Bariatric Surgery Techniques Research Articles

The Impact of the Length of the Common Intestinal Loop on Metabolic and Nutritional Outcomes of Patients with Severe Obesity Who Undergo of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy: 5-Year Follow-Up.

Introduction: Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a recent bariatric surgery technique, highly effective in terms of weight loss. Nevertheless, data regarding the impact of SADI-S at mid-long term (after >5 years of follow-up) are scarce. Objectives: To evaluate the effect of lengths of common intestinal loop on the evolution of patients with morbid obesity (MO), who undergo SADI-S. Materials and Methods: Descriptive study (case series), including patients with MO who underwent SADI-S procedure between January 2012 and December 2015 with at least 5 years of follow-up. Patients were classified as "Old-SADI-S" (OS) when length of the common alimentary loop was <2.5 m and "New-SADI-S" (NS) when length was >2.5 m. Clinical parameters and nutritional parameters were included. Results: Twenty-nine cases were included (17 OS; 12 NS), 86.2% women and mean age 46.7 ± 1 years. After 12 months, OS had significantly lower body mass index (29.7 ± 4.8 kg/m2 versus 32.0 ± 5.1 kg/m2, P = .01), without significant differences in the resolution of comorbidities. Nevertheless, OS group had severe malabsorptive complications requiring surgical conversion of OS to NS in 7 patients after 8 months. At 5 years of follow-up, no significant difference was seen between the two groups and resolution of comorbidities was maintained during this period of time. Conclusions: SADI-S is effective in terms of weight loss and resolution of comorbidities at 5 years of follow-up, regardless of the length of the common intestinal loop. However, a common intestinal loop <2.5 m was associated with severe malabsorptive complications that determined the surgical re-conversion in all cases.

Early and late complication of sleeve gastrectomy

The rate of obesity is on rise worldwide and almost 13% of the global population is obese leading to development of various other diseases and complications. Lack of effective outcome from conventional approach for weight control and loss is causing a transition among people to approach for bariatric surgeries. Sleeve gastrectomy is one of the surgical techniques of bariatric surgery aimed to achieve weight loss. Like any other surgical procedure, it also has certain post-operative complications associated with it. The complications of sleeve gastrectomy are further divided into early and late phase. The purpose of this research is to review the available information about early and late complication of sleeve gastrectomy. In the surgical treatment of morbid obesity, sleeve gastrectomy is the most widely performed bariatric procedure. It is a minimally invasive and risk-free surgery with a low risk of complications and death. The complication rates for early and late complication range from 5.4% to 7.3%, with incidence of serious complications ranging from 1.2% to 2.2%. Early complications include bleeding such as intraluminal or extraluminal, a leak in the staple line, and the formation of an abscess. While gastric stenosis, nutritional shortages, mediastinal pouch migration, and the development or worsening of gastroesophageal reflux disease are all late consequences. Older age, male sex, increased body mass index, smoking, and comorbidities are considered the risk factors for the development of complications of sleeve gastrectomy. Overall, sleeve gastrectomy is considered a safe and effective surgical weight loss technique.

Influence of CLOCK Gene Variants on Weight Response after Bariatric Surgery.

The Circadian Locomotor Output Cycles Kaput (CLOCK) gene has been linked to metabolic dysfunction and obesity. The purpose of this study was to analyze the association between single nucleotide polymorphisms (SNPs) of CLOCK gene with obesity and with long-term weight response after different bariatric surgery (BS) techniques. The cohort includes 375 patients with morbid obesity (MO) and 230 controls. In the association study of SNPs with weight response we combined several variables as phenotype at 6 years after surgery. The study protocol was registered in ISRCTN (ID80961259). The analysis of the selected SNPs was performed by allelic discrimination using Taqman® probes. The genotype association study was performed using the SNPStats program, with comparisons adjusted for sex, age, initial Body Mass Index, type 2 diabetes and hypertension diagnosis, and type of surgery. In the case-control study two of three SNPs were significantly associated with MO. The variant rs1801260 had a protective effect for MO whereas the TT genotype of rs3749474 variant had the strongest association with MO (OR = 2.25 (1.39–3.66); p = 0.0006). In the linear regression analysis both variants showed significant association with long-term weight loss and weight regain after BS, independently of the pre-surgery patient profile.

Transition from a circular to a linear stapling protocol in laparoscopic Roux-en-Y gastric bypass surgery and its impact on quality of life: a 5-year outcome study.

