.98, 95% CI 0.91-1.05). There was a 23% decreased risk of CTS incidence observed within >1-3 years after bariatric surgery (HR 0.77, 95% CI 0.68-0.88). Decreased CTS risks were observed among bariatric surgery patients aged 18-34 years (HR 0.87, 95% CI 0.74-1.01) and those who underwent sleeve gastrectomy (HR 0.81, 95% CI 0.63-1.03), but these risks did not reach significance compared to obese unexposed patients. However, there was a 20% increased CTS risk after 6 years (HR 1.20, 95% CI 1.05-1.36). ConclusionOur results suggest that marked weight does not have a lasting impact in the reduction of CTS incidence.

960 Quality of Life Outcomes of Metabolic and Bariatric Surgery Tourism: A Single-Centre Survey-Based Study

Abstract Global obesity affects one in three adults, prompting increased demand for metabolic and bariatric surgery (MBS). Despite its effectiveness, limited access to MBS has led to more people seeking it through medical tourism for lower costs and shorter wait times. However, ethical concerns arise due to limited follow-up care and potential complications. This study compares the quality of life (QOL) of native MBS patients (n = 69) to those engaged in MBS tourism (n = 36) from 11 different countries, utilizing the Bariatric Quality of Life Index (BQLI). Conducted in Lahore, Pakistan, with 105 participants who had MBS in the last 3 years, the survey-based study aims to assess the impact of MBS tourism on QOL and the efficacy of bariatric surgery for weight loss. The study revealed no significant difference in the quality of life between MBS tourism participants and native patients (p &amp;gt; 0.05). Both cohorts experienced considerable weight reduction post-MBS (p = 0.00001). A higher total weight loss percentage (TWL%) correlated positively with increased BQLI scores (p = 0.01). Younger patients experienced significantly improved quality of life after MBS compared to their older counterparts (r = -0.3, p = 0.005). The TWL% exhibited a progressive increase as the months advanced post-MBS (r =0.3, p = 0.004). The type of bariatric surgery (SG, RYGB, OAGB, SADI) didn't significantly affect post-MBS quality of life (p &amp;gt; 0.05).

Observations of Ramadan fasting in the initial year after bariatric surgery

BackgroundRamadan is considered to be the holiest month of the Islamic religion. Hundreds of millions of Muslims practice the commitments of Ramadan, which include the abstinence from eating and drinking during daylight hours. Although there are exemptions to fasting for medical reasons, there is very limited guidance in terms of the safety of fasting in the postoperative period after bariatric surgery. ObjectivesTo assess outcomes and impact of fasting on patients who underwent bariatric surgery within the year leading up to Ramadan 2023. SettingCommunity hospital health system. MethodsRetrospective review of medical records and direct patient contact for 376 study participants. ResultsOf the 376 participants who underwent bariatric surgery in the year before Ramadan, only 8 patients (2.1%) reported they did not intend to fast during Ramadan. Patients who ended up having to break fasting were closer to their surgery date, at 4.3 months from surgery, than patients who were able to fast for the entire month of Ramadan, who were 5.1 months out from surgery. There was no difference between the number of patients needing to break fasting on the basis of what type of bariatric surgery they had performed. The number of patients needing to go to the emergency department and receive intravenous fluids was small, at 11 patients (2.9%), and these patients were also closer to surgery than those not needing to go to the emergency department or receive intravenous fluids. Side effects experienced during Ramadan, including abdominal pain, nausea/vomiting, and hypoglycemia, were more common in patients that were closer to their surgery, notably within 4 months of their surgery date. Patients who lost weight during Ramadan were closer to their surgery date at 4.9 months from surgery compared with those who maintained or gained weight, who were 7.0 months out from surgery. ConclusionsThere are a limited number of studies examining the safety and patient outcomes in those who fast for religious purposes after bariatric surgery. In this study, 376 participants who were within 1 year of undergoing surgery were followed throughout the month of Ramadan. Patients closer to surgery were more likely to break fasting, present to the emergency department, and experience side effects. However, the overall rate of complications was low, suggesting that fasting in the setting of a religious tradition in the carefully chosen patient with counseling and supervision may be a safe option.

Gut hormone multi-agonists for the treatment of type 2 diabetes and obesity: advances and challenges.

