Excess Body Weight Loss Research Articles

What patient factors influence bariatric surgery outcomes? A multiple regression analysis of Ontario Bariatric Registry data.

Background:As bariatric surgery evolves and gains popularity, statistical analysis of its outcomes could improve the process of decision-making and risk assessment. This study aimed to evaluate the influence of age and other factors on bariatric surgery outcomes in order to improve patient selection and outcomes.Methods:We analyzed data from the Ontario Bariatric Registry to evaluate the influence of age and 10 other factors on early (< 90 d) and 1-year surgical outcomes among patients aged 18 years or older who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between January 2010 and May 2013. Early outcomes included composite adverse events and readmission. The 1-year outcomes included percent excess body weight loss (%EBWL), and remission of diabetes mellitus and hypertension. We performed multiple regression analysis to identify independent variables that influenced these outcomes.Results:We identified 3166 patients (2655 women [83.9%] and 511 men [16.1%], mean age 44.8 yr, mean body mass index [BMI] 48.4) who underwent LRYGB (2839 [89.7%]) or LSG (327 [10.3%]) over the study period and completed their 1-year follow-up. Preoperative American Society of Anesthesiologists (ASA) score and history of angina were independent variables that influenced the composite adverse event outcome. Obstructive sleep apnea was the only factor that influenced early readmission. The independent factors that influenced %EBWL were age, type of surgery, BMI and baseline glycosylated hemoglobin (HbA1c) level: age was found to influence hypertension remission, and HbA1c level and obstructive sleep apnea were found to influence diabetes remission.Conclusion:Complications after bariatric surgery can be predicted by preoperative ASA score and history of angina; patient age was not related to an increase in postoperative complications. These factors could help both surgeon and patient make appropriate surgical decisions.

S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric surgery: a prospective randomized study.

Early postoperative weight loss can be predictive of one-year outcomes. It is unclear if poor performers identified in the first post-operative month can have improvement in outcomes with additional support and education. To evaluate the impact of a structured targeted support program for patients with lower-than-average early post-operative weight loss on 1-year outcomes. This was a prospective randomized study of bariatric surgery patients who experienced less than 50th percentile excess body weight loss (%EWL) at 3 weeks. Subjects with EWL < 18% were randomized into two groups: an intervention (IV) arm or a control (NI, no intervention) arm. The IV arm was offered a program with 7-weekly behavioral support sessions, while the NI patients received routine post-operative care. A total of 128 patients were randomized: 65 NI and 63 IV. In the IV group, 20 attended all sessions, 7 attended < 4, and 36 did not participate. There was no difference in baseline demographics, procedure type, or BMI. At 1 year, there was no difference in %EWL (ratio 0.993, 95% CI 0.873, 1.131), %EBMIL (ratio 0.997, 95% CI 0.875, 1.137), and %TWL (ratio 1.016, 95% CI 0.901, 1.146) between groups. A subgroup analysis including only the subjects who participated in all seven sessions showed similar results. Patients who present with suboptimal weight loss early after bariatric surgery do not experience a significant weight loss improvement with a structured behavioral support program. Importantly, despite being alerted to their poor early weight loss, patients demonstrated poor adherence to the proposed interventions.

One Anastomosis Gastric Bypass Versus Long Biliopancreatic Limb Roux-en-Y Gastric Bypass

BackgroundRoux-en-Y gastric bypass (RYGB) is one of the most effective bariatric procedures. The study aimed to explore the value of lengthening the biliopancreatic limb (BPL) in RYGB compared to the outcome of one-anastomosis gastric bypass (OAGB). MethodsThis prospective study included morbidly obese patients divided into two groups. The RYGB group (n = 36) was subjected to long biliary limb Roux-en-Y gastric bypass (LPRYGB), and the OAGB Group (n = 36) had one anastomosis gastric bypass. During follow-up, weight, BMI, percentage of excess body weight loss (%EBWL), resolution of obesity-related comorbidities, and quality of life (QoL) were evaluated.ResultsThere was no significant difference in weight and BMI after 3 and 6 months. At 12-month follow-up, weight loss was significantly higher in the OAGB group. After 12 months, the two groups showed significant improvement of comorbid conditions without significant difference between the two groups. The Qol was significantly higher in the LPRYGB group 3, 6, and 12 months after surgery compared to the OAGB group.ConclusionsExtending the BPL length in RYGB to 150 cm is as effective as OAGB in remission of comorbidities, including diabetes. It was also equally effective in weight reduction in the short term. OAGB was more efficient in weight reduction and a significantly faster operation. LPRYGB showed a better QoL of life 1 year after surgery.Graphical abstract

Safety and efficacy of endoscopic sleeve gastroplasty for obesity management in new bariatric endoscopy programs: a multicenter international study.

