Bariatric Surgery Research Articles

Continuous peri-operative glucose monitoring in noncardiac surgery: A systematic review.

Glucose management is an important component of peri-operative care. The usefulness of continuous glucose monitoring (CGM) in noncardiac surgery is uncertain. To systematically assess the glycaemic profile and clinical outcome of patients equipped with a CGM device during the peri-operative period in noncardiac surgery. Systematic review. Electronic databases were systematically searched up to July 2024. Any studies performed in the peri-operative setting using a CGM device were included. Closed-loop systems also administering insulin were excluded. Analyses were stratified according to diabetes mellitus status and covered intra-operative and postoperative data. Outcomes included glycaemic profile (normal range 3.9 to 10.0 mmol l-1), complications, adverse events, and device dysfunction. Twenty-six studies (1016 patients) were included. Twenty-four studies were not randomised, and six used a control arm for comparison. In bariatric surgery, diabetes mellitus patients had a mean ± SD glucose of 5.6 ± 0.5 mmol l-1, with 15.4 ± 8.6% time below range, 75.3 ± 5.5% in range and 9.6 ± 6.7% above range. During major surgery, diabetes mellitus patients showed a mean glucose of 9.6 ± 1.1 mmol l-1, with 9.5 ± 9.1% of time below range, 56.3 ± 13.5% in range and 30.6 ± 13.9% above range. In comparison, nondiabetes mellitus patients had a mean glucose of 6.4 ± 0.6 mmol l-1, with 6.7 ± 8.4% time below range, 84.6 ± 15.5% in range and 11.2 ± 4.9% above range. Peri-operative complications were reported in only one comparative study and were similar in CGM and control groups. Device-related adverse events were rare and underreported. In 9.21% of cases, the devices experienced dysfunctions such as accidental removal and issues with sensors or readers. Due to the limited number of controlled studies, the impact of CGM on postoperative glycaemic control and complications compared with point-of-care testing remains unknown. Variability in postoperative glycaemic profiles and a device dysfunction rate of 1 in 10 suggest CGM should be investigated in a targeted surgical group.

Small bowel obstruction caused by rare intraluminal hematoma secondary to gastric bypass: a case report

Abstract Introduction: With the increase in obesity and therefore obesity surgery in the world, there is also an increase in surgery-related complications. Mechanical small bowel obstruction after gastric bypass is a common complication and the most common causes of obstruction are kinking or stenosis of the entero-enterostomy, internal herniation, adhesions, external compression on the transverse mesocolon, incarceration of an abdominal wall hernia, or intussusception. One of these complications is intraluminal hematoma, which, although rare, has dangerous consequences that can even lead to mortality. Since it is a life-threatening complication, early diagnosis and emergency intervention are important. Case report: In this case report, we wanted to emphasize the early effectiveness of radiology and surgery in the diagnosis and treatment processes of a patient with intraluminal hematoma after laparoscopic roux-NY gastric bypass. Conclusion: . The most common location of intraluminal hematoma is the jejunojejunal anastomosis area. Symptoms may occur earlier (at the 12th postoperative hour). Whole-abdominal MDCT remains the main method of diagnosing intestinal obstruction, including small bowel obstruction resulting from intraluminal hematoma.

Is It Possible to Predict Difficulties During Laparoscopic Sleeve Gastrectomy? A Single Centre Experience

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric surgery across the globe. Understanding preoperative risk factors for possible intraoperative complications can aid in predicting surgical outcomes and shaping the approach to the procedure. This study aimed to identify and analyze potential risk factors associated with intraoperative difficulties during LSG. Patients and methods: The analysis encompassed consecutive patients who underwent LSG from 2017 to 2020. Patients who encountered intraoperative difficulties during the procedure were categorized into Group 1, whereas those who did not experience such complications were placed in Group 2. To identify potential risk factors for intraoperative challenges, a thorough evaluation of demographic characteristics was conducted, including variables such as age, body mass index (BMI), comorbidities, and previous surgical history. Results: Group 1 included 37 patients (11.71%), while Group 2 comprised 279 patients (88.29%). Apart from higher rates of diabetes, pulmonary disease, and sleep apnea in Group 1, no significant differences were observed between the groups regarding demographic parameters. A univariate logistic regression analysis identified several risk factors associated with intraoperative difficulties, including a body mass index (BMI) greater than 50 kg/m2 (OR 2.15, 95%, CI 1.05–4.39, p = 0.0362), the experience of the operating surgeon (OR 9.22, 95% CI 4.31–19.72, p = 0.0058), the presence of diabetes (OR 2.44, 95% CI 1.19–4.98, p = 0.0146), and pulmonary disease (OR 12.22, 95% CI 1.97–75.75, p < 0.0001). In multivariate logistic regression analysis, only the surgeon’s experience (OR 8.61, 95% CI 3.75–19.72, p < 0.0001) remained a significant factor influencing intraoperative difficulties. Conclusions: The sole significant factor influencing the occurrence of intraoperative difficulties was the level of the surgeon’s experience

