Bariatric Surgery Techniques Research Articles

Bone loss after bariatric surgery is observed mainly in the hip trabecular compartment and after hypoabsorptive techniques

We evaluated the impact of bariatric surgery on bone mineral density (BMD) and microarchitecture over one year using dual-energy X-ray absorptiometry (DXA), the trabecular bone score (TBS), and 3D-DXA to assess changes after different surgical techniques. This prospective, single-center study of 153 patients with severe obesity contrasts the effects on bone health of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch/single anastomosis duodeno-ileostomy with sleeve gastrectomy (DS/SADIS). To our knowledge, this is the first study to evaluate patients undergoing DS/SADIS and to incorporate 3D-DXA analysis in the assessment of bone loss.Patients were 81 % female with a mean age of 50 ± 9 years. Fifty-four per cent underwent SG; 16 %, RYGB; and 30 %, DS/SADIS. Our findings revealed a significant decrease in areal BMD at the LS (−3.49 ± 5.44 %), FN (−5.24 ± 5.86 %), and TH (−8.06 ± 5.14 %) one year after bariatric surgery. Bone microarchitecture at the LS assessed by TBS was degraded in 30 % of patients. Proximal femur 3D-DXA analysis showed that surgery-induced bone loss predominantly affects the trabecular compartment (Trabecular volumetric (v) BMD: −8.00 ± 6.57 %) rather than the cortical compartment (Cortical vBMD: −1.37 ± 2.79 %).These results suggest hypoabsorptive and mixed techniques (DS/SADIS and RYGB) were associated with greater BMD loss and deterioration of microarchitecture than restrictive techniques (SG).The primary determinants of bone density and impairment of microarchitecture were the extent of weight loss and the type of surgical procedure. Despite overall bone loss, Z-score assessments indicated that post-surgical bone status remained within or above the average ranges compared to a healthy population, except for TH following DS/SADIS.In conclusion, our research shows differences in the impact of bariatric surgery techniques on bone density and microarchitecture, emphasizing the need for careful postoperative monitoring of bone health, particularly in patients undergoing hypoabsorptive and mixed procedures.

Tratamiento de la obesidad

Obesity is a disease that increases mortality due to its association with multiple comorbidities. Its management must include a comprehensive intervention on the patient's lifestyle, providing advice on how to follow a healthy diet and physical exercise, as well as working on behavior modification that allows for maintaining these changes in the long term. Clinical trials that evaluate the efficacy of anti-obesity drugs have demonstrated weight loss of 5% to 22.5% when used together with lifestyle modification. Bariatric surgery is considered to be the most effective long-term medical treatment for reducing the complications and morbidity and mortality associated with morbid obesity. Gastric bypass has several advantages over other techniques. For this reason, it is one of the most widely used techniques in bariatric surgery. It leads to good quality of life and yields excellent results in weight loss and improvement of comorbidity.

Mesenteric Vascular Occlusion after Bariatric Surgery: A Systematic Review and Meta-Analysis

Abstract Background Portomesenteric vein thrombosis (PMVT) is a potentially severe complication that can occur after bariatric surgery. PMVT has gained importance because of the increasing number of bariatric surgeries being performed Aim and Objectives The main aim of this study was to assess how to investigate and manage the complications of the mesenteric vascular occlusion as well as to evaluate the clinical and radiological outcomes of patients undergoing bariatric surgery and the association of this surgical procedure and mesenteric vascular occlusion. Subjects and Methods This meta-analysis obtained 295 articles from PubMed, 603 articles from Scopus, 1 article from Cochrane library and 444 from web of science. 509 duplicated articles were removed using Endnote X8 program (Tompson Reuter, USA), 834 articles manually underwent titles and Abstracts screening and 247 articled underwent full-text review. 35 studies finally met our inclusion criteria. Results A total of thirty two studies reported the incidence of porto-mesenteric thrombosis with a total number of 41438 underwent different techniques of bariatric surgery. The overall incidence of porto-mesenteric thrombosis was 0.3% [OR = 0.003, (95% CI = 0.002: 0.004). Most of the studies were consistent in reporting an incidence rate nearby by 0.3% except few studies which reported higher incidence rate. Conclusion PMVT is a rare presentation after LSG, which requires early diagnosis and management. Conservative management through anticoagulants and thrombolytic therapy is quite effective and, if indicated, should always be considered as the primary treatment option.