Surgical technique in bariatric surgery has been refined over the past decades. This study analysed the effect of changing the stapling protocol on the quality of life (QoL) at a midterm follow-up. The retrospective cohort study included patients undergoing Roux-en-Y gastric bypass between June 2012 and March 2016. Patients were stratified into the circular stapling protocol (CSP, n = 117) or the linear stapling protocol (LSP, n = 118). QoL was quantified by the Moorehead score at 12, 24 and 60months. Multivariate testing was used to identify confounders. The age was 42.8 ± 11.5years and the body mass index (BMI) was 43.8 ± 6.2kg/m2, with no baseline intergroup differences. Overall baseline Moorehead score was 0.42 ± 1.1 and improved in both groups after 12months (1.97 ± 0.74, p < 0.001), 24months (1.86 ± 0.79, p < 0.001) and 60months (1.71 ± 0.9, p < 0.001). LSP was associated with improved Moorehead score after 60months (odds ratio [OR] 1.251, 95% confidence interval [CI] 1.06-1.48, p = 0.010). Overall, a drop of mean BMI occurred and this effect lasted throughout the observation period (- 12.48kg/m2, p < 0.001). More profound BMI reduction was further positively associated with Moorehead scores after 24 and after 60months (OR 0.97, p = 0.028; OR 0.96, p = 0.007). Complications, rehospitalisations and reoperations were more frequent in the CSP group (50% vs 23.7%, p < 0.001; 39.7% vs 22.9%, p = 0.009; 37.1% vs 18.6%, p = 0.003). The CSP and LSP achieve a long-lasting increase in QoL, although the LSP is associated with fewer complications, persistent weight loss and improved Moorehead score. Therefore, the LSP might be considered the favourable protocol in Roux-en-Y gastric bypass.

A CASE REPORT OF CHYLOUS ASCITES AND TRANSIENT MIDGUT VOLVULUS THROUGH PETERSENS DEFECT THREE YEARS POST ONE-ANASTOMOSIS GASTRIC BYPASS- MINIGASTRIC BYPASS

One-anastomosis gastric bypass- Minigastric bypass (OAGB-MGB) is an emerging bariatric surgery technique replacing the RYGP with reasonable short- and long-term side effects. Here we would like to present a late complication of OAGB-MGB associated with signs of peritoneal irritation and severe pain due to transient midgut volvulus associated with chylous ascites.. We observed peritoneal lymphatic collection in association with features suggestive for small bowel obstruction 3 years followingOAGB-MGB. So, we believe that such complication should be considered as a potential side effect during short and long term follow up after gastric bypass.A strong recommendation should be provided.

Effects of laparoscopic sleeve gastrectomy on serum lncRNA levels in obese patients

Obesity is a disease associated with excessive fat accumulation in the body, which body mass index (BMI) is greater than 30 kg/m. Bariatric surgery technique is one of the most common treatment options for obesity with the advantage of faster weight loss in a short time. lncRNAs play a role in adipogenesis and metabolic diseases, including obesity, type 2 diabetes, cardiovascular disease (CVD), osteoarthritis, and hypertension, so they are significant targets for therapeutic options. In this study, we aimed to determine lncRNAs and specific parameters that show different expressions in the plasma of patients with obesity. We included fifteen patients with BMI greater than 30 kg/m2 before and less than 30 kg/m2 after laparoscopic sleeve gastrectomy (LSG) in the study. Total RNAs, including lncRNAs and other non-coding RNAs, were isolated from plasma samples of patients, and eight lncRNAs (H19, Neat1, HOTAIR, ANRIL, MALAT1, ATB, SNGH5, UCA1) were quantified by real-time PCR. Gene Ontology, KEGG, and relation of obesity analysis were utilized. Unpaired Student's t-test Pearson correlation analysis was used for statistical analysis. We observed a statistically significant increase in the expression levels of all lncRNAs in the patients with the post-operative BMI change. We have added a new dimension to the biomarker studies related to obesity and the clinical follow-up of patients undergoing LSG surgery. Further studies are required for enlighting the molecular mechanisms.

