Bariatric Surgical Intervention Research Articles

Generalizability of Randomized Clinical Trial Outcomes for Diabetes Control Resulting From Bariatric Surgery

Objective: To assess the external validity of randomized controlled trials (RCTs) of bariatric surgical treatment on diabetes control. Background: Multisite RCTs provide the strongest evidence supporting clinical treatments and have the greatest internal validity. However, characteristics of trial participants may not be representative of patients receiving treatment in the real world. There is a need to assess how the results of RCTs generalize to all contemporary patient populations undergoing treatments. Methods: All patients undergoing sleeve gastrectomy at University of California Los Angeles (UCLA) between January 8, 2018 and May 19, 2023 had their baseline characteristics, weight change, and diabetes control compared with those enrolled in the surgical treatment and medications potentially eradicate diabetes efficiently (STAMPEDE) and diabetes surgery study (DSS) RCTs of bariatric surgery’s effect on diabetes control. Weight loss and diabetes control were compared between UCLA patients who did and did not fit the entry criteria for these RCTs. Results: Only 65 (17%) of 387 patients with diabetes fulfilled the eligibility criteria for STAMPEDE, and 29 (7.5%) fulfilled the criteria for DSS due to being older, having higher body mass index, and lower HbA1c. UCLA patients experienced slightly less weight loss than patients in the RCTs but had similar diabetes control. The 313 (81%) patients not eligible for study entry into either RCT had similar long-term diabetes control as those who were eligible for the RCTs. Conclusions: Even though only a very small proportion of patients undergoing bariatric surgery met the eligibility criteria for the 2 major RCTs, most patients in this contemporary cohort had similar outcomes. Diabetes outcomes from STAMPEDE and DSS generalize to most patients undergoing bariatric surgery for diabetes control.

Gastro-esophageal diagnostic workup before bariatric surgery or endoscopic treatment for obesity: position statement of the International Society of Diseases of the Esophagus.

Obesity is a chronic and multifactorial condition characterized by abnormal weight gain due to excessive adipose tissue accumulation that represents a growing worldwide challenge for public health. In addition, obese patients have an increased risk of hiatal hernia, esophageal, and gastric dysfunction, as well as gastroesophageal reflux disease, which has a prevalence over 40% in those seeking endoscopic or surgical intervention. Surgery has been demonstrated to be the most effective treatment for severe obesity in terms of long-term weight loss, comorbidities, and quality of life improvements and overall mortality decrease. The recent emergence of bariatric endoscopic techniques promises less invasive, more cost-effective, and reproducible approaches to the treatment of obesity. With the endorsement of the International Society for Diseases of the Esophagus, we started a Delphi process to develop consensus statements on the most appropriate diagnostic workup to preoperatively assess gastroesophageal function before bariatric surgical or endoscopic interventions. The Consensus Working Group comprised 11 international experts from five countries. The group consisted of gastroenterologists and surgeons with a large expertise with regard to gastroesophageal reflux disease, bariatric surgery and endoscopy, and physiology. Ten statements were selected, on the basis of the agreement level and clinical relevance, which represent an evidence and experience-based consensus of the International Society for Diseases of the Esophagus.

Cost Effectiveness of Bariatric Surgical Treatment Methods: A Systematic Review

Obesity has become an epidemic today and has become one of the important public health problems. Pharmacological treatment, exercise, cognitive behavioural therapy, medical nutrition and bariatric surgery are used in the treatment of obesity. The aim of this study was to systematically identify and evaluate the national and international literature on the cost-effectiveness of bariatric surgery methods. In this context, a systematic search of electronic databases was conducted. Screening, data extraction, and critical assessment of methodological quality were evaluated according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Incremental cost-effectiveness ratio (ICER) and cost per quality-adjusted life year (QALY) were interpreted using the outcome measure. A total of 448 articles were accessed and the full text of 164 articles was analysed. Within the framework of inclusion and exclusion criteria, 20 articles were included in the study. According to the studies in the literature, bariatric surgery is a low-cost or cost-saving treatment option in the long term. There is limited evidence about the long-term clinical effects and safety of bariatric surgery. Therefore, further studies in this context will significantly contribute to the results of cost-effectiveness studies.