Background:Endoscopic sleeve gastroplasty (ESG) is an incisionless procedure that reduces the size of the gastric cavity. In prior studies, it has been proven to be a safe and effective treatment for obesity. In this study, we performed a collaborative study to evaluate the effectiveness of ESG among new endobariatric programs.Methods:This was an international, multicenter study reviewing the outcomes of ESG in centers starting ESG programs. Total body weight loss, change of body mass index (BMI), excess body weight loss (EBWL), technical success, duration of hospitalization, and immediate and delayed adverse events and complications at 24 h, 1 week, and 1, 3, and 6 months post-procedure were evaluated.Results:A total of 91 patients (35 males) from six centers were included. The patients’ mean BMI before the procedure was 38.7 kg/m2. BMI reduction at 3 months was 7.3 (p < 0.000), at 6 months 9.3 (p < 0.000), and at 12 months 8.6 (p < 0.000) from baseline. EBWL was 17.3% at 1 month (p < 0.000), 29.2% at 3 months (p < 0.000), and 35.6% at 6 months (p < 0.000). The mean procedure duration was 85.1 min. The mean length of hospital stay post-procedure was 27 h.Conclusion:ESG provides EBWL percentage sustained up to 12 months. These results are equivalent among the new ESG centers compared to previous studies by expert centers.Lay titleEndoscopic sleeve gastroplasty in new bariatric endoscopy programs:Plain Language SummaryThis article is the result of a collaborative international study on new endoscopic programs offering endoscopic sleeve gastroplasty.The minimally invasiveness and increasing accessibility of this technique makes it very attractive for patients with obesity while being poor candidate for surgery or refusing surgery.This study will also provide valuable information regarding this rising technique of endobariatric treatment.

Effectiveness and Safety of Adjustable Gastric Banding in Morbidly Obese Patients After 5 Years of Follow-up

Abstract Obesity is a civilization disease that promotes the emergence and development of many diseases, such as type II diabetes, cardiovascular, and some cancers. It directly affects the length and quality of life. The purpose of this retrospective study was to show the short- and long-term results of weight loss after laparoscopic adjustable gastric banding (LAGB) as well as to assess the results of the procedure and the percentage of reoperations. Case series analysis included 228 subsequent patients who underwent LAGB due to obesity. In the postoperative period, there was a gradual reduction in body weight, especially in the first 24 months after surgery. After 3 years, no further weight reduction was observed, and sometimes, a slight increase in weight was observed 5 years after surgery; the trend in weight reduction over the entire time period was significant. A similar result was found for percentage of BMI loss (%BMIL) and percentage of excess body weight loss (%EWL), especially in the first 36 months after surgery. Our study confirmed the good early results and low effectiveness of laparoscopic adjustable gastric banding in the long-term treatment of pathological obesity. On the other hand, the simplicity and safety of the procedure, the minimal effects of malnutrition, the low number of early complications, and the total reversibility or conversion procedure for any other bariatric surgery are the strengths of laparoscopic adjustable gastric banding for a selected group of patients.

6M50LSG Scoring System Increased the Proportion of Adequate Excess Body Weight Loss for Suspected Poor Responders After Laparoscopic Sleeve Gastrectomy in Asian Population.