Sleeve gastrectomy as a surgical technique in bariatric surgery: Results of safety and effectiveness

IntroductionThe aim of this study is to evaluate the safety and effectiveness results of sleeve gastrectomy as a bariatric technique. MethodsObservational follow-up study of a cohort of patients who underwent sleeve gastrectomy in our center between 2008 and 2017. A total of 223 patients were included: 166 as a primary technique (group 1) and 57 as a hypothetical first stage (group 2). ResultsIn group 1, the postoperative morbidity is 12.6%, with a fistula rate of 4.2%; 5.4% required reoperation and mortality was 0.6%. In group 2, postoperative morbidity is 14%, with a fistula rate of 5.3%; 10.5% required reoperation and mortality was 5.3%. In group 1, 79.6% and 62.5% of patients at 2 and 5 years respectively managed to achieve a % EBMIL > 50%. In group 2, the second stage was completed only in 8 patients (14.0%). Of the patients who did not complete the second stage, 32.2% and 5.9% achieved a % EEBMIL > 100% at 2 and 5 years. Analyzing those who completed the second stage, the mean EEBMIL% was 90.5% and 93.4% at 2 and 5 years. ConclusionsSleeve gastrectomy is a safe technique in patients with BMI < 45 and effective in terms of weight loss in the short-medium term. In patients with BMI > 55, a preoperative optimization aimed at reducing morbidity and mortality is necessary, as well as adequately planning the second stage, without which it is clearly insufficient.

ACCURACY OF ELASTOGRAPHY IN THE ASSESSMENT OF REDUCTION IN LIVER STEATOSIS AND FIBROSIS IN THE EARLY POSTOPERATIVE PERIOD AFTER BARIATRIC SURGERY.

ABSTRACTBACKGROUND:Nonalcoholic hepatic steatosis is found in most obese patients and has a strong association with metabolic syndrome. The Roux-en-Y gastric bypass and the sleeve gastrectomy are the two techniques of bariatric surgery. Patients who underwent bariatric surgery have regression of nonalcoholic steatohepatitis due to a reduction in body mass index and changes in incretin hormones.AIMS:This study aimed to analyze the acuity of elastography in the regression of hepatic steatosis and fibrosis in obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy 2 months after surgery.METHODS:Patients in the preoperative period of bariatric surgery underwent an anthropometric evaluation and hepatic elastography to quantify fibrosis and hepatic steatosis. Two months after surgery, the same evaluation was performed again.RESULTS:All 17 patients who met the inclusion criteria participated in the study. Out of this, nine underwent sleeve gastrectomy, and eight underwent Roux-en-Y gastric bypass. The Roux-en-Y gastric bypass group had lower fibrosis levels postoperatively compared to preoperatively (p=0.029, p<0.05). As for steatosis, patients who underwent Roux-en-Y gastric bypass had lower postoperative values (p=0.01, p<0.05). There was also a reduction in fibrosis postoperatively in the sleeve gastrectomy group compared to preoperatively (p=0.037, p<0.05).CONCLUSIONS:Elastography accurately demonstrated decreased hepatic steatosis and fibrosis in the early postoperative period of bariatric surgery. Moreover, Roux-en-Y gastric bypass and sleeve gastrectomy are suitable surgical methods to improve hepatic steatosis and fibrosis within 2 months postoperatively.

Reflux following bariatric surgery

Bariatric surgery is the most effective treatment for morbidly obese patients. Studies investigating the relationship between bariatric surgery and gastroesophageal reflux disease (GERD) are discordant. Depending on the type of intervention, pre-existing GERD can improve, worsen, or develop “de novo” in previously unaffected patients. Therefore, a review of the literature is performed to evaluate the effects of different bariatric surgical procedures on GERD. Currently, the bariatric surgical procedures more frequently performed are laparoscopic sleeve gastrectomy (LSG) and gastric bypass. The majority of studies examining the relationship between GERD and bariatric surgery are low quality, small, and non-randomized. Furthermore, GERD has been investigated through clinical symptoms scales or questionnaires, which often do not correlate with objective endoscopic or functional findings. Therefore, the interpretation of the results of these studies is challenging. Roux-en-Y gastric bypass is considered the preferred surgical operation for bariatric patients with GERD. Despite contradictory results reported among the studies, GERD seems to be a major issue after LSG. Preliminary results on mini-gastric bypass/one anastomosis gastric bypass seem to indicate that biliary reflux might be overrated, but more long-term results are mandatory before drawing conclusions. Further studies are needed to clarify the role of extensive preoperative examinations prior to bariatric surgery, even in asymptomatic patients, and provide clear guidance regarding the indications for the bariatric surgery technique of choice according to the patient’s characteristics.