Առավել հաճախ կիրառվող բարիատրիկ վիրաբուժական միջամտությունների ժամանակակից միջազգային փորձը

No more than 10% of patients with morbid obesity can achieve the desired treatment result using traditional therapy. Currently, for more than 10 years, bariatric surgery is the only widely used surgical approach that has proved its efficacy in reducing body weight in patients. The purpose of this literature review is a generalized analysis of the international experience of the most frequently used modern bariatric surgical interventions. We have undertaken a generalized presentation of data on the most popular bariatric procedures - laparoscopic Sleeve Gastrectomy and Roux-en-Y gastric bypass, available in the Russian and English literature, published over the past 10 years. The choice was made according to the principle of correspondence of the research topics with modern ideas about the indicated aspects of contemporary bariatric surgery. The evaluation of the published data showed that both studied techniques demonstrated significant effectiveness in treating morbid obesity. However, the researchers presented discrete results that prove the discrepancy between the indicators of postoperative complications, the rate of weight loss and regression of comorbidities. The analysis of the data led us to the conclusion that it is necessary to develop modification of the surgical technique to improve the efficiency of management of this contingent of patients.

Endoscopic Biliary Drainage in Surgically Altered Anatomy.

Endoscopic retrograde cholangiopancreatography (ERCP) is considered the preferred method for managing biliary obstructions. However, the prevalence of surgically modified anatomies often poses challenges, making the standard side-viewing duodenoscope unable to reach the papilla in most cases. The increasing instances of surgically altered anatomies (SAAs) result from higher rates of bariatric procedures and surgical interventions for pancreatic malignancies. Conventional ERCP with a side-viewing endoscope remains effective when there is continuity between the stomach and duodenum. Nonetheless, percutaneous transhepatic biliary drainage (PTBD) or surgery has historically been used as an alternative for biliary drainage in malignant or benign conditions. The evolving landscape has seen various endoscopic approaches tailored to anatomical variations. Innovative methodologies such as cap-assisted forward-viewing endoscopy and enteroscopy have enabled the performance of ERCP. Despite their utilization, procedural complexities, prolonged durations, and accessibility challenges have emerged. As a result, there is a growing interest in novel enteroscopy and endoscopic ultrasound (EUS) techniques to ensure the overall success of endoscopic biliary drainage. Notably, EUS has revolutionized this domain, particularly through several techniques detailed in the review. The rendezvous approach has been pivotal in this field. The antegrade approach, involving biliary tree puncturing, allows for the validation and treatment of strictures in an antegrade fashion. The EUS-transmural approach involves connecting a tract of the biliary system with the GI tract lumen. Moreover, the EUS-directed transgastric ERCP (EDGE) procedure, combining EUS and ERCP, presents a promising solution after gastric bypass. These advancements hold promise for expanding the horizons of comprehensive and successful biliary drainage interventions, laying the groundwork for further advancements in endoscopic procedures.

A Cross-Sectional Study on Awareness and Knowledge of Sleeve Gastrectomy in the Eastern Province of Saudi Arabia.

Obesity is a global health concern associated with a plethora of chronic diseases. Genetic and lifestyle factors play a pivotal role in its development, making it a significant challenge for healthcare systems worldwide. In this context, sleeve gastrectomy has emerged as a prominent bariatric surgical intervention, but the level of awareness and knowledge regarding its indications and complications in the Eastern Province of Saudi Arabia is underexplored. This descriptive cross-sectional study was conducted over one year, from January 2022 to December 2022. The study aimed to assess the level of awareness among adults residing in the Eastern Province of Saudi Arabia regarding the indications and potential complications associated with sleeve gastrectomy. The study utilized random sampling and distributed a well-designed questionnaire in both English and Arabic. The questionnaire, validated for reliability, covered demographic data, general knowledge of sleeve gastrectomy, awareness of its indications, and knowledge of potential complications. The study included 1730 participants, with a majority in the 18-25 age group, predominantly female, and possessing a bachelor's degree. Awareness of sleeve gastrectomy was remarkably high, with 99% of respondents having heard of it, but only 50.1% accurately recognized the correct body mass index range for classifying obesity. Knowledge scores revealed 61.7% with poor knowledge, 31% with moderate knowledge, and 7.2% with good knowledge levels. Only 56.1% correctly identified the indications for sleeve gastrectomy. While participants displayed awareness of common complications, such as nutritional deficiencies, knowledge gaps persisted. This study exposes significant gaps in awareness and knowledge regarding sleeve gastrectomy, particularly concerning its indications and potential complications. It underscores the urgent need for targeted educational initiatives and active healthcare provider engagement in disseminating accurate information. Bridging these knowledge gaps through tailored public health campaigns can empower individuals to make informed decisions about the management of obesity.