We aimed to evaluate the efficacy of the predictive tool, 6M50LSG scoring system, to identify suspected poor responders after laparoscopic sleeve gastrectomy (LSG). The 6M50LSG scoring system has been applied since 2019. Suspected poor responders are defined by EBWL at 1month < 19.5% or EBWL at 3months < 37.7% based on the 6M50LSG scoring system. Our analysis included 109 suspected poor responders. Based on the date of LSG, the patients were separated into two groups: the 2016-2018 group (before group, BG, with regular care) and the 2019-2020 group (after group, AG, with upgrade medical nutrition therapy). At the end of the study, the AG group had a significantly higher proportion of adequate weight loss, which was defined as EBWL ≥ 50% at 6months after LSG, than that in the BG group (18.92% in BG vs. 48.57% in AG, p = 0.003). The AG group demonstrated significantly more 3-months-TWL (BG: 15.22% vs. AG: 17.54%, p < 0.001) and 6-months-TWL (BG: 21.08% vs. AG: 25.65%, p < 0.001). In multivariate analyses and adjustments, the scoring system (AG) resulted in significantly higher chances of adequate weight loss in suspected poor responders (adjusted OR 3.392, 95% CI = 1.345-8.5564, p = 0.010). One year after LSG, suspected poor responders in AG had a significantly higher weight loss than those in BG (BG vs. AG: TWL 27.17% vs. 32.20%, p = 0.014) . This study confirmed that the 6M50LSG scoring system with upgraded medical nutrition therapy increased the proportion of suspected poor responders with adequate weight loss after LSG.

Can gastric botulinum toxin A injection be used as minimally invasive procedure in the short-term treatment of obesity?

Background/Aim:Gastric botulinum toxin A (BTX-A) injection is a type of endoscopic obesity treatment option that delays gastric emptying. However, there is little and contradictory information concerning the treatment efficacy of BTX-A injection. This study evaluated the treatment efficacy of BTX-A injection in the treatment of obesity.Materials and Methods:This was an open-label, prospective study of obese individuals with a body mass index >30 kg/m2 admitted to our clinic. The sample consisted of 72 consecutive treatment-naive patients with obesity divided into age–sex-matched three groups: gastric BTX-A injection (study group), calorie-restricted (15–20 Kcal/kg) diet (control) and bariatric surgery (BS) (control) groups. İn the study group, 200 IU BTX-A was injected to the antrum and corpus endoscopically. The study and control groups were compared for their total body weight loss (TBWL) and excess body weight loss (EBWL) at the 6th month.Results:Gastric BTX-A injection therapy was applied to 24 patients. The mean age was 39.1 ± 9.1/years. 54.1% of the patients (n = 13) was female. At the 6th month, the mean TBWL and EBWL of patients were; 10% ±4.1 and 37.2% ±13.9 for gastric BTXA injection group, 5% ±2.3 and 20.2% ±9.3 for diet group, 30.7% ±5.3 and 66.9% ±14.4 for BS group. Patients who underwent gastric BTX-A injection lost weight more effectively than patients who were on diet alone, while BS patients lost weight more effectively than those who had gastric BTX-A injection (P < 0.001). In the gastric BXT-A injection group, the first 3-month delta EBWL and TBWL (change of EBWL and TBWL percentages) were found significantly higher than the 3–6th month and 6–12th month (P = 0.001 and P < 0.001).Conclusion:Gastric BTX-A injection is a minimally invasive and short-term effective method that can be used in the treatment of obesity.

Gastric Bypass versus Sleeve Gastrectomy in Morbid Obesity Management

Abstract Background Obesity is caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications, or psychiatric illness. The main aim of obesity therapy is weight loss and maintenance by dietary interventions and increased physical activity. Aim of the Work to review two of the most commonly performed modalities of weight loss namely Sleeve Gastrectomy, Gastric Bypass, and to study their early post-operative complications, outcomes, effects regarding excess body weight loss (EBWL), life style changes and sustainability. Patients and Methods This is a prospective comparative randomize study included 40 patients presented with morbid obesity with BMI range between (40 to 60 kg/m2) were treated 20 cases by laparoscopic sleeve Gastrectomy and 20 cases by laparoscopic Gastric Bypass (15 cases one anastomosis gastric bypass – 5 cases Roux-en-Y bypass) in Ain Shams Hospital during the period from October 2017 till May 2018. Cases were followed up monthly for 6 months and after 1 year. Results Laparoscopic sleeve gastrectomy has higher incidence of complications (15%) than the incidence of complications of Laparoscopic Gastric Bypass (5%). Conclusion Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass are both safe and effective procedures for the surgical management of morbid obesity. Laparoscopic Gastric Bypass has slightly higher mean of (EBWL%) than Laparoscopic sleeve gastrectomy at 6 months, and a higher mean of (EBWL%) than Laparoscopic sleeve gastrectomy at 1 year follow up.