Evaluation of the Impact of ChatGPT on the Selection of Surgical Technique in Bariatric Surgery.

With the growing interest in artificial intelligence (AI) applications in medicine, this study explores ChatGPT's potential to influence surgical technique selection in metabolic and bariatric surgery (MBS), contrasting AI recommendations with established clinical guidelines and expert consensus. Conducting a single-center retrospective analysis, the study involved 161 patients who underwent MBS between January 2022 and December 2023. ChatGPT4 was used to analyze patient data, including demographics, pathological history, and BMI, to recommend the most suitable surgical technique. These AI recommendations were then compared with the hospital's algorithm-based decisions. ChatGPT recommended Roux-en-Y gastric bypass in over half of the cases. However, a significant difference was observed between AI suggestions and actual surgical techniques applied, with only a 34.16% match rate. Further analysis revealed any significant correlation between ChatGPT recommendations and the established surgical algorithm. Despite ChatGPT's ability to process and analyze large datasets, its recommendations for MBS techniques do not align closely with those determined by expert surgical teams using a high success rate algorithm. Consequently, the study concludes that ChatGPT4 should not replace expert consultation in selecting MBS techniques.

Evaluation of the effect of sleeve gastrectomy versus Roux-en-Y gastric bypass in patients with morbid obesity: multicenter comparative study

IntroductionRoux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed techniques in bariatric surgery. The aim of this study is to compare two surgical procedures in terms of weight loss and the development of comorbidities such as type II diabetes mellitus T2D, arterial hypertension, sleep apnea (OSAS), and gastroesophageal reflux disease (GERD).MethodsData from the German Bariatric Surgery Registry (GBSR) from 2005 to 2021 were used. 1,392 RYGB and 1,132 SG primary surgery patients were included. Minimum age 18 years; five-year follow-up data available. Tests were performed with a 5% significance level.ResultsLoss of follow-up 95.41% within five years. Five years after surgery, the RYGB showed significant advantages in terms of excess weight loss (%EWL 64.2% vs. 56.9%) and remission rates of the studied comorbidities: hypertension (54.4% vs. 47.8%), OSAS (64.5% vs. 50.1%), and GERD (86.1% vs. 66.9%). Compared to the pre-test, individuals diagnosed with insulin-dependent T2D showed significant improvements with RYGB over a five-year period (remission rate: 75% vs. 63%). In contrast, non-insulin-dependent T2D showed no significant difference between the two approaches (p = 0.125).ConclusionBoth surgical procedures resulted in significant weight loss and improved comorbidities. However, the improvement in comorbidities was significantly greater in patients who underwent RYGB than in those who underwent SG, suggesting that the RYGB technique is preferable.Nevertheless, RYGB requires a high degree of surgical skill. Therefore, acquiring expertise in the technical facets of the surgery is essential to achieving favorable outcomes.

Anemia Status Changes Among Patients With Obesity Following Bariatric Surgery.

Objective This study aims to investigate trends in anemia severity among patients with pre-existing anemia who underwent bariatric surgery due to obesity. It also examines how different bariatric surgery techniques impact anemia outcomes. Methods This prospective study included 280 patients aged 18 to 65 with obesity who underwent bariatric surgery. The patients were categorized into three groups based on the type of surgery: sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass. Anemia severity was evaluated over a 12-month follow-up period. Chi-square tests were used to assess the homogeneity of baseline factors among the groups, and McNemar tests along with generalized estimating equations were used to compare anemia outcomes. Results Before surgery, the rates of moderate anemia across the three surgical groups ranged from 18.2% to 22.4%, with no cases of severe anemia observed. There was no significant difference among the groups (p=0.949). During the 12-month follow-up, the odds ratio for reducing anemia severity in the sleeve gastrectomy and Roux-en-Y gastric bypass groups were 2.13 and 1.91, respectively, compared to the one-anastomosis gastric bypass group. Additionally, the odds ratio for reducing anemia severity in patients with hypothyroidism was 1.84 compared to those without hypothyroidism. Conclusion The choice of bariatric surgery technique significantly affects anemia outcomes, with sleeve gastrectomy showing a higher success rate in reducing anemia severity. The role of hypothyroidism in anemia management also appears to be significant.