Biomechanical characterization of the passive porcine stomach

The complex mechanics of the gastric wall facilitates the main digestive tasks of the stomach. However, the interplay between the mechanical properties of the stomach, its microstructure, and its vital functions is not yet fully understood. Importantly, the pig animal model is widely used in biomedical research for preliminary or ethically prohibited studies of the human digestion system. Therefore, this study aims to thoroughly characterize the mechanical behavior and microstructure of the porcine stomach. For this purpose, multiple quasi-static mechanical tests were carried out with three different loading modes, i.e., planar biaxial extension, radial compression, and simple shear. Stress-relaxation tests complemented the quasi-static experiments to evaluate the deformation and strain-dependent viscoelastic properties. Each experiment was conducted on specimens of the complete stomach wall and two separate layers, mucosa and muscularis, from each of the three gastric regions, i.e., fundus, body, and antrum. The significant preconditioning effects and the considerable regional and layer-specific differences in the tissue response were analyzed. Furthermore, the mechanical experiments were complemented with histology to examine the influence of the microstructural composition on the macrostructural mechanical response and vice versa. Importantly, the shear tests showed lower stresses in the complete wall compared to the single layers which the loose network of submucosal collagen might explain. Also, the stratum arrangement of the muscularis might explain mechanical anisotropy during tensile tests. This study shows that gastric tissue is characterized by a highly heterogeneous microstructure with regional variations in layer composition reflecting not only functional differences but also diverse mechanical behavior. Statement of SignificanceUnfortunately, only few experimental data on gastric tissue are available for an adequate material parameter and model estimation. The present study therefore combines layer- and region-specific stomach wall mechanics obtained under multiple loading conditions with histological insights into the heterogeneous microstructure. On the one hand, the extensive data sets of this study expand our understanding of the interplay between gastric mechanics, motility and functionality, which could help to identify and treat associated pathologies. On the other hand, such data sets are of high relevance for the constitutive modeling of stomach tissue, and its application in the field of medical engineering, e.g., in the development of surgical staplers and the improvement of bariatric surgical interventions.

Verification of Safety and Efficacy of Sleeve Gastrectomy Based on National Registry by Japanese Society for Treatment of Obesity.

In Japan, bariatric surgical treatment was started in 1982. The Japanese Society for Treatment of Obesity (JSTO) was established in 2007, and then, JSTO started the national registry of bariatric surgery cases and multidisciplinary educational program. A total of 44 facilities registered 4055 bariatric surgical cases until 2021. In this study, the purpose is to clarify the indication, the safety and the effectiveness of the sleeve gastrectomy using national registry database compiled by JSTO. Preoperative BMI ranged from 27.6 to 90.7 kg/m2, and the mean value was 42.7. With regard to gender, men/women was 1/1.3. Age was 42.2 as mean. As preoperative comorbidities, DM ratio was 54.4% of the patients, hypertension 64.5%, dyslipidemia 65.1%, and sleep apnea syndrome 69.8%. As an operation method, laparoscopic method was conducted in 99.7% of the cases. The intraoperative incidence rate was 0.9%. Conversion rate to open method was 1.1%. Postoperative morbidity ratio was 5.6%, and mortality was 0%. Reoperations were performed in 1.5% of the cases. Postoperative hospital stay was 5 days in median value. Body weight loss was 27.6 kg in the mean value after follow-up days of 279 ± 245. As the effect on the preoperative metabolic comorbidities, DM has improved in 82.9% of the cases, hypertension 67.9% and dyslipidemia 66.6%. In conclusion, using JSTO database, we evaluated the indication, postoperative complications and weight loss effect of sleeve gastrectomy in Japan. Regarding the evaluation of the effect on preoperative comorbidities, future follow-up based on more detailed criteria was considered to be necessary.