Early Outcomes of Laparoscopic Sleeve Gastrectomy (LSG) in Morbidly Obese Patients

Objective: To determine the early outcomes of laparoscopic sleeve gastrectomy with respect to weight loss and amelioration of comorbid conditions in morbidly obese patients. Study Design: Prospective descriptive study. Place and Duration of Study: MTI-Lady Reading hospital Peshawar and Royal Imperial hospital Swat from January 2018 to January 2020. Materials and Methods: Total thirty-eight morbidly obese patients of either sex with age range of 25-65 years were included in this study. Informed written consent was taken from all the patients and their demographic details such as age, sex and comorbid conditions were recorded. All the patients underwent laparoscopic sleeve gastrectomy. Preoperative and postoperative data such as body mass index, total &amp; excess weight loss and impact on comorbidities were analyzed. Bariatric Analysis and Reporting Outcome System (BAROS) scoring system was used to analyze the outcomes. Follow-up was taken at 1 year post-operatively. Results: Majority were female 25 (65.8%) patients and 13 (34.2%) males with mean age of 45.39±9.64 years. Comorbidities such as hypertension, diabetes mellitus, hyperlipidemia and obstructive sleep apnoea were recorded in 13.2%, 26.3%, 7.9% and 10.53% patients respectively. Mean excess body weight loss (EWL) was 60.25±12.7 kg and mean body mass index loss was 15.14+9.33 kg/m2at 1 year follow up. Postoperative systolic blood pressure improvement was observed in 23 (60.5%) patients. A significant improvement was observed regarding diabetes mellitus (preoperatively mean HbA1C 9.7±5.9 vs postoperatively mean HbA1C 4.42±3.6) p-value &lt;0.001. According to the BAROS score, 5 (13.3%) showed excellent, 14 (36.8%) showed very good, 17 (44.74%) showed good, 2 (5.3%) showed fair and no patient showed poor outcomes. Satisfaction rate among patients was 94.7%. Conclusion: Laparoscopic sleeve gastrectomy is an excellent procedure both in terms of weight loss and amelioration of comorbid conditions in morbidly obese patients. Key words: Sleeve gastrectomy, Laparoscopic, Excess body weight loss, Morbid obesity

VERY LOW-CARBOHYDRATE KETOGENIC DIET FOR THE TREATMENT OF SEVERE OBESITY AND ASSOCIATED NON-ALCOHOLIC FATTY LIVER DISEASE: THE ROLE OF SEX DIFFERENCES

Very low-carbohydrate ketogenic diets (VLCKDs) are a new type of weight loss (WL) intervention for severe obesity and are associated with a significant improvement in non-alcoholic fatty liver disease (NAFLD).Little is known about the effect of sex differences on weight loss induced by following a VLCKD.The aim of this study was to investigate the effects of sex differences on weight loss and NAFLD improvement in patients with severe obesity undergoing a VLCKD. Seventy-three patients (42 females and 28males) with morbid obesity (BMI 40kg/m2 or 35 kg/m2+comorbidity) eligible for sleeve gastrectomy underwent a 25-day-long VLCKD.Anthropometric parameters, peripheral BP, bioimpedentiometry, degree of liver steatosis measured by ultrasonography, liver function tests, and glucose homeostasis were measured before and after the VLCKD. Males experienced a significantly larger excess body weight loss (EBWL, 14.5 vs11.7% respectively,p=0.018) and a greater reduction in y-glutamyl transferase (ϒ-GT, 17 vs6 IU/L respectively,p=0.003) than females. Dividing the female group by menopausal status, a significant difference between males and pre-menopausal females was found for both EBWL (14.5 vs10.8% respectively,p=0.017) and ϒ-GT (17 vs3 IU/L respectively,p<0.001). No significant difference was observed for EBWL and ϒ-GT between males and post-menopausal women and between sexes for improvement in the Edmonton stage or in the degree of steatosis. The efficacy of VLCKD in severe obesity is influenced by sex differences and, for females, by menopausal status. Males seem to experience larger benefits than females in terms of EBWL and NAFLD improvement. These differences seems attenuated after menopause, probably because of changes in hormonal profile and body composition.