Effect of laparoscopic mini gastric bypass versus laparoscopic single anastomosis sleeve ileal bypass on serum iron and calcium levels

Background Although bariatric surgery techniques are very effective in the treatment of obesity, they are usually associated with evident nutritional deficiencies. Such operations require ongoing medical care along with vitamin (Vit) and nutrition supplements. Aim Is to determine and compare the effect of Laparoscopic mini gastric bypass (MGB) versus laparoscopic single anastomosis sleeve ileal bypass (SASI) on serum iron and calcium levels. Methodology The current prospective Randomized controlled study included 62 patients who were randomly allocated into one of two equal groups. Group A (n=31) underwent MGB while group B (n=31) underwent SASI. Follow-up was designed for 6 and 12 months in both groups for the serum iron profile, serum folate, Vit B12, Vit D, parathyroid hormone, and calcium level. Results There was a statistically significant decrease in Excess weight loss (EWL)% in both groups after 1, 6, and 12 months and a significant EWL % in group A more than group B (P=0.045*). There was a statistically significant drop in the Iron profile components’ levels in both groups after 1, 6, and 12 months in comparison with the corresponding baseline levels. There was a statistically significant decrease in the calcium level as well as Vit D3 within both groups at 1, 6, and 12 months follow-up with a significant increase in Parathyroid hormone in both groups at the same interval of follow-up. Conclusion Both MGB and SASI are effective methods for the treatment of morbid obesity. However, adherent follow-up for the Iron profile, Vit B12, Vit D3, parathyroid hormone, and calcium levels are mandatory.

Simultaneous erosion of gastric band into stomach and transverse colon

Laparoscopic adjustable banding was previously considered to be the safest and least invasive technique in bariatric surgery in the mid-1990s. It has since been performed less frequently as newer bariatric interventions and surgical techniques, and a fuller understanding of gastric banding complications have been elucidated. Nevertheless, there are a significant number of patients with in situ gastric bands, and cases of significant and unusual complications involving multiple visceral organs must be described and documented in order to enhance providers’ awareness and facilitate early recognition.

New mechanistic insights of anti-obesity by sleeve gastrectomy-altered gut microbiota and lipid metabolism.

The obesity epidemic has been on the rise due to changes in living standards and lifestyles. To combat this issue, sleeve gastrectomy (SG) has emerged as a prominent bariatric surgery technique, offering substantial weight reduction. Nevertheless, the mechanisms that underlie SG-related bodyweight loss are not fully understood. In this study, we conducted a collection of preoperative and 3-month postoperative serum and fecal samples from patients who underwent laparoscopic SG at the First Affiliated Hospital of Shandong First Medical University (Jinan, China). Here, we took an unbiased approach of multi-omics to investigate the role of SG-altered gut microbiota in anti-obesity of these patients. Non-target metabolome sequencing was performed using the fecal and serum samples. Our data show that SG markedly increased microbiota diversity and Rikenellaceae, Alistipes, Parabacteroides, Bactreoidales, and Enterobacteraies robustly increased. These compositional changes were positively correlated with lipid metabolites, including sphingolipids, glycerophospholipids, and unsaturated fatty acids. Increases of Rikenellaceae, Alistipes, and Parabacteroide were reversely correlated with body mass index (BMI). In conclusion, our findings provide evidence that SG induces significant alterations in the abundances of Rikenellaceae, Alistipes, Parabacteroides, and Bacteroidales, as well as changes in lipid metabolism-related metabolites. Importantly, these changes were found to be closely linked to the alleviation of obesity. On the basis of these findings, we have identified a number of microbiotas that could be potential targets for treatment of obesity.

IBC-Oxford University2023_BJSOral_23Video Presentation: Gastric Clip Bariclip as A New Technique in Bariatric Robotic Surgery

Abstract Robotic Bariatric Surgery is a safe and effective way to perform surgical procedures in the obese patient. The gastric Clíp (Bariclip) is a device implemented as a new bariatric technique to treat obesity accepted for the patients since lower BMI. Between many advantages of this procedure, it is a reversible procedure, avoiding to change the anatomy of the stomach and it can be performed as an ambulatory procedure. We present the first Ambulatory Bariatric Robotic Bariclip Procedure in Mexico City Mexico in August 15th, 2022 at Angeles Pedregal Hospital.

The Evaluation of Serum Endocan, Interleukin-6, and CRP Levels Following Sleeve Gastrectomy.