Dietary Supplements for Weight Loss.

The Federal Drug Administration has approved, following rigorous testing, 6 pharmacologic agents and one drug in device form for the management of overweight and obesity. Myriad products that purport to act on physiological mechanisms leading to weight loss also pervade the market with minimal regulatory oversight. Systematic reviews and meta-analyses of these products and their ingredients fail to establish any as meaningfully effective at the clinical level. Moreover, safety concerns prevail with adulteration, hypersensitivity reactions, and recognized adverse reactions. Lifestyle, pharmacologic, and bariatric surgical treatments are increasingly available, effective, and safe management tools for practitioners who should council patients, many of whom are susceptible to misinformation, on the lack effective and safe dietary supplements for weight loss.

LAPAROSCOPIC SLEEVE GASTRECTOMY AND GASTRIC PLICATION: INFLUENCE ON THE MAIN INDICATORS OF HORMONAL HOMEOSTASIS IN METABOLIC SYNDROME

Improvements in living standards have led to an increase in the annual global incidence of obesity to 13% among adults in 2021.
 Laparoscopic gastroplication is safe to perform, essentially organ-preserving and relatively inexpensive from an economic point of view.
 Among the advantages of gastroplication should be included its simplicity in performance, which makes a wider circle of its use. It should also be noted that during gastroplication there is no crossing of the organ cavity (stomach), which makes such complications as failure of the suture line, bleeding from the suture line impossible. However, it remains relevant to determine the effect of this type of intervention on the level of orexogenic and anorexigenic hormones in the postoperative period.
 Aim of the research: to evaluate the influence of sleeve-gastrectomy and gastric plication on the main indicators of hormonal homeostasis in metabolic syndrome.
 The Goal is to evaluate the influence of sleeve gastrectomy and gastroplication on the main indicators of hormonal homeostasis in metabolic syndrome.
 Materials and methods. The work is based on the materials of clinical examination and surgical treatment of 12 patients with metabolic syndrome, 4 men and 8 women aged 45±3.75 years with a body mass index >40 kg/m2. Depending on the chosen surgical intervention, all patients included in the study were divided into two groups: laparoscopic sleeve gastrectomy - 5 patients, laparoscopic gastric plication - 7 patients.
 Results. A decrease in ghrelin concentration was established 4 weeks after sleeve-1 surgery by 35.06% (p=0.0595), while after 3 months this indicator decreased by 58.57% (p=0.0065), and after 6 months by 60.31% (p=0.0057 ). Gastric plication also demonstrated a decrease in the ghrelin level (1 month – 22.17% (p=0.1290), 3 months – 32.82% (p=0.0245), however, this type of surgical intervention did not cause its significant decrease in the corresponding time periods. The use of surgical sleeve-1 and sleeve-2 methods showed a significant decrease in the level of leptin, which is evidence of a decrease in the degree of resistance. Thus, after sleeve-1 in terms of 1, 3 and 6 months, a decrease in its serum level by 38.47% was noted (p=0.0342), 54.67% (p=0.0056), 56.95% (p=0.0069), respectively. And in patients after word-2 in terms of 1, 3 and 6 months, a decrease in its serum level by 24.67% (p =0.1230), 35.68% (p=0.0193), 48.29% (p=0.0028), respectively.
 On the other hand, the used bariatric surgical interventions caused an increase in the concentration of adiponectin. Its level increased by 7.14% (p=0.9124) after 1 month, by 30.63% (p=0.5741) after 3 months, and by 36.64% (p=0.4093) six months after sleeve-1 surgery. After gastric plication, an increase of 7.71% (p=0.8731), 16.71% (p=0.6198) and 30.89% (p=0.4304) was registered in the respective observation periods.
 Conclusions. Significant changes in the levels of adipokines after bariatric surgery, such as an increase in adiponectin and a decrease in leptin, indicate a high potential in reducing the manifestations of metabolic syndrome and the risk of developing type 2 diabetes. And the decrease in the level of ghrelin, which interacts with these hormones in a feedback type, is the trigger for the regulation of hormonal homeostasis, which can be achieved by bariatric surgery.