Comparison of Induction Chemotherapy in NSG and NOD- Rag1 null IL2rg null Mouse Models of FLT3 Mutant AML

Background and objectives: Induction chemotherapy that combines Ara-C (cytarabine, 7 days) with an anthracycline such as daunorubicin or doxorubicin (Adriamycin, 3 days) (DA) is a standard induction therapy in AML. Immunodeficient NSG or NSGS mice are extremely useful for preclinical drug testing and are promiscuous recipients of primary AML engraftment. However, these models have limitations for use of genotoxic chemotherapy that often induces toxicity and mortality to the recipient mice, particularly in AML patient-derived xenograft (PDX) models when irradiation is required. The sensitivity of NSG or NSGS mice to genotoxic drugs and irradiation are due to SCID mutation in the mice. In this study we have compared tolerability and efficacy of DA chemotherapy in NSG and NRG (NOD- Rag1 null IL2rg null) AML-bearing mice. We used a FLT3 mutant AML Molm13 cell line to generate AML xenograft in NRG and NSG mice and then tested the response to chemotherapy using combined Ara-C and doxorubicin chemotherapy with or without sub-lethal irradiation. Testing of chemotherapy regimen in human AML PDX models is ongoing and will be presented.Methods and results: The AML mouse models were established by i.v. injection of GFP and firefly luciferase transduced Molm13 cells (0.6 x 106 cells per mouse) into NSG and NRG mice (n=5 per group, F, 8 weeks old). In experiments testing sub-lethal radiation, NSG mice were irradiated with 200 cGy and NRG mice with 400 cGy before cell injection. AML cell engraftment and growth in vivo was monitored by bioluminescent imaging (BLI). Engraftment was confirmed on day-3 (Fig. 1A-B) and chemotherapy started on day-4 using combined Ara-C (50 mg/kg, i.v. 5 days) and doxorubicin (1.5 mg/kg, i.v., 3 days) (DA 5+3) or PBS. NSG and NRG mice (n=3 each) that served as naïve controls without bearing Molm13 cells also received the chemotherapy. Mouse health conditions and body weights were monitored daily, and mice were followed for survival.As shown by BLI in Figure 1 A-B, DA 5+3 significantly reduced leukemic burden in both NRG and NSG mice compared to PBS treated mice (p<0.001 on day 13 or 14). The chemotherapy also induced transient toxicity in all treated mice with significant body weight loss in the sub-lethal irradiated AML NSG mice (Figure 1C, 30% loss on day 10, p=0.016 vs PBS treated mice), resulting in lethality earlier than PBS treated mice (Figure 1D, p=0.0019). Complete blood cell counts showed pancytopenia with anemia of the moribund treated Molm13 NSG mice. Overall, chemotherapy induced more body weight loss in NSG than that in NRG mice (a transient 25% body weight loss in naive NSG and AML NSG mice compared to 10% loss in NRG mice on day 10), indicating that NSG mice are more susceptible to chemotherapy-induced toxicity. All AML NRG mice and NSG mice without prior sub-lethal irradiation survived the chemotherapy and had significantly prolonged survival.We further challenged the NRG mice with a more intensive chemotherapy regimen by administrating Ara-C for 7 days (DA 7+3) mimicking the one used in AML patients. BLI confirmed more effective leukemia control by this regimen compared to DA 5+3 and significantly extended survival.Conclusion: The results demonstrate that Molm13 bearing NSG and NRG mice have identical latency, leukemia growth kinetics, and survival, suggesting that like NSG mice, NRG mice are suitable recipients for AML xenograft studies. Both Molm13 NSG mice and NRG mice showed strong efficacy in response to chemotherapy using Ara-C (cytarabine, 50 mg/kg) and doxorubicin (1.5 mg/kg) with the regimen of DA 5+3. However, this regimen was not tolerable when mice required prior sublethal irradiation, with excessive bodyweight loss and mortality in NSG but not in NRG mice. In contrast, Molm13 NRG mice can tolerate a more intensive combination chemotherapy regimen of AraC administered for 7 days (DA 7+3). In summary, NRG mouse model showed better tolerance to chemotherapy and irradiation than the NSG model, thus representing a superior in vivo AML model for pre-clinical studies with genotoxic agents. [Display omitted] DisclosuresCarter:Daiichi Sankyo: Research Funding; novartis: Research Funding.