The excessive accumulation of fat tissue in obesity is the source of chronic low-level inflammation and causes future dysmetabolic and cardiovascular disorders. Removal of this excessive fat tissue with the aid of bariatric surgery (BS) techniques, such as sleeve gastrectomy, may reverse adverse inflammatory outcomes. The aim of this study is to investigate the impact of sleeve gastrectomy on inflammatory markers, specifically endocan, IL-6, and CRP, in individuals with obesity. Thirty-two patients with class 3 obesity and class 2 obesity + comorbidities were enrolled in the study. Clinical characteristics including age, comorbidity, body mass index (BMI), waist, and hip circumferences of the participants were noted before and 3 months after sleeve gastrectomy. Blood samples were collected during those periods to assess biochemical features such as serum endocan, interleukin-6 (IL-6), C-reactive peptide, fasting insulin, glycosylated hemoglobin A1c levels, and lipid panel. A statistical package program was used for the analysis of those parameters, and p<0.05 was accepted as significant at a 95.0% confidence interval. BMI reduced from 43.55±6.78 to 36.16±6.14 kg/m2 within 3 months following BS (p<0.001). Preoperative serum endocan, IL-6, and CRP levels were correlated with BMI, and in line with BMI reduction, their serum levels decreased after BS (p<0.05). HOMA-IR also reduced after BS, and both in the pre and post-BS periods correlated with BMI, IL-6, endocan, and CRP levels (p<0.05). The mean total body weight loss was 20.4% within 3 months post-BS. BS techniques are effective in weight loss and reversing the inflammatory processes caused by obesity. Serum endocan, IL-6, and CRP levels are promising markers for describing obesity-related inflammation and objectively checking the alleviation of inflammation following BS.

Barrett's esophagus and esophageal cancer after sleeve gastrectomy. Myth or reality?

Sleeve gastrectomy has become the most performed bariatric surgery technique in the world. This bariatric technique has been related to the appearance of gastroesophageal reflux and recently with de novo Barrett's esophagus. It is not clear that this leads to an increased incidence of esophageal adenocarcinoma. In this review we analyze the current scientific literature to try to answer the true incidence of Barrett's esophagus and adenocarcinoma after sleeve gastrectomy, and whether these data should make us change the indications for this technique.

Effect of laparoscopic mini-gastric bypass versus laparoscopic sleeve gastrectomy on hypertension and dyslipidemia in obese type 2 diabetes mellitus patients.

The aim of the research was to compare the effect of the laparoscopic mini-gastric bypass (LMGB) technique with the laparoscopic sleeve gastrectomy (LSG) technique in bariatric surgery on type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia in obese T2DM patients. A prospective, cross-sectional study, conducted in Surgery Department at Al-Mouwasat and Al-Assad University Hospitals in Damascus, and included T2DM obese patients who would undergo bariatric surgery using the LMGB or LSG technique. The research included two groups: the LSG group (92 patients, 60.9% female, age 44.6 year, BMI 41.85kg/m2) and the LMGB group (137 patients, 59.1% female, age 47.1 year, BMI 43kg/m2). Before surgery, the prevalence of HTN and dyslipidemia were similar in the two groups. After one year: T2DM improvement and remission rate in the LMGB group (13.9, 80.3%) were greater than in the LSG group (13, 62%), the difference was statistically significant. The HTN improvement and remission rate in the LMGB group (52.9, 41.4%) were greater than in the LSG group (47.5, 39%), the difference was not statistically significant. The dyslipidemia improvement rate was greater in LSG group (47.2 vs. 32.7%), while the dyslipidemia remission rate was greater in LMGB group (67.3 vs. 52.8%), the difference was statistically significant. The authors found that the LMGB technique was more effective than the LSG technique in controlling cardiovascular risk factors of obesity, T2DM, HTN, and dyslipidemia.

Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review.

Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks that obesity poses to pregnancy. But on the other hand, decreased intake and malabsorption may increase the risk of malnutrition and micronutrient deficiency and negatively affect maternal and foetal health. The aim of this narrative review is to provide an updated analysis of the impact of different bariatric surgery techniques on mineral and micronutrient nutritional status during pregnancy and the possible effect on maternal-foetal health.