Liraglutide 3.0 (Saxenda) in bariatric patients: a retrospective real-world clinical evaluation of effectiveness

Background: Glucagon-like peptide-1 analogues such as liraglutide 3.0 mg (Saxenda) have yielded significant weight loss in clinical trials when combined with lifestyle interventions. Despite the recent approval of liraglutide 3.0 mg, its success among patients attending specialist bariatric units remains uncertain. Objective: This study investigated the effectiveness of liraglutide 3.0 mg on weight, body mass index (BMI), treatment tolerability and its effects on glycated haemoglobin (HbA1c). Methods: Clinical data were retrospectively obtained from medical records within Tier 3-4 bariatric weight management clinics. Wilcoxon signed rank tests were employed to establish the statistical significance (p<0.05) of changes in weight and HbA1c. Results: 33 patients were identified (72.7% female with mean baseline age, weight and BMI of 44.8 years, 156.6 kg and 55.0 kg/m2, respectively). Eighteen patients had completed 26 weeks of treatment. Of the 18 patients, the discontinuation rate due to side effects was 15.2%, indicating substantial treatment tolerance. After 26 weeks of treatment, BMI (±standard deviation) was significantly reduced by 7.9±6.3% (p<0.05) and 72.2% of patients achieved at least 5% weight loss. Additionally, a significant decrease in median HbA1c (4.5±4.5 mmol/mol) was observed (p<0.05), concurrent with increased remission from prediabetes. Conclusion: This retrospective study revealed that liraglutide 3.0 mg, together with lifestyle management, reduced weight and improved glycaemic control. These results support liraglutide’s application in certain high-risk populations, including patients waiting for bariatric surgical intervention.

BS P04 Global Level of Harm experienced by Bariatric Surgeons for Bariatrics surgical interventions: An exploration of predictors

Abstract Background COVID-19 pandemic has taken the world by surprise with the depth and breadth of its effect on all walks of life, bariatric surgery being no exception. With the scientific literature hitherto unable to comment and ascertain the influence of the COVID-19 pandemic on bariatric surgery and the level of harm experienced by bariatric surgeons, we- TUGS ‘Level of Harm’ collaborative group- attempted to gauge the effect of the said pandemic on bariatrics surgery specifically vis a vis the level of harm experienced by bariatric surgeons due to the pandemic. Methods A virtual questionnaire- developed on both: Google forms and Survey Monkey- was circulated via TUGS social media platforms to reach bariatric consultant surgeons, fellows and residents practising throughout the world in a bid to explore the influence of the COVID-19 pandemic on their surgical practice including but not limited to the annual surgical volume including re-do surgeries volume and postoperative complications. Moreover, they were also requested to categorise their respective level of harm vis a vis bariatric surgical interventions they undertake. After de-identification of the data, SPSS (V.26) was adopted to undergo statistical analysis. After exploring the dataset by descriptive analyses, the Chi-square test was applied to pursue the association of categorical variables with the reported level of harm. A double-sided p-value of less than 0.05 was considered statistically significant. Results 16.8% of the respondents (21/125) indicated no harm vis a vis bariatrics surgery work whereas a comparative 18.4% of the respondents (23/125) reported moderate harm with significant worsening of symptoms. None of those who indicated less than 10% increase in surgery waitlisted patients being subjected to endoscopic interventions (0/14) reported Moderate Harm for bariatrics surgery work with significant worsening of symptoms whereas 1 in every 3 of those who indicated between 10% to 25% increase in surgery waitlisted patients being subjected to endoscopic interventions (5/15) reported such level of harm for bariatrics surgery work. (p < 0.001) Upon exhaustive sub-group analysis, it was uncovered that 33.6% of bariatrics surgical professionals perceived no harm (no evidence of change in clinical condition) during gastric band or related surgery work with only 4% perceiving Moderate Harm (significant worsening of symptoms/ comorbidities control/ minor increase in medications) for such surgical interventions. All of those who reported No harm for gastric band or related surgical work reported that Single anastomosis duodeno–ileal bypass (SADI-S) accounts for 10% of their practice whereas none of those who indicated that SADI-S accounts for more than 10% of their practice reported No harm for such surgical work. (p = 0.019) Conclusions The global snapshot illustrates a trend of low harm vis a vis bariatrics surgery work in surgical professionals practising in the private sector with a lesser number of patients developing COVID-19 postoperatively and no postoperative COVID-19 related mortality. The patient being subjected to endoscopic intervention portends a higher level of harm for bariatrics surgical work- strict adherence to criteria and safety protocols being a logical inference. For gastric band and related surgery work, preoperative COVID-19 testing appears to be influenced by confounders in its effect on the surgeon's level of harm for the said interventions warranting further exploration. SADI-S, at a cut-off of 10%, exhibits strong interaction with the surgeon's level of harm for gastric band insertion and relation surgery work. Women surgical professionals came out to exhibit equivalent mental resilience and technical prowess at par with their male colleagues when it came to bariatrics surgical intervention.