Maternal and neonatal risks and outcomes after bariatric surgery: a comparative population based study across BMI categories in Qatar

The impact of Bariatric Surgery (BS) on maternal and neonatal outcomes among pregnant women is not fully understood, especially in comparison to different weight categories. The primary aim of this study is to assess the factors associated to women who have undergone BS. The study also investigates the maternal and neonatal outcomes amongst this group in comparison to the three Body Mass Index (BMI) groups (women with obesity, overweight and normal weight). A 12-month population-based retrospective study was conducted using registry data from the PEARL-Peristat Study at the Women's Wellness and Research Center (WWRC) in Qatar from January 1, 2017, through December 31, 2017. Both univariate and multivariable regression analyses were employed to scrutinize risk factors and maternal and neonatal outcomes. The study included 6212 parturient women, of which 315 had a history of BS, while 5897 with no BS history. Qatari women, aged 35 and higher, with parity > 1, diabetes, and hypertension were more likely to be in the post-BS group. Women in the post-BS group were found to be more likely to have a cesarean delivery (37.5% vs. 24%, Adjusted Odds Ratio (aOR) = 1.59, CI 1.18–2.14), preterm babies (10% vs. 7%, aOR = 1.66, CI 1.06–2.59), and stillbirth (1.6% vs. 0.4%, aOR = 4.53, CI 1.33–15.50) compared to the normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than women with obesity (15% vs. 8%, aOR = 1.77, CI 1.153–2.73), overweight (15% vs. 7%, aOR = 1.63, CI 1.09–2.43), and normal weight (15% vs. 8%, aOR = 1.838, CI 1.23–2.75). Finally, women in the post-BS group were more likely to have low-birth-weight neonates amongst term babies than women with obesity and overweight. Pregnancies with post-BS should be considered a high-risk group for certain medical outcomes and should be monitored closely. These findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women.

Impact of Sleeve Gastrectomy on Body Weight and Food Intake Regulation in Diet-Induced Obese Mice

The epidemic of obesity has increased worldwide and is associated with comorbidities such as diabetes and cardiovascular disease. In this context, strategies that modulate body weight and improve glycemic metabolism have increased, and bariatric surgeries such as Sleeve Gastrectomy (SG) have been highlighted in obesity treatment. However, the mechanism by which SG reduces body weight and improves glycemic control remains unknown. Thus, in this study, we aimed to evaluate food intake and the expression of hypothalamic genes involved with the regulation of this process in diet-induced obese mice submitted to SG. For this, we used C57BL/6 mice submitted to a 10-week high-fat diet protocol and submitted to SG. Food intake, fed and fasted glycemia, as well as hypothalamic anorexigenic and orexigenic gene expression were evaluated 4 weeks after the surgical procedure. First, we observed that SG reduces body weight (44.19 ± 0.47 HFD, 43.51 ± 0.71 HFD-SHAM, and 38.22 ± 1.31 HFD-SG), fasting glycemia (115.0 ± 4.60 HFD, 122.4 ± 3.48 HFD-SHAM, and 93.43 ± 4.67 HFD-SG), insulinemia (1.77 ± 0.15 HFD, 1.92 ± 0.27 HFD-SHAM, and 0.93 ± 0.05 HFD-SG), and leptinemia (5.86 ± 1.38 HFD, 6.44 ± 1.51 HFD-SHAM, and 1.43 ± 0.35 HFD-SG) in obese mice. Additionally, SG reduces food (5.15 ± 0.18 HFD, 5.49 ± 0.32, HFD-SHAM, and 3.28 ± 0.26 HFD-SG) and total (16.88 ± 0.88 HFD, 17.05 ± 0.42, HFD-SHAM, and 14.30 ± 0.73 HFD-SG) calorie intake without alterations in anorexigenic and orexigenic gene expression. In conclusion, these data indicate that SG improves obesity-associated alterations at least in part by a reduction in food intake. This effect is not associated with the canonical food intake pathway in the hypothalamus, indicating the involvement of non-canonical pathways in this process.