Atuais técnicas em cirurgia bariátrica e seus benefícios: Uma revisão da literatura

Introduction: Bariatric, restrictive and mixed (predominantly restrictive or malabsorptive) surgery is a therapy to reduce weight and control associated diseases. This literature review discusses the relevance of procedures approved by the Federal Council of Medicine (CFM) according to bibliographic references of significant scientific evidence. Objectives: To review the techniques currently used in bariatric surgery, advantages and disadvantages. Methods: Literature review of the techniques employed in bariatric surgery, by descriptors in Portuguese (techniques in bariatric surgery, gastric banding, vertical gastrectomy, Roux-en-Y gastric bypasses and biliopancreatic bypass). Results: Gastric banding is a silicone prosthesis wrapped around the stomach, which generates weight regain. Vertical gastroplasty reduces the stomach by a ring-mediated suture with good results but high recurrence. The intragastric balloon is the introduction of a silicone prosthesis with methylene blue, which must be removed after 6 months. Gastric bypass has low mortality and high efficacy, being the most used in Brazil. Vertical gastrectomy preserves the small intestine and partially the stomach, and its low postoperative mortality determines its frequent indication. The Scopinaro technique is 5% of the procedures performed in Brazil, the duodenal switch or vertical gastrectomy with intestinal detour generates nutritional deficiency. Conclusion: Comparing the surgical methods, it is up to the surgeon and the team, the particular analysis to decide which fits best for the patient. However, regardless of the technique used, scientifically it is the conduct with more positive results in the long term, compared to clinical approaches.

Laparoscopic Sleeve Gastrectomy With Transit Loop Bipartition and Transit Bipartition in Type 2 Diabetic Patients With Obesity: A Retrospective Analysis.

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

Prior bariatric surgery is associated with an increased rate of complications after primary shoulder arthroplasty independent of body mass index

Bariatric surgery (BS) is a debated, yet commonly used, management strategy in the treatment of morbidly obese patients. Despite recent advances in BS techniques, there is limited data on the potential impact of prior BS in patients undergoing shoulder arthroplasty. This investigation evaluated the outcomes of primary shoulder arthroplasty (SA) in patients with prior BS when compared to matched controls. Over a 31-year period (1989-2020), 183 primary SA (12 hemiarthroplasties [HAs], 59 anatomic total shoulder arthroplasties [aTSAs], and 112 reverse shoulder arthroplasties [RSAs]) in patients with prior BS and a minimum of 2-year follow-up had been performed at a single institution. This cohort was matched 1:1:1 according to age, sex, diagnosis, implant, American Society of Anesthesiologists score, Charlson Comorbidity Index, and SA surgical year to separate control groups of SA with no history of BS and a BMI of either <40 (low BMI group) or≥40(high BMI group). Surgical complications, medical complications, reoperations, revisions, and implant survivorship were assessed. The mean follow-up time was 6.8 years (range, 2-21 years). The bariatric surgery cohort had a higher rate of any complication (29.5% vs. 14.8% vs. 14.2%; P<.001), surgical complications (25.1% vs. 12.6% vs. 12.6%; P=.002), and noninfectious complications (20.2% vs. 10.4% vs. 9.8%; low P=.009 and high P=.005) relative to both low and high BMI groups. For BS patients, the 15-year survivorship free of any complication was 55.6 (95% confidence interval [CI], 43.8%-70.5%) compared with 80.3% (95% CI, 72.3%-89.3%) in the low BMI group and 75.8% (65.6%-87.7%) in the high BMI group (P<.001). Comparisons of the bariatric and matched groups demonstrated no statistical differences between the risk of reoperation or revision surgery. When SA was performed within 2 years of BS, higher rates of complications (50% vs. 27.0%; P=.030), reoperations (35.0% vs. 8.0%; P=.002), and revisions (30.0% vs. 5.5%; P=.002) were observed. Primary shoulder arthroplasty in patients with prior bariatric surgery demonstrated an elevated complication profile when compared to matched cohorts of patients with no history of BS and either low or high BMI. These risks were more pronounced when shoulder arthroplasty was performed within 2 years of bariatric surgery. Care teams should be aware of the potential implications of the postbariatric metabolic state and investigate whether further perioperative optimization is warranted.