Resolución laparoscópica de un caso de “Candy Cane” en un postoperatorio de By Pass Gástrico

El by pass gástrico (BPG) es una técnica de cirugía bariátrica de probada eficacia en el control de la obesidad y la resolución de enfermedades asociadas, como diabetes e hipertensión. El dolor abdominal en el postoperatorio alejado del BPG es un verdadero desafío, y exige para su diagnóstico etiológico comprender la técnica quirúrgica y las posibles causas que originan el dolor. Las principales causas de dolor son la úlcera de neoboca, las hernias internas (por el espacio de Petersen o la brecha mesentérica), la litiasis vesicular sintomática y el síndrome del “bastón de caramelo” (o “Candy Cane syndrome” por su nombre anglosajón). El mismo resulta de una excesiva longitud del cabo yeyunal ciego del asa alimentaria, luego de la anastomosis gastro yeyunal. Cuando mide más de 4 cm puede llenarse de alimentos, actuando como una bolsa o reservorio, generando dolor, náuseas o vómitos. El diagnóstico surge de la clínica y un estudio contrastado que demuestre la longitud excesiva del extremo del asa alimentaria. El tratamiento es quirúrgico y la desaparición de los síntomas confirma el diagnóstico. Ver el video en: https://www.youtube.com/watch?v=wxLU_Xh8o7Q

The Jejunojejunostomy: an Achilles Heel of the Roux-en-Y Gastric Bypass Construction

BackgroundLaparoscopic Roux-en-Y gastric bypass (RYGB) has for long been the gold standard technique in bariatric surgery, especially in the Scandinavian countries. In a tertiary hospital setting, we observed an increasing number of patients with postprandial abdominal pain and nausea, often associated with complex hypoglycemia.ObjectivesThe present study aimed to characterize the clinical patterns, patient characteristics, and clinical outcomes after surgical revision of dysfunctional RYGB at Sahlgrenska University Hospital in Gothenburg, Sweden.MethodsThis cohort study included patients with RYGB who underwent revision of the jejunojejunostomy (JJ) after 2013. Information was obtained by reviewing medical records and performing complementary interviews.ResultsLaparoscopic revisional surgery was performed in 115 cases with either adhesiolysis or total revision of the JJ (mean age 41 years, range 19–67 years; 90% women). The median time to assessment after the last revision was 33 months (range 12–75 months). Forty-four (38%) patients reported that they were symptom-free long-term after the intervention, and 32 (28%) patients experienced an improvement in the symptoms that were the indication for revision. However, 31 (27%) patients reported no long-term improvement, and half of them (n = 16) subsequently had a reversal of the anatomy. Eight (7%) patients were lost to follow-up.ConclusionsDysfunction of the JJ appears to be a relatively common cause of postprandial pain and nausea after ante-colic/ante-gastric RYGB. Most patients with symptoms of dysfunction experienced partial or total relief following revisional surgery, but a substantial minority had persistent problems, with one in five eventually undergoing reversal of the anatomy.Graphical

Bilateral Fascial Plan Block for Post Abdominoplasty Pain Control; Erector Spinae Plane Block Contrasted with Transversus Abdominis One

Background: Abdominoplasty is a popular aesthetic procedure. Both patients and doctors are concerned about post-operative pain and discomfort. erector spinae plane block (ESP) with ultrasound guidance (UG) was an excellent analgesic technique in bariatric surgery. Objectives; to evaluate the intensity and duration of analgesia (ESP) technique to that provided by the transversus abdominis plane (TAP) technique were done bilaterally with (UG) post abdominoplasty. Study Design; A single-blinded, clinical, prospective, randomized study. Patients and Methods; 51 patients received bilateral (UG) block: (ESP) group (n = 25), and (TAP) group (n = 26), Using the same dosage and volume of local anesthetics. Pain intensity using VAS score at first 30 minutes, and then at 2, 4, 6, 8, 12, 16, 20, and 24 hours postoperatively, IV boluses of pethidine (rescue analgesic) were administrated if VAS ≥ 4, The primary outcome considered as the duration of effective analgesia for each block. While the Secondary outcome measured the over-all pethidine usage, patient satisfaction and the incidence of harmful effects from the techniques. RESULTS; VAS score in the ESP group was significantly lower at 8hrs and 12hrs. There was significant prolonged time to the first analgesic dose in ESP group (9.16±1.07 hours) than TAP group (7.65±0.75 hours). Also, a significant reduction in to the overall pethidine intake in 24 hours (110.40±12.74mg.) in the ESP group. Conclusion: Especially in comparison to the TAP block, the ESP block enables more reliable alleviation of pain, longer analgesic period, extends the time to initial analgesic requirements, reduces pethidine usage.