Safety and efficacy of laparoscopic sleeve gastrectomy in patients with portal hypertension with liver function of Childs A.

Advanced liver disease and portal hypertension (PH) are seen as a relative contraindication for bariatric and metabolic surgery. Several studies have shown significant improvement in liver function and liver histology after bariatric surgery. There are very few studies describing bariatric surgery in patients with PH. The purpose of this retrospective study is to evaluate the feasibility and results of laparoscopic sleeve gastrectomy (SG) in patients with PH. We present our experience of performing laparoscopic SG in 15 patients with evidence of PH. All the patients were Childs Pugh Criteria A. PH was confirmed by the presence of dilated esophageal varices on endoscopy. The mean operative time was 77.33 ± 15.22min and mean blood loss was 80.67 ± 37.12ml. The mean length of stay was 2.73 ± 0.59days. There were no intraoperative or immediate postoperative complications. None of the patients required blood transfusion in the postoperative period. The weight, BMI, Excess body weight loss% (EBWL%), Total weight loss (TWL) and TWL% at 1year were 86.05 ± 14.40kg, 31.16kg/m2 ± 3.82, 63.84% ± 15.24, 31.49 ± 9.54kg and 26.50 ± 5.42%, respectively. Diabetes and hypertension resolution at 1 year was 80% and 72.72%, respectively. All the patients were followed up for mean 3 ± 1.5years. There were no immediate or long-term morbidity and mortality noted. SG is a feasible and safe option for the treatment of obesity in carefully selected patients with PH with good weight loss and comorbidity resolution.

Very-low-calorie ketogenic diet for the management of obesity, overweight and related disorders.

Very-low-calorie ketogenic diet (VLCKD) is a promising lifestyle intervention for the management of overweight and obesity. It is characterized by a restriction of both calories and carbohydrates, while assuring the adequate proteins, fats and micronutrients intake. Significant results in terms of excess body weight loss have been reported and this strategy considered also in the preoperative settings. Improvements in hypertension, type 2 diabetes and dyslipidemia follows. PubMed and Google Scholar were searched for papers reporting data on VLCKD as a strategy for the management of overweight, obesity and related disorders in adults. Four main documents are available in the literature and were included in the present narrative review. The present review discusses available evidence and provides practical recommendations for the management of VLCKD.

Conservative Management of Obesity in Kidney Transplant Candidates

Obesity is prevalent in patients with chronic kidney disease and is associated with increased complications after kidney transplantation (KT). A body mass index limit is used in most transplant programs, though few studies have focused on conservative weight loss in KT candidates. The objective of this retrospective study is to evaluate the efficacy of a basic conservative weight management program in morbidly obese KT candidates and to perform a comprehensive nutritional evaluation. This retrospective study included patients with a body mass index (BMI) >35kg/m2, with grade IV or V chronic kidney disease. The conservative weight loss program consisted of anthropometric measurements every 3months, consultation with a nutritionist, daily exercise, and counseling for healthier eating habits. Overall and quarterly BMI targets were defined. A subset of patients further underwent a comprehensive nutritional evaluation to measure socioeconomic characteristics, food intake behavior, motivation for change, and a 4-day food diary. Eighty patients were observed for a mean of 24months. Successful weight loss (BMI<35kg/m2) was achieved in 26.3%, associated with women and those already close to the limit. The mean 1-year excess body weight loss was 8.4%. No patient with a BMI >40kg/m2 was successful. The comprehensive nutritional evaluation was performed with 44 patients and found that only 14.6% had previously received nutritional counseling for weight loss. Cognitive restraint scored highest in the food-intake behavior. Most patients were motivated to lose weight with 66% in the action phase. There was little evidence of overeating with a recommended mean calculated daily caloric intake of 82.9%. The conservative weight loss program can have limited but non-negligible, success. Future successful nutritional interventions should take into consideration this surprising comprehensive profile of morbidly obese KT candidates.