Utilization of Enhanced Recovery After Surgery (ERAS) protocol in pediatric laparoscopic sleeve gastrectomy: a quality improvement project.

The obesity epidemic has led to an increased number of adolescents requiring metabolic and bariatric surgery (MBS), but there is paucity of data on the impact of implementing all aspects of Enhanced Recovery After Surgery (ERAS) protocols to improve outcomes in this population. We implemented a comprehensive ERAS pathway for adolescents undergoing laparoscopic sleeve gastrectomy (LSG). Key elements included pre-operative fasting with carbohydrate loading in the morning of surgery, comprehensive anti-emetic and analgesic regimens including intra-operative lidocaine infusion (initiated before formal ERAS launch), regional anesthesia, and early goal-directed ambulation. We tracked opioidutilization, rescue anti-emetic use, time to oral intake,and hospital length of stay (HLOS) as outcome measures, and post-operative pain and returns to the system as balancing measures. Eighty-six patients(52 patients pre-ERAS and 34 patients post-ERAS) underwent LSGwith no differences in demographics. The post-ERAS group had earlier time to oral intake (3.0 vs. 5.5 h, p = 0.003), used less rescue anti-emetics, (8.0vs.16.0 mg, p < 0.001), and had shorter HLOS (33 vs. 54 h, p < 0.001) but no difference in opioid use (0.370 vs. 0.435 MME/kg, p = 0.17), post-operative pain scores or return to the system. Our novel use of bariatric-specific ERAS protocol with intra-operative lidocaine infusion accelerates the time to goal-directed oral intake and decreases HLOS without increasing the rate of returns to the system. This study highlights the feasibility and effectiveness of adapting adult ERAS protocols to the pediatric MBS population. Level III.

Reliability of the Cleveland Clinic Behavioral Rating System (CCBRS) Among Diverse Patients Seeking Bariatric Surgery.

The CCBRS is a multidimensional assessment tool developed to aid in the psychosocial evaluation of patients seeking bariatric surgery. To date, three studies support the interrater reliability, internal consistency, and predictive validity of the CCBRS for a number of postoperative outcomes. However, research has predominantly been with White females. This study examines the reliability of the CCBRS with diverse individuals from three surgery clinics. The relative contribution of demographic and psychosocial variables to overall CCBRS ratings and differences in overall CCBRS ratings based on these factors are also explored. Patients seeking bariatric surgery (n = 407; 86.2% female; 49.6% Black; mean BMI 48.3kg/m2, SD = 8.5) were evaluated with a standardized multimodal assessment. CCBRS domain and overall ratings were made based on the integration of assessment data. Patient weight, BMI, and weight loss surgery procedure were obtained from the initial bariatric surgery consult. Internal consistency of the CCBRS was good (Cronbach's alpha = .80) for this sample though lower than previously found. Most patients (75.6%) were cleared for surgery. Statistically significant differences in overall CCBRS ratings were found only based on employment status and referring clinic. Hierarchical regression analysis demonstrated a small effect for demographic and psychosocial factors, with only past alcohol abuse, current substance abuse, and referring clinic explaining statistically significant variance in overall CCBRS ratings. Results support the reliability of the CCBRS; however, additional research is needed with diverse populations.

Effect of bariatric surgery on HDL-mediated cholesterol efflux capacity

Effect of bariatric surgery on HDL-mediated cholesterol efflux capacity

Association of High-Sensitivity C-Reactive Protein (hs-CRP) with Weight Loss After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass at 10 Years: A Secondary Analysis of the SLEEVEPASS Randomized Clinical Trial.