Imaging features in management of laparoscopic mini/one anastomosis gastric bypass post-surgical complications

Obesity is a widespread pathology among the population related to an increase in mortality and morbidity of patients. Bariatric surgery provides several forms of treatment for obese patients. Laparoscopic mini/one anastomosis gastric bypass (MGB/OAGB) is a recent low risk bariatric surgical procedure common in a large number of countries in the treatment of severe obesity. MGB/OAGB, compared to other bariatric surgery techniques, offers the significant technical improvement of requiring only one anastomosis in place of two. In this scenario, diagnostic imaging takes a significant role in the postoperative period, to evaluate the outcomes of surgical treatment and to detect possible complications both in early and late postoperative period. The prevalent radiological procedure to investigate suspicions of clinical post-operative complications is Computed tomography (CT) with oral and intravenous contrast administration. This pictorial essay aims to illustrate and identify normal radiological aspects of MGB/OAGB and post-surgery complication imaging features. We think that this article will serve to familiarize all the specialists with the diagnostic imaging of MGB/OAGB.

Liver transplantation and bariatric surgery: a new surgical reality: a systematic review of the best time for bariatric surgery.

Non-alcoholic fatty liver disease has increased in parallel with the obesity. This situation represents a new reality for patients with an indication for liver transplant (LT) and bariatric surgery (BS). We undertook a systematic review of BS and LT using the terms 'liver transplant', 'obesity' and 'bariatric surgery'. The variables analyzed were number of patients, technique and timing of BS, surgical complications, follow-up and mortality. A total of 190 papers were identified and, 28 articles were discussed (6 papers with BS before a LT, 6 with both procedures simultaneously and 16 studies with BS after a LT). In the last 7 years, 22 of the 28 papers (78.6%) were published on this subject. A total of 144 patients had both procedures: 27 (18.8%) before, 42 (29.1%) simultaneously and 75 (52.1%) after. Sleeve gastrectomy was the most performed BS (121 cases-84%) followed by a Roux-en-Y gastric bypass (20 cases-13.9%). The number of publications has increased substantially in recent years. The majority papers of BS after LT could be explained because of commodity of the flow of these patients. The best moment to perform BS in these patients has yet to be established.

Plasma angiopoietin-like 4 protein: Long term evolution after 3 different techniques of bariatric surgery

Plasma angiopoietin-like 4 protein: Long term evolution after 3 different techniques of bariatric surgery

Treatment of liver failure post one anastomosis gastric bypass by revising to normal anatomy: A case report.

IntroductionObesity and the associated metabolic syndrome are global health problems. Significant weight loss after bariatric surgery can cause a substantial difference in those comorbidities in obese patients. In this case, we described a rare complication of a patient who developed acute liver failure after an uneventful one anastomosis gastric bypass treated conservatively and revision of the one anastomosis gastric bypass to normal anatomy.Case presentationWe present a 52-year-old female known to have hypothyroidism and morbid obesity with a BMI of 45. For that, she underwent uneventful one anastomosis gastric bypass. Later, she developed liver failure and hepatic encephalopathy, which was managed conservatively and revision surgery to normal anatomy.DiscussionBariatric surgery plays an integral role in treating obese patients for its associated impacts, like facilitating weight loss and related metabolic syndrome improvement. The effects of bariatric surgery on liver functioning are controversial. Some malabsorptive procedures are linked to postoperative hepatic complications. However, it is uncommon in a recent new technique in bariatric surgery. Liver transplant and revision of the bariatric surgery have been described as management. However, optimal nutrition support without a liver transplant along with revision surgery is possible in experienced hands.ConclusionEarly detection of liver impairment and early intervention by a revision to normal anatomy by an experienced surgeon is considered the safest and most effective procedure for such patients. However, late detection where liver failure occurs, liver transplantation is the only effective treatment for preventing fatal outcomes.

Impact of bariatric surgery on gastroesophageal reflux disease and esophageal motility.