The Impact of Bariatric Surgery on the Incidence of Colorectal Cancer in Patients with Obesity—a Systematic Review and Meta-analysis of Registry Data

PurposeCancer and obesity represent two of the most significant global health concerns. The risk of malignancy, including colorectal cancer (CRC), increases with obesity. The aim of this study was to perform a systematic review and meta-analysis to determine the value of bariatric surgery in reducing CRC risk in patients with obesity using registry data.Materials and MethodsA systematic review and meta-analysis were performed as per PRISMA guidelines. The risk of CRC was expressed as a dichotomous variable and reported as odds ratios (OR) with 95% confidence intervals (CIs) using the Mantel-Haenszel method. A multi-treatment comparison was performed, examining the risk reduction associated with existing bariatric surgery techniques. Analysis was performed using RevMan, R packages, and Shiny.ResultsData from 11 registries including 6,214,682 patients with obesity were analyzed. Of these, 14.0% underwent bariatric surgery (872,499/6,214,682), and 86.0% did not undergo surgery (5,432,183/6,214,682). The mean age was 49.8 years, and mean follow-up was 5.1 years. In total, 0.6% of patients who underwent bariatric surgery developed CRC (4,843/872,499), as did 1.0% of unoperated patients with obesity (54,721/5,432,183). Patients with obesity who underwent bariatric surgery were less likely to develop CRC (OR: 0.53, 95% CI: 0.36–0.77, P < 0.001, I2 = 99%). Patients with obesity undergoing gastric bypass surgery (GB) (OR: 0.513, 95% CI: 0.336–0.818) and sleeve gastrectomy (SG) (OR: 0.484, 95% CI: 0.307–0.763) were less likely to develop CRC than unoperated patients.ConclusionAt a population level, bariatric surgery is associated with reduced CRC risk in patients with obesity. GB and SG are associated with the most significant reduction in CRC risk.PROSPERO RegistrationCRD42022313280.Graphical

Is Food Tolerance Different After Bariatric Surgery Depending on the Surgical Procedure?

Bariatric surgery (BS) is a very effective treatment regarding body weight loss but might affect food tolerance and energy and protein intake. The aim of this study was to compare three BS techniques (biliopancreactic diversion (BPD), gastric bypass (GB), and sleeve gastrectomy (SG)) and their effect on food tolerance. Prospective study conducted between April 2016 and April 2019. Visits included were 1 before and 6, 12, and 24months after BS. Food tolerance test (FTT), 24-h recall, and bioelectrical impedance (TANITA MC780) were performed at all visits. Sixty-six patients were included (74.2% women). FTT showed a better self-perception of the intake after surgery in BPD at 6months (p = 0.013), and at 12months (p = 0.006). BPD had a better tolerance of 8 food groups at 6months (red meat p = 0.017, white meat p = 0.026, salad p = 0.017, bread p < 0.001, rice p = 0.047, pasta p = 0.014, fish p = 0.027) and at 12months, but only red meat (p = 0.002), bread (p < 0.001), rice (p = 0.025), and pasta (p = 0.025) remained statistically different. Twenty-four months after surgery, only the red meat food group (p = 0.007) showed differences. BPD had the lowest incidence of vomiting at 6months (p < 0.001), 12months (p = 0.008), and 24months (p = 0.002). The total score of FTT was better in BPD at 6months [25.6 (SD 1.5), p < 0.001], 12months [25.6 (SD 2.4), p < 0.001], and 24months [25.7 (SD 1.3), p = 0.001]. BPD showed the best intake in energy and proteins at 6months [1214.8 (SD 342.4) kcal and 67.1 (SD 18.4) g] and 12months [1199.6 (SD 289.7) kcal and 73.5 (SD 24.3) g]. % FML was higher in GB both at 6 and 12months being statistically different (p < 0.050). Biliopancreatic diversion appears to be the technique with a better food tolerance and protein and energy intake in the first year of follow-up after BS.

Esófago de Barrett y cáncer de esófago tras gastrectomía vertical. ¿Mito o realidad?

Sleeve gastrectomy has become the most performed bariatric surgery technique in the world. This bariatric technique has been related to the appearance of gastroesophageal reflux and recently with de novo Barrett's esophagus. It is not clear that this leads to an increased incidence of esophageal adenocarcinoma. In this review we analyze the current scientific literature to try to answer the true incidence of Barrett's esophagus and adenocarcinoma after sleeve gastrectomy, and whether these data should make us change the indications for this technique.