Severe obesity is associated with a low-grade chronic inflammation, and high-sensitivity C-reactive protein (hs-CRP) is a marker that can be used to evaluate chronic inflammation status. Metabolic bariatric surgery (MBS) is shown to decrease hs-CRP level, but long-term results are scarce, and association with weight loss outcomes is undetermined. This study aims to evaluate chronic inflammation in patients with obesity using hs-CRP, and its association with long-term weight loss outcomes after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The long-term follow-up data of SLEEVEPASS (ClinicalTrials.gov NCT00793143) randomized clinical trial (RCT) was used. Hs-CRP was measured at baseline, and at 6months, 1, 3, 5, 7, and 10years after surgery, and the association with weight and weight loss outcomes were analyzed. Hs-CRP at baseline was available for 59 out of 240 (24.6%) patients. In the whole study population, the nadir hs-CRP (mean estimate 1.14mg/ml, 95% CI 0.87-1.49) was achieved at 3years after surgery with a statistically significant difference to baseline (p = 0.003). No statistically significant difference was seen between LSG and LRYGB in hs-CRP change over time (operation*time interaction p = 0.540). Higher hs-CRP correlated with higher BMI at baseline (Spearman correlation 0.282, p = 0.030) and at 10years (Spearman correlation 0.490, p = 0.001). At 10years, a greater percentage total weight loss (%TWL) correlated with lower hs-CRP level (Spearman correlation - 0.558, p < 0.001). Baseline hs-CRP (Spearman correlation - 0.152, p = 0.299) and hs-CRP change in first 6months postoperatively (Spearman correlation 0.167, p = 0.254) did not correlate statistically significantly with %TWL at 10years. MBS decreases hs-CRP also at long-term follow-up with weight loss as the driving force. Neither baseline hs-CRP nor hs-CRP change at 6months were feasible as a predictive marker for long-term outcomes.

Investigation of homocysteine level after bariatric metabolic surgery, effect on vitamin B12 and folate levels

BackgroundObesity is a serious health problem with increasing incidence. worldwide and remains one of the most important causes of preventable deaths. We aimed to examine the relationship between Vitamin B12 and Folic acid, which have an important role for human life, and homocysteine is widely recognized for its association with the development of cardiovascular disease, although its role as an independent risk factor remains a topic of ongoing debate.Materials and methodsWe evaluated 126 patients who underwent bariatric metabolic surgery between September 2019-September 2020. In addition to demographic characteristics of the patients, weight, Vitamin B12, folate, HbA1c, cholesterol, triglyceride, ferritin, serum iron, albumin levels at preoperative, postoperative 1st month, 6th month, 12th month follow-ups were analyzed.ResultsPatients with the desired biochemical parameters at the determined follow-up points were identified and two groups were formed as RYGB(n = 43) and SG(n = 7) patients. When biochemical parameters were analyzed between the groups, homocysteine, HbA1c, HDL Cholesterol, VLDL Cholesterol, Total Cholesterol, Triglycerides, Ferritin, Serum Iron levels showed a statistical difference (p < 0.001). Folate (p = 0.064) and albumin (p = 0.257) did not show a significant difference over time. The change in vitamin B12 (p = 0.409) over time was not significant in the SG group, whereas a significant difference was observed in the RYGB group (p < 0.001). When we established a marginal model to determine the factors affecting the change in homocysteine over time, vitamin B12 and folate values.ConclusionsThe relationship between Vitamin B12, folate and homocysteine is important in order to better understand the complications that develop in bariatric metabolic surgery patients, to prevent possible complications and to better manage the process.

The Effect of Ultrasound-Guided Erector Spinae Plane Block on Postoperative Opioid Consumption and Respiratory Recovery in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study.

The aim of this prospective, randomized, controlled study was to evaluate the effect of ultrasound (US)-guided bilateral erector spinae plane (ESP) block on postoperative opioid consumption and respiratory recovery in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG). The study was conducted on 40 patients scheduled for LSG. The patients were randomly allocated into either the ESP block group or the control group. The US-guided bilateral ESP block was performed preoperatively. The control group received no intervention. Postoperative median [IQR] tramadol consumption was significantly lower in the ESP block group [150.0 [100-200] mg vs 450.0 [400-500] mg, p < 0.0001]. Postoperative spirometric variables were significantly impaired in both groups, compared with preoperative variables (p < 0.0001). Intraoperative median [IQR] fentanyl consumption was 200.0 [200-200] µg in the ESP block group, and 350.0 [300-400] µg in the control group (p < 0.0001). Postoperative mean pain scores at rest and during movement were significantly lower in the ESP block group, at all time points (p < 0.05). In terms of mean arterial PH, Horowitz ratio, and PaCO2, there was no statistically significant difference between the groups (p > 0.05). None of the patients experienced postoperative respiratory adverse events and/or block-related complications. US-guided bilateral ESP block significantly reduced both intraoperative and postoperative analgesic consumptions and provided effective postoperative pain control for patients with obesity undergoing bariatric surgery. Following bariatric surgery, all patients' postoperative pulmonary functions deteriorated. The effect of US-guided bilateral ESP block on postoperative respiratory recovery could not be clearly demonstrated. Randomized controlled studies with a larger patient population are necessary.