Impact of Chronic Immunosuppression on Short-, Mid-, and Long-Term Bariatric Surgery Outcomes.

Bariatric surgical outcomes depend heavily on proper healing of gastrointestinal anatomy, metabolic alterations, and patient lifestyle modifications which are all negatively impacted by immunosuppression and underlying inflammatory diseases. There is a lack of literature exploring how patients with diseases requiring immunosuppression respond to bariatric surgical intervention in the long term. A retrospective analysis of chronically immunosuppressed patients who underwent primary bariatric surgeries at Mayo Clinic was conducted (2008-2020). Data collected included patient demographics, BMI, underlying disease, and immunosuppression regimen and complications at 3, 6, 12, 24, and 60months. We identified a total of 89 (RYGB = 49, SG = 34, BPD/DS = 6) patients on chronic immunosuppression who underwent bariatric surgery at our center. RYGB (N = 49), 38.2% had a SG (N = 34) and 6.7% had a BPD/DS (N = 6). Rheumatoid arthritis and renal transplantation were the most underlying condition at 20.22% each (N = 18). There were a total of 2 (2.25%) intraoperative complications. In the immediate post-operative period, there were 15 (16.5%) minor complications. In follow-up, 6.1% of RYGB patients experienced marginal ulcerations, while no gastrointestinal leaks occurred. The mean pre-surgical BMI was 48.29kg/m2 (SD = 18.41). Percent total weight loss (%TWL) and BMI reduction were 30.89% and 14.83kg/m2 (SD = 9.07) at 12months and 29.48% and 14.43kg/m2 (SD = 13.46) at 60months, respectively. The mean follow-up time was 30.49months. Bariatric surgery remains safe and effective therapy for chronically immunosuppressed patients with excellent long-term outcomes for patients with moderate to severe obesity.