Efficacy and safety of bariatric revisions in patients older than 65 years old

BackgroundBariatric surgery in advanced age patients (>65-years-old) has been proven safe and effective. Revisional bariatric surgery is infrequently required for cases of refractory obesity. However, there is a paucity of data regarding revisional surgery for the elderly. We hypothesize that revisional bariatric surgery is viable and safe in elderly patients. MethodsRetrospective chart review of all bariatric revisions performed at two high-volume bariatric centers of excellence between 2011 and 2018. Perioperative and long-term outcomes were compared between patients >65 and those <65-years-old. Results145 bariatric revisions were performed for weight loss. 10% (N = 15) were >65 years old. There were no differences in mortality between the two groups There was a longer median length of stay in the younger cohort (2 vs 1 day, p = 0.001). Percent excess weight loss was similar at 12-months, as was resolution of comorbidities. ConclusionsBariatric revisions in elderly patients appears to be safe and effective. Revisional surgery in this population was not shown to have increased morbidity or mortality with similar excess body weight loss when compared to a younger cohort.

Successful surgical weight loss with laparoscopic sleeve gastrectomy for morbid obesity prior to kidney transplantation

Morbid obesity in kidney transplant (KT) candidates is associated with increased complications and graft failure. Multiple series have demonstrated rapid and significant weight loss after laparoscopic sleeve gastrectomy (LSG) in this population. Long-term and post-transplant weight evolutions are still largely unknown. A retrospective review was performed in eighty patients with end-stage kidney disease (ESKD) who underwent LSG in preparation for KT. From a median initial BMI of 43.7kg/m2 , the median change at 1-year was -10.0kg/m2 . Successful surgical weight loss (achieving a BMI<35kg/m2 or an excess body weight loss >50%) was attained in 76.3% and was associated with male gender, predialysis status, lower obesity class and lack of coronary artery disease. Thirty-one patients subsequently received a KT with a median delay of 16.7months. Weight regain (increase in BMI of 5kg/m2 postnadir) and recurrent obesity (weight regain+BMI>35) remain a concern, occurring post-KT in 35.7% and 17.9%, respectively. Early LSG should be considered for morbidly obese patients with ESKD for improved weight loss outcomes. Early KT after LSG does not appear to affect short-term surgical weight loss. Candidates with a BMI of up to 45kg/m2 can have a reasonable expectation to achieve the limit within 1year.

The Efficacy and Safety of Endoscopic Sleeve Gastroplasty as an Alternative to Laparoscopic Sleeve Gastrectomy.

Endoscopic sleeve gastroplasty (ESG) is a therapeutic endoscopic technique for reducing the size of the gastric reservoir in obese patients, using a full-thickness endoscopic suturing device. The effectiveness of ESG in weight loss is significantly greater than that of high-intensity diet and lifestyle therapy and lower than that of laparoscopic sleeve gastrectomy (LSG). The efficacy at 12 months after ESG in terms of percentage of total body weight loss and excess body weight loss was approximately 16% and 60%, respectively. The well-known predictive factors for increased weight loss by ESG are good compliance with regular monitoring and post-procedure care involving a multidisciplinary team approach. Although the underlying mechanism of weight loss induced by ESG is debatable, delayed gastric emptying and early satiation are some of the proposed mechanisms. The pooled rate of adverse events after ESG reported in several meta-analysis studies ranged from 1.5% to 2.3% and the incidence of new-onset gastroesophageal reflux disease after ESG was negligible, indicating that ESG has a superior safety profile to LSG. Moreover, ESG reduced the risk of obesity-related metabolic comorbidities, evidenced by the reduction in HbA1c level, systolic blood pressure, triglyceride level, and risk of hepatic steatosis and fibrosis; it even improved the quality of life. ESG could be considered safe and qualify as an alternative treatment to LSG.