Clinical utility of echocardiography in internal medicine: a narrative review

Echocardiography has emerged as an invaluable tool in internal medicine, providing real-time, non-invasive evaluation of cardiac structure and function. Its clinical utility spans a wide range of applications, including the diagnosis and management of heart failure, valvular heart diseases, and cardiomyopathies, as well as systemic conditions like sepsis and chronic kidney disease. The ability to perform bedside echocardiography has made it particularly useful in critical care settings, allowing for rapid assessment of cardiac function in hemodynamically unstable patients. Echocardiography also plays a key role in guiding therapeutic interventions, from fluid management to valvular repair and replacement procedures. Despite its many advantages, echocardiography is not without limitations. Image quality may be compromised in patients with obesity, lung disease, or prior thoracic surgery, necessitating alternative imaging modalities like cardiac magnetic resonance imaging or computed tomography. Operator expertise is another critical factor influencing diagnostic accuracy, underscoring the importance of proper training. Recent advancements, including artificial intelligence integration and portable devices, are expected to further expand the role of echocardiography, making it more accessible in diverse clinical settings. This narrative review highlights the broad clinical utility of echocardiography in internal medicine, its challenges, and the future directions that promise to enhance its role in patient care.

Your Weight and Your Wallet: Comparing Out-of-Pocket Costs of Bariatric Surgery and GLP1 Agonists.

Your Weight and Your Wallet: Comparing Out-of-Pocket Costs of Bariatric Surgery and GLP1 Agonists.

Bariatric Surgery in Adolescent Age Group

Obesity in children is a problematic condition which interfere with physical and mental health. It is a complicated disorder with interwoven environmental, genetic, biological components, developmental, and behavioral. A combination of medical treatment and behavioral and lifestyle modifications was typically what causes poor short-term weight loss and long-term failure. For this reason, adolescents who suffer from moderate to severe obesity and have attempted lifestyle interventions in the past but had no success should think about having bariatric surgery. Specifically, laparoscopic sleeve gastrectomy is thought to be the most often carried out bariatric procedure globally. The technique is safe and doable. It has been demonstrated that this surgical weight loss procedure is effective in young patients. However, there are obstacles that need to be removed at the levels of patients, providers, and the healthcare system. Above all, for ensuring successful long-term treatment and permit healthy growth, more should be done to stop the nutritional status decline that frequently follows bariatric surgery, as well as to prevent insufficient weight loss and weight regain. With a focus on LSG, nutritional management, and the resolution of metabolic comorbidities, we examined the clinical indications, surgical treatment options, and outcomes in adolescents with severe obesity in this narrative review.

Long-Term Cancer Outcomes Following Bariatric Surgery: A Comparative Analysis of Surgical Procedures

Background/Objectives: Metabolic and bariatric surgery (MBS) is known to reduce cancer risk. However, the association between specific bariatric procedures and cancer incidence is not well-studied. This study examined the association between four different MBS procedures and cancer incidence. Methods: Bariatric surgery registry data were linked with statewide cancer registry data from 1979 to 2018. The study included 27,092 adult subjects (aged ≥ 18 years old at surgery) who underwent MBS (BMI ≥ 30 kg/m2 at surgery) from 1979 to 2017. Cancer records were linked to MBS patient records, resulting in 1547 cancer cases. Cox proportional hazards regression was used to examine the association between MBS procedure types and cancer incidence. Results: Of all patients, 75% underwent Roux-en-Y gastric bypass (RYGB), 9% adjustable gastric banding (AGB), 10% sleeve gastrectomy (SG), and 6% duodenal switch (BPD-DS). The overall cancer incidence during the follow-up period was 6.4% for RYGB, 4.6% for AGB, 1.6% for SG, and 5.9% for BPD-DS. The mean follow-up duration from surgery to cancer incidence or censoring was 167 months (standard deviation = 121 months). Compared to RYGB, patients who underwent AGB (Hazard Ratio [HR] = 1.26, p = 0.03) and BPD-DS (HR = 1.91, p &lt; 0.01) had a significantly higher hazard of developing cancer, while SG (HR = 1.17, p = 0.33) showed no significant difference. Conclusions: These findings suggest that AGB and BPD-DS may be associated with higher cancer risks compared to RYGB. Additional large population studies are needed to better understand the long-term cancer risks and mechanisms associated with different MBS types.