БАРИАТРИЧЕСКИЕ ОПЕРАЦИИ ПРИ МОРБИДНОМ ОЖИРЕНИИ

Objective. To improve the results of surgical treatment of patients with morbid obesity. Methods. The database of bariatric surgery (2014-2020 yrs) was created and analyzed in the center, retrospectively and prospectively. Total 292 operations, including 150 sleeve gastrectomy, 84 mini gastric bypass procedures, 37 adjustable gastric bandings, 12 Roux-en-Y gastric bypasses, 5 gastric plications and 4 gastric plications with gastric fundus resection have been included in this database. There were 215 females and 77 males. The mean age was 41 years. All surgeries were performed laparoscopically and meanoperative time was 108 minutes. Results. As the result of performed bariatric surgeries, 36 complications were registered. Total complication rate was 11,8% without any case of mortality. Staple line and anastomotic leakage rate after surgery, related to the stomach resection or bypass, was 3,4%. Staple line and anastomotic bleeding rate after the same procedures - 3,1%. The the aforementioned complications were the most frequent and accounted up to 47% of all bariatric surgery complications. Other complications occurred much less frequently with incidence rate 0,4% - 1,2%. Conclusion. The bariatric surgery database allows analyzing the structure of performed operations and its complications as well as identifying the regularity of their development. That would help to develop methods of the most frequent complication prevention and their early diagnostics. Compatibility of the database format with IFSO Global Registry allows providing the collected data for further analysis at the international level. Data on the spectrum and frequency of postoperative complications in the center correlate with international experience. The most significant complications in the practice of the center are incompetence, anastomotic leakage and bleeding from the lines of sutures and anastomoses after operations associated with gastric resection or bypass. Therefore, the specific measures for improvement preventionofcomplications permits increasing significantly bariatric surgery safety. What this paper adds The structure of postoperative complications of bariatric surgical interventions performed in a multidisciplinary hospital has been determined. Staplelinefailure withgastricleak are the most common early complications after the operations related to resection or gastric bypass and account for more than 47% of all complications. Prevention of complications to improve outcome significantly increases the safety of the performed bariatric interventions.

Management of Obesity and Nonalcoholic Fatty Liver Disease: A Literature Review.

With the recent urbanization and globalization, the adult obesity rate has been increasing, which was paralleled with a dramatic surge in the incidence and prevalence of nonalcoholic fatty liver disease (NAFLD). NAFLD poses a growing threat to human health as it represents the most common cause of chronic liver disease in developed countries. It encompasses a wide spectrum of conditions starting from a build-up of fat in hepatocytes (steatosis), to developing inflammation (steatohepatitis), and reaching up to cirrhosis. It is also associated with higher rates of cardiovascular mortalities. Therefore, proper timely treatment is essential and weight loss remains the cornerstone in the treatment of obesity-related liver diseases. When diet, exercise, and lifestyle changes are not successful, the current recommendation for weight loss includes antiobesity medications and bariatric endoscopic and surgical interventions. These interventions have shown to result in significant weight loss and improve liver steatosis and fibrosis. In the current literature review, we highlight the expected outcomes and side effects of the currently existing options to have a weight-centric NAFLD approach.

New Technique of Posterior Fixation of Tube With Fibrin Sealant Prevents Dysphagia in Patients Undergoing Sleeve Gastrectomy.

This study compared the effects of posterior fixation (PF) of the remnant tube with fibrin tissue glue to prevent sharp angulation and gastric twist and traditional techniques on postoperative dysphagia and vomiting. In total, 200 patients scheduled to undergo laparoscopic sleeve gastrectomy (LSG) as a bariatric surgical intervention were randomly classified into 2 groups (LSG + PF and LSG alone). We compared postoperative dysphagia symptoms among patients who underwent PF and those who did not. The Dysphagia Handicap Index (DHI) results were compared statistically among these groups. The study included a total of 191 patients (85.9% (n = 164) women and 14.1% (n = 27) men) who underwent LSG for obesity. The groups were similar in terms of the patient demographics. The DHI scores of the LSG + PF group were statistically significantly lower than those of the LSG alone group. Adoption of a standardized method of PF with a standardized surgical procedure after LSG considerably reduced the rate of surgical complications.

Preoperative body-related emotional distress and culture as predictors of outcomes of bariatric surgery

Findings concerning the impact of bariatric surgical intervention on both psychological variables and weight loss are often controversial and misconstrued the world over. The aim of this study was to classify bariatric surgery patients according to patterns of preoperative measures that may predict postoperative psychological and physiological outcomes and to compare these patterns between two distinct cultures. Of 169 consecutive bariatric surgery candidates from Israel and 81 candidates from the United States, 73 and 35 patients, respectively consented to be included in a follow-up phase. Body image dissatisfaction, emotional eating behaviors, risk of suicide, depressive symptoms, anxious symptoms, and percent excess weight loss were measured. K-means clustering procedure was used to classify bariatric surgery patients according to their preoperative body-related emotional distress, which was composed of body image dissatisfaction and emotional eating. The joint effect of culture and body-related emotional distress cluster on psychological distress was tested. The cluster analysis revealed two preoperative body-related emotional distress patterns: high body-related emotional distress and low body-related emotional distress. Following surgery, US patients showed a higher risk of suicide and lower excess weight loss than Israeli patients within only the high body-related emotional distress cluster (a significant interaction effect). Preoperative assessment of body-related emotional distress patterns among bariatric surgery candidates may enable professionals to identify potential postoperative risks of suicide, anxiety, and decreased weight loss. The relationship between the body-related emotional distress cluster and outcome measures is culture dependent. Case-control analytic study.