The rapidly rising incidence of obesity, coupled with type 2 diabetes mellitus (T2DM), is a growing concern. Glucagon-like peptide 1 (GLP-1), an endogenous peptide secreted by enteroendocrine L-cells, demonstrates exceptional pharmacological potential for the treatment of T2DM and obesity, primarily through its pivotal roles in regulating glucose homeostasis, stimulating glucose-dependent insulin secretion, and promoting satiety. Considering its proven efficacy in glucoregulation and weight loss, GLP-1 receptor agonists (GLP-1RAs) have emerged as a revolutionary breakthrough in the arena of diabetes management and weight control. Additional gastrointestinal hormones, such as glucose-dependent insulinotropic peptide (GIP) and glucagon, exhibit structural similarities to GLP-1 and work synergistically to lower blood glucose levels or aid in weight loss. Today, various classes of gut hormone receptor multiple agonists are steadily progressing through development and clinical trials, including dual GLP-1/glucagon receptor agonists (first discovered in 2009), dual GLP-1/GIP receptor agonists (first described in 2013), and triple GLP-1/GIP/glucagon receptor agonists (initially designed in 2015). The GLP-1/GIP receptor co-agonist, tirzepatide, was approved by the U.S. Food and Drug Administration (FDA) for the treatment of T2DM, outperforming basal insulin or selective GLP-1RAs by providing superior HbA1c reductions. Remarkably, tirzepatide also facilitated unprecedented weight loss of up to 22.5% in non-diabetic individuals living with obesity. This result is comparable to those achieved with certain types of bariatric surgery. Therefore, the advent of gut hormone multi-agonists signifies the dawn of an exciting new era in peptide-based therapy for obesity and T2DM. This review offers a comprehensive summary of the various types of gut hormone multiple agonists, including their discovery, development, action of mechanisms, and clinical effectiveness. We further delve into potential hurdles, limitations, and prospective advancements in the field.

Efficacy of Omentopexy on Complications of Laparoscopic Sleeve Gastrectomy

BackgroundLaparoscopic sleeve gastrectomy (LSG) is a commonly performed type of bariatric surgery. Early complications of LSG include bleeding, leakage, pulmonary embolism, and surgical site infections. Most surgeons try to implement preventive methods, such as omentopexy. Staple line-imbrication, which has a difficult learning curve, often prevents complications. This study aimed to evaluate the effect of omentopexy on patients with imbricated LSG.Material and MethodsThe study applied a retrospective data analysis design to patients who underwent LSG between 2020 and 2023. All patients’ staple lines were imbricated, and patients were then divided into two groups: omentopexy group and control group. Patients’ demographic features, such as age, gender, height, weight, body mass index(BMI), bleeding, leakage, and reoperations, were recorded and examined retrospectively.ResultsA total of 1356 patients were included in the study (540 in omentopexy, 816 in control), of which the mean age was 37.9 ± 10.5 years, 82.3% were women, and mean BMI was 40.9 ± 5.8 kg/m2. The mean bleeding rate was 1.0% (1.3–0.7%), the mean leakage rate was 0.2% (0.2–0.2%, respectively), and the mean reoperation rate was 0.6% (0.7% and 0.5%, respectively). No statistically significant differences were observed.ConclusionOmentopexy is a technique that is widely used to prevent staple line complications. According to our study, omentopexy applied to an imbricated stapler line increased the operation time but did not affect bleeding or leakage ratios. This is the first study to evaluate the effect of omentopexy on imbricated staple lines. The findings of the study indicate that omentopexy has no additional benefit on early complications when using staple-line imbrication.Graphical

Characterization of the plasma metabolome and lipidome in response to sleeve gastrectomy and gastric bypass surgeries reveals molecular patterns of surgical weight loss

ObjectivesBariatric surgery improves metabolic health, but the underlying mechanisms are not fully understood. We analyzed the effects of two types of bariatric surgery, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), on the plasma metabolome and lipidome. MethodsWe characterized the plasma metabolome (1268 metabolites) and lipidome (953 lipids) pre-operatively and at 3 and 12 months post-operatively in 104 obese adults who were previously recruited to a prospective cohort of bariatric surgery. The metabolomic and lipidomic responses to bariatric surgery over time were analyzed using multivariable linear mixed-effects models. ResultsThere were significant changes in multiple metabolites and lipids, including rapid early changes in amino acid and peptide metabolites, including decreases in branched-chain amino acids (BCAAs), aromatic AAs, alanine and aspartate, and increases in glycine, serine, arginine and citrulline. There were also significant decreases in many triglyceride species, with increases in phosphatidylcholines and phosphatidylethanolamines. There were significant changes in metabolites related to energy metabolism that were apparent only after 12 months. We observed differences by bariatric surgery type in the changes in a small number of primary and secondary bile acids, including glycohyocholate and glyco-beta-muricholate. ConclusionsOur findings highlight the comprehensive changes in metabolites and lipids that occur over the 12 months following bariatric surgery. While both SG and RYGB caused profound changes in the metabolome and lipidome, RYGB was characterized by greater increases in bile acids following surgery.

Effects of intestine-specific deletion of FGF15 on the development of fatty liver disease with vertical sleeve gastrectomy.