Obesity is rapidly increasing in prevalence, and bariatric surgery has become a popular treatment option that can improve all-cause mortality in obese individuals. Gastroesophageal reflux disease (GERD) and esophageal motility disorders are common in the obese population, and the effects of bariatric surgery on these conditions differ depending on the type of bariatric surgery performed. Laparoscopic adjustable gastric banding has declined in popularity due to its contributions to worsening GERD symptoms and the development of esophageal dysmotility. Although laparoscopic sleeve gastrectomy (LSG) is the most popular type of bariatric surgery, a comprehensive assessment for acid reflux should be performed as LSG has been linked with worsening GERD. Novel methods to address GERD due to LSG include magnetic sphincter augmentation and concomitant fundoplication. Due to the decreased incidence of postoperative GERD and dysmotility compared to other types of bariatric surgeries, Roux-en-Y gastric bypass should be considered for obese patients with GERD and esophageal dysmotility. Bariatric surgery can affect esophageal motility and contribute to worsening or development of GERD. A thorough workup of gastrointestinal symptoms before bariatric surgery should be performed with consideration for formal testing with high-resolution manometry and pH testing. Based on these results, the choice of bariatric surgery technique should be tailored accordingly to improve clinical outcomes.

ROBUST INFERENCE WHEN COMBINING INVERSE-PROBABILITY WEIGHTING AND MULTIPLE IMPUTATION TO ADDRESS MISSING DATA WITH APPLICATION TO AN ELECTRONIC HEALTH RECORDS-BASED STUDY OF BARIATRIC SURGERY.

While electronic health records present a rich and promising data source for observational research, they are highly susceptible to missing data. For settings like these, Seaman et al. (Biometrics 68 (2012) 129-137) proposed a strategy wherein one handles missingness in some variables using inverse-probability weighting and others using multiple imputation. Seaman et al. (Biometrics 68 (2012) 129-137) show that Rubin's variance estimator for averaging results across datasets is asymptotically valid when the analysis and imputation models are correctly specified and the weights are either known or correctly specified. Modeled after the approach of Robins and Wang (Biometrika 87 (2000) 113-124), we propose a method for asymptotically valid inference that is robust to violation of these conditions. Following a simulation study in which we demonstrate that a proposed variance estimator can reduce bias due to model misspecification, we illustrate this approach in an electronic health records-based study investigating whether differences in long-term weight loss between bariatric surgery techniques are associated with chronic kidney disease at baseline. We observe that the weight loss advantage after five years of Roux-en-Y gastric bypass surgery, compared to vertical sleeve gastrectomy, is less pronounced among patients with chronic kidney disease at baseline compared to those without.

Bariatric Surgery on Reproductive Outcomes: the Impact According to the Diagnosis of Polycystic Ovarian Syndrome and Surgical Procedures.

There is limited evidence on the impact of bariatric surgery (BS) on reproductive outcomes in the general population and specifically in patients with polycystic ovarian syndrome (PCOS) or the effect of different BS techniques. The study aims to investigate the impact of BS on fertility, pregnancy, and newborn outcomes in reproductive age women who have undergone BS and the outcomes according to surgical procedure and PCOS diagnosis. This was a retrospective, descriptive, cross-sectional study performed in women from 18-39 years undergoing BS in our centre from January 2005 to December 2010. We performed a telephone interview including a structured reproductive health survey on fertility, pregnancy, and offspring outcomes before and after BS. Of the women, 872 underwent BS during the study period, 298 were 18-39 years old, and reproductive data was obtained from 217. Women with regular menstrual cycles increased from 52.9% before BS to 72.9% 1 year after surgery. The percentage of patients with a time-to-pregnancy longer than 12 months was higher after laparoscopic sleeve gastrectomy (LSG) (17.8%) compared to laparoscopic Roux-en-Y gastric bypass (7.1%; p = 0.02). Menstrual regularity was less frequent in PCOS (n = 43) (26.0%) compared to non-PCOS women before BS (60.1%; p = 0.01), with no differences after surgery. Several perinatal results showed an improvement after BS, with a reduction in macrosomia rate and birth weight. BS was associated with an improvement in several reproductive outcomes. Menstrual regularity was especially improved in PCOS women. Further research may clarify the impact of LSG on fertility.

Factors Affecting Metabolic Outcomes Post Bariatric Surgery: Role of Adipose Tissue.

Obesity is an ever-growing public health crisis, and bariatric surgery (BS) has become a valuable tool in ameliorating obesity, along with comorbid conditions such as diabetes, dyslipidemia and hypertension. BS techniques have come a long way, leading to impressive improvements in the health of the majority of patients. Unfortunately, not every patient responds optimally to BS and there is no method that is sufficient to pre-operatively predict who will receive maximum benefit from this surgical intervention. This review focuses on the adipose tissue characteristics and related parameters that may affect outcomes, as well as the potential influences of insulin resistance, BMI, age, psychologic and genetic factors. Understanding the role of these factors may help predict who will benefit the most from BS.