Long-term durability of weight loss after bariatric surgery; a retrospective study

BackgroundThe surgical operation of Bariatric is taken into consideration to be the best treatment for excessive obesity. The prime requirement for the broad usage of bariatric surgical treatment is the durability. This study compares the weight variation up to five years between patients treated by RYGB (Roux-en-Y Gastric Bypass) and non-surgical methods. MethodsThe current work is a retrospective cohort study which was performed on one hundred patients who subjected to RYGB surgical treatment and matched severely obese controls that had not treated by bariatric surgery in the period from 2011 to 2015 and completed five years follow up. ResultsThe differences between the two study groups were significant according to their loss in weight within a five years record. More than 90% of Patients were satisfied inside the RYGB group versus a percent of 4% in Non-surgical Matches group with a great significant difference. ConclusionThe concluded results confirm that bariatric surgical treatment is the handiest and giving the best results in reducing enormous excess weight in patients with sharp obesity. These effects provide additional proof of the valuable combination between direct loss of weight by surgery and long-term methods.

Preoperative Binge Eating and Weight Loss After Bariatric Surgery: A Systematic Review and Meta-analysis.

Several studies have investigated if bariatric surgery candidates with binge eating disorder (BED) are at risk for suboptimal postoperative weight loss. The aim of this systematic review with meta-analysis was to evaluate the association between binge eating diagnosed preoperatively and weight loss after bariatric surgery. MEDLINE, EMBASE, CENTRAL, LILACS, and other specialized databases were searched on August 2020. Clinical trials and observational studies including individuals who had undergone any type of bariatric surgical treatment with preoperative evaluation of BED and at least one postoperative measure of weight were initially selected. Four reviewers independently screened for eligibility. The mean difference was calculated using the random-effects model. Nineteen studies, comprising 3223 participants (80.25% women; median age 41years), met the inclusion criteria for meta-analysis. At 6months postoperative, the percentage of total weight loss (%TWL) was not significantly different between BED and non-BED groups [6 studies, 914 participants: - 0.75% (95% CI, - 2.79 to 1.29; I2 = 0%)], even when analyzing only those three studies that included gold standard assessment tools. No significant differences were found at 12, 24, 36, or 60months. Pre-bariatric BED seems to have little or no influence on weight loss after surgery. However, many questions remain unanswered because of the use of different measures across studies. The heterogeneity among studies emphasizes the importance of investigators using the same assessment measures.

New intragastric sleeve technique reduces adipose tissue in pig experimental model: tomographic study

In order to implement a new bariatric surgery technique, we verify the efficacy of intragastric sleeve to reduce weight gain and subcutaneous adipose tissue (SAT). Animals were divided into two groups: G1 (single-port intragastric sleeve) and G2 (sham group). The stomach was surgically reduced by single-port intragastric sutures to fo a gastric sleeve. Animals were submitted to computer tomography (CT) before the surgical procedure and after 18 weeks.Images were analyzed and measurements of the thickness of SAT, depth and width of the longissimus dorsi muscle and the rib eye area were made. Body weight and CT measurements were analyzed using the GLM PROC. The correlation coefficients were calculated among weight, moments and measures. There was a significant difference in weight gain, in which G1 had an average of 42.803 ± 3.206 kg, lower than G2 (45.966 ± 4.767 kg). The mean values for SAT and muscle measurements differed significantly between groups, in which G1 achieved the lowest values. All variables had significant correlations and high magnitude. Intragastric sleeve surgery induced a significant decrease of SAT. The new intragastric sleeve technique is feasible, safe and effective, mainly in reducing fat deposition, making it an important alternative in bariatric surgical treatment.