Laparoscopic one anastomosis gastric bypass: a revisional procedure for failed open vertical banded gastroplasty in treatment of morbid obesity: a prospective study

Background The main indications for revision of bariatric surgery are inadequate weight loss, weight regain, or complications, so laparoscopic one anastomosis gastric bypass (LOAGB) is a promising bariatric procedure used as a revisional procedure for failed open vertical banded gastroplasty (VBG). Aim The aim was to evaluate LOAGB as a revisional bariatric procedure for failed open VBG regarding technical feasibility, weight loss, improvement in comorbidities, and complications. Patients and methods This prospective cohort study was carried out at the Gastrointestinal and Laparoscopic Surgery Unit, General Surgery Department, Tanta University, between October 2017 and October 2018. It included 20 patients who underwent LOAGB as a revisional bariatric procedure for failed open VBG. Results The study population included 17 females and three males, with a mean age of 38.25±5.36 years. The mean preoperative BMI was 48.15±4.35 kg/m2. The mean operative time was 145.36±25.19 min, and the mean postoperative hospital stay was 3.12 days. Neither conversion to open technique or to other bariatric procedures nor mortality occurred. Early complications were encountered in 3 patients (15%). Late complications included four (20%) patients. Severe biliary gastritis occurred in one (5%) patient, who was managed by side-to-side jejunojejunostomy. The mean postoperative excess body weight loss percent (EBWL%) achieved was 47.14±15.24 at 1 year and 60.85±12.17 at 2 years. The mean BMI achieved was 32.72±5.46 at 1 year and 28.14±4.45 at 2 years. Conclusion LOAGB surgery as a revisional procedure for failed open VBG is an effective bariatric surgical procedure producing significant weight loss and resolution or improvement of comorbidities with low perioperative complications.

Safety and Outcomes of Laparoscopic Sleeve Gastrectomy in a General Surgery Residency Program.

Background:With the escalation of surgical treatment of morbid obesity, there is a growing interest in the training of bariatric surgeons. Laparoscopic sleeve gastrectomy (LSG) gained popularity both as a first-stage approach and as a stand-alone procedure.Objectives:The aim of this study was to assess detectable differences in LSG with intra-operative resident involvement.Methods:We reviewed obese patients, who had undergone LSG between January 1, 2017 and January 31, 2020. Collected data reported demographic factors, operative time, postoperative complications, and outcomes.Results:Among 313 patients who met the inclusion criteria, 94 were men and 219 were women. The procedures were performed either by an expert bariatric surgeon (group 1), or a general surgery resident (group 2), respectively in 228 and 85 cases. Mean operative time of the first group was 65.3 ± 18.8 minutes, while it was 74.3 ± 17.2 among trainees (p < 0.001). Perioperative complications were diagnosed in 13 patients (10 in group 1 and 3 in group 2). Mean excess body weight loss after 12 months was 87.7 ± 28.2% in the first group and 81.1 ± 31.6% in the residents group. Between the two groups, we found no differences in the incidence of perioperative complications and in surgical outcomes. Trainee involvement was associated with increased operative time, with no correlation with a worse postoperative course.Conclusions:Residents can safely perform LSG in referral centers under the supervision of an expert bariatric surgeon. Trainee involvement is not related to increased leak rate, nor to suboptimal short-term outcome.

Short-term results of single-anastomosis gastric bypass after failed sleeve gastrectomy

Background It is recognized that sleeve gastrectomy (SG) is one of the most common bariatric procedures worldwide. It is considered a relatively safe and effective option in the treatment of morbid obesity. However, SG operations may fail in the treatment of obesity. In cases of unsuccessful SG surgery, revisional bariatric surgery may be used. One anastomosis gastric bypass (OAGB) was considered as an outstanding choice for revision surgery. Objective To assess the efficacy and safety of OAGB as a redo surgery after the failure of previous sleeve gastrectomy operation. Patients and methods This study is a retrospective cohort study, conducted in Bariatric Surgery Unit, Ain Shams University Hospital, Cairo, Egypt, from February 2018 to July 2019, with 6 months of postoperative follow-up till January 2020. We included 50 patients who underwent OAGB who were adults fit for surgery, aged between 18 and 60 years, with a history of failed SG. Results A total of 50 patients with history of failed SG underwent OAGB surgery with excess body weight loss of 14.10% at 1 month, 28.85% at 3 months, and 45.43% at 6 months. Weight loss was 7.14–32.43 kg (SD 6.14). The type 2 diabetes mellitus remission rate was 100% by 6 months, with glycated hemoglobin level of 5.88±0.77 (range, 5.4–7.2). Hypertension resolution was 40%. Overall, 100% of patients with sleep apnea improved symptomatically. No morbidity or mortality cases were reported. Conclusion OAGB operation is considered to be an effective and safe revisional surgical procedure after a failed primary SG operation.