Vertical sleeve gastrectomy (SGx) is a type of bariatric surgery to treat morbid obesity and metabolic dysfunction-associated steatotic liver disease (MASLD). The molecular mechanisms of SGx to improve MASLD are unclear, but increased bile acids (BAs) and FGF19 (mouse FGF15) were observed. FGF15/19 is expressed in the ileum in response to BAs and is critical in not only suppressing BA synthesis in the liver but also promoting energy expenditure. We hypothesized the reduction of obesity and resolution of MASLD by SGx may be mediated by FGF15/19. First, we conducted hepatic gene expression analysis in obese patients undergoing SGx, with the results showing increased expression of FGF19 in obese patients' livers. Next, we used wild-type and intestine-specific Fgf15 knockout mice (Fgf15ile-/-) to determine the effects of FGF15 deficiency on improving the metabolic effects. SGx improved metabolic endpoints in both genotypes, evidenced by decreased obesity, improved glucose tolerance, and reduced MASLD progression. However, Fgf15ile-/- mice showed better improvement compared to wild-type mice after SGx, suggesting that other mediators than FGF15 are also responsible for the beneficial effects of FGF15 deficiency. Further gene expression analysis in brown adipose tissue suggests increased thermogenesis. FGF15 deficiency, the larger BA pool and higher levels of secondary BAs may increase energy expenditure in extrahepatic tissues, which may be responsible for improved metabolic functions following SGx.

The proteomic profile is altered but not repaired after bariatric surgery in type 2 diabetes pigs

To reveal the sources of obesity and type 2 diabetes (T2D) in humans, animal models, mainly rodents, have been used. Here, we propose a pig model of T2D. Weaned piglets were fed high fat/high sugar diet suppling 150% of metabolizable energy. Measurements of weight gain, blood morphology, glucose plasma levels, cholesterol, and triglycerides, as well as glucose tolerance (oral glucose tolerance test, OGTT) were employed to observe T2D development. The histology and mass spectrometry analyses were made post mortem. Within 6 months, the high fat-high sugar (HFHS) fed pigs showed gradual and significant increase in plasma triglycerides and glucose levels in comparison to the controls. Using OGTT test, we found stable glucose intolerance in 10 out of 14 HFHS pigs. Mass spectrometry analysis indicated significant changes in 330 proteins in the intestine, liver, and pancreas of the HFHS pigs. These pigs showed also an increase in DNA base modifications and elevated level of the ALKBH proteins in the tissues. Six diabetic HFHS pigs underwent Scopinaro bariatric surgery restoring glycaemia one month after surgery. In conclusion, a high energy diet applied to piglets resulted in the development of hyperlipidaemia, hyperglycaemia, and type 2 diabetes being reversed by a bariatric procedure, excluding the proteomic profile utill one month after the surgery.

Nutritional assessment among patients undergoing bariatric surgeries

Background Bariatric surgery is currently the most effective treatment for morbid obesity. It aims to reduce dietary intake; it could lead to nutritional deficiencies as a consequence of decreased oral intake or decreased absorption of nutrients. Aim To assess the nutritional status of patients undergoing bariatric surgeries. Design A descriptive exploratory research design was utilized in the current study. Sample A convenient sample of 60 adult male and female patients who performed bariatric surgeries was enrolled in the current study within 1 year. Tools Two tools were utilized to collect data: Personal &amp; Medical data Form and Nutritional Assessment Form. Results The age of the study sample ranged between 19 to more than 50 years old, with a mean age of 36.81±10.09 years. There were 86.7% females, 73.3% married, and 71.7% performed gastric sleeve. There was a statistical significant difference in BMI (χ 2=35.29, P=0.000). Also, there were statistically significant differences in macronutrient and micronutrient consumption of recommended dietary allowances (P=0.000) among the study sample before surgery and after 1 and 3 months of surgery also, most of them complained of gastrointestinal tract upset and change in nutritional status beside micronutrient and macronutrient disturbance. Conclusion There were changes in the nutritional status 1 and 3 months after bariatric surgery. Recommendations Further studies should be conducted to assess and compare long-term follow-up nutritional status among different types of bariatric surgeries.

Effect of bariatric surgery on metabolism in diabetes and obesity comorbidity: Insight from recent research

Obesity is a prevalent cause of diabetes mellitus (DM) and is a serious danger to human health. Type 2 DM (T2DM) mostly occurs along with obesity. Foodborne obesity-induced DM is caused by an excessive long-term diet and surplus energy. Bariatric surgery can improve the symptoms of T2DM in some obese patients. But different types of bariatric surgery may have different effects. There are some models built by researchers to discuss the surgical procedures’ effects on metabolism in diabetes animal models and diabetes patients. It is high time to conclude all this effects and recommend procedures that can better improve metabolism.