Distinct brain and neurocognitive transformations after bariatric surgery: a pilot study

BackgroundObese patients have worse outcomes after surgery and are at increased risk for perioperative neurocognitive disorders (PND). Our aim was to detail the cognitive trajectories of patients undergoing bariatric surgery (BS) and map distinct structural brain changes using magnetic resonance imaging (MRI) to better understand the association between the vulnerable brain, surgery, and the arc of PND.MethodsProspective pilot study with longitudinal comprehensive cognitive assessments and MRI were performed on obese patients scheduled for BS. We analyzed baseline cognitive function and high-resolution T1-/T2-weighted brain images on 19 obese patients [age, 54 (9) years, BMI, 40 (36, 42) kg m−2] and compared with 50 healthy control subjects [age, 52 (6) years; BMI, 25 (24, 27) kg m−2]. Patients were evaluated within five days of BS (baseline), immediately after (within 48h), and follow up at six months.ResultsAt baseline, obese patients had significant brain tissue changes seen in MRI and decreased cognitive scores compared to controls (MoCA 26 vs 28, P = 0.017). Surgery induced further gray matter volume and brain tissue changes along with reduced cognitive scores within the immediate postoperative period (MoCA 26 vs 24, P &amp;lt; 0.001). At six months, we observed reversal of brain alterations for most patients and a concomitant rebound of cognitive scores to patient’s baseline status.ConclusionsBariatric surgery resulted in worsening of preexisting brain structural integrity and lower cognitive function for obese patients compared to baseline. These distinct brain lesions are consistent with specific domains of cognition. Most of these changes reverted to patient’s baseline condition within six months after surgery.

Effect of bariatric surgery on the pharmacokinetics of drugs used for attention-deficit hyperactivity disorder-A case series.

Changes in gastrointestinal physiology following bariatric surgery may affect the pharmacokinetics of drugs. Data on the impact of bariatric surgery on drugs used for attention-deficit/hyperactivity disorder (ADHD) are limited. In patients treated with ADHD medication and undergoing bariatric surgery, serial drug concentrations were measured for 24 h preoperatively and one, six and 12months postoperatively. Primary outcome was change in area under the concentration-time curve from 0 to 24 h (AUC0-24), with other pharmacokinetic variables as secondary outcomes. Eight patients treated with lisdexamphetamine (n= 4), dexamphetamine (n= 1), methylphenidate (n= 1) and atomoxetine (n= 2) were included. In total, 409 samples were analysed. Patients underwent sleeve gastrectomy (n= 5) and Roux-en-Y gastric bypass (n= 3). AUC0-24 and Cmax of dexamphetamine increased after surgery in those using the prodrug lisdexamphetamine. There was no clear-cut reduction in tmax postoperatively. For ritalinic acid and atomoxetine, no changes in AUC0-24 were observed, but for atomoxetine, a higher Cmax and a shorter tmax were observed postoperatively. Bariatric surgery may increase the systemic exposure of dexamphetamine after intake of lisdexamphetamine. Patients using lisdexamphetamine should be followed with regard to adverse drug reactions after bariatric surgery, and, if available, therapeutic drug monitoring should be considered.

Changes in anthropometry, adiposity, and inflammation in Black and White women engaged in intentional weight loss.

We examined associations among changes in anthropometry, regional adiposity, and inflammatory markers in Black and White women participating in intentional weight loss. A total of 104 women with BMI ≥ 25 kg/m2 self-selected bariatric surgery (n = 66) or a diet and exercise program (n = 38). Anthropometric, dual-energy x-ray absorptiometry-quantified regional adiposity, and inflammatory markers (C-reactive protein [CRP], tumor necrosis factor α [TNF-α], soluble TNF receptor I [sTNFRI], sTNFRII, interleukin [IL]-6, and soluble IL-1 receptor antagonist) were measured at baseline and 6 months. Weight, BMI, visceral adipose tissue, and regional (android and gynoid) adiposity declined in the bariatric surgery group. Among bariatric surgery participants, Black women experienced declines of lesser magnitude in terms of weight and BMI than White women, but changes in regional adiposity and visceral adipose tissue did not differ. In the bariatric surgery group, decreases in weight and BMI were associated with decreases in CRP and IL-6 among White women, but not Black women. Decreases in weight, BMI, and android fat were associated with increases in TNF-α, sTNFRI, and sTNFRII among Black women, but not White women. Decreases in anthropometry and adiposity were observed among Black and White bariatric surgery participants; however, associations among changes in adiposity, anthropometry, and inflammation differed by race.

Long-Term Outcomes of Sleeve Gastrectomy Versus Gastric Bypass.

Extremely obese patients can benefit greatly from bariatric surgery, a common and successful therapeutic procedure for treating obesity and accompanying medical issues. Although sleeve gastrectomy and gastric bypass have already demonstrated their effectiveness in this demographic, long-term results were not stated in the literature. The purpose of this research is to examine the long-term outcomes of sleeve gastrointestinal surgery and gastric bypass. This retrospective, single-center study compares 100 patients aged 25 years and older who visited the gastrointestinal tract surgical unit at Dar El-Fouad Hospital in Cairo, Egypt, between January 1 and August 31, 2019, according to the inclusion and exclusion criteria. The patients underwent either a Roux-en-Y gastric bypass (RYGB-50%) or sleeve gastrectomy (SG-50%) for severe obesity. Follow-up occurred at one year and up to four years following surgery to collect information from the study subjects. Two tools were used to assess BMI, weight loss, complications after surgery, and incidence outcome of comorbidities after the two surgeries. Qualitative data were presented as number and percentage and frequency distribution tables, and every analysis was done at a significance value < 0.05. The average age of patients within the SG group was 43.02 ± 9.19 years, whereas the average age of patients within the RYGB group was 41.02 ± 11.06 years. In addition, 74% of patients were women in both procedures. The BMI mean of the SG group was 43.90 ± 5.78, the BMI mean of the RYGB group was 42.73 ± 5.12, and the main comorbidity in both techniques was joint pain. The mean BMI at one year was 29.70 kg/m2 after SG compared with 28.64 kg/m2 after RYGB. After four years, BMI was regained within the obese range in both techniques - 30.67 kg/m2 and 30.32, respectively. Fewer postoperative complications occurred in SG than in RYGB. RYGB was superior to SG in managing dyslipidemia (DL), hypertension (HT), type 2 diabetes (T2DM), joint pain, and gastroesophageal reflux disease (GERD). There are no significant differences between the SG and RYGB in long-term outcomes regarding BMI before surgery and at follow-up, after four years, while there were statistically significant differences between them after four years than one year after surgery, and both groups showed a significant decrease in weight. However, RYGB shows improvement to some extent in comorbidities within follow-up period, including BMI, T2DM, HT, DL, HT, DL, GERD, and joint pain than SG, but with a higher rate of minor complications, while greater resolution of OSAS occurred in SG. Finally, at four years, there were no discernible variations in BMI between SG and RYGB because the patients' mean BMI was within the obese range once more.

PSYCHOSOCIAL FACTORS AND CURRENT PRACTICES IN THE PSYCHOLOGICAL ASSESSMENT PROCESS FOR BARIATRIC SURGERY: A literature review

The psychological evaluation for bariatric surgery is mandatory, and its conduction by the psychologist must adhere to professional principles and guidelines, as well as specific legislation. Therefore, the study aimed to investigate the process of psychological evaluation for bariatric surgery and, additionally, to identify the psychological factors assessed and the instruments used in the process. This is a bibliographic research with data collection conducted between September and October 2023, in electronic databases such as Lilacs, Scielo, PubMed, and Pepsic, including full-text, open-access scientific articles published from 2018 to 2023. A total of 119 articles were found, of which 14 were selected for analysis. As a result, four categories were identified regarding psychological evaluation in bariatric surgery: 1) Importance of evaluation: involves expectations, support network, stress, and mental health; 2) Relevant psychosocial factors: such as social support and lifestyle; 3) Resources used: tools like BDI–II, BAI, ECAP, BAROS, EFS, IDATE, and LIS-A to assess emotional and cognitive aspects; 4) Challenges: highlight the complexity and the need for a multidisciplinary approach. Difficulties faced by psychologists in conducting these evaluations were also identified, requiring well-structured strategies and practices. Based on these findings, it is crucial that the responsible bodies—such as the Federal Council of Psychology—coordinate efforts, as the implementation of specific documents benefits psychologists and candidates for bariatric surgery by providing clear guidelines and standardizing procedures, making the professional practice more precise, safe, and accessible.