Excess Weight Loss Research Articles

Metabolic revitalization: exploring erythrocyte fatty acid profile following laparoscopic sleeve gastrectomy.

Obesity is linked to metabolic disorders. Bariatric surgery offers a promising therapeutic approach, but its impact on fatty acid (FA) profiles within erythrocytes and the associated clinical implications remain underexplored. This study aimed to assess changes in erythrocytes' membranes FA after Laparoscopic Sleeve Gastrectomy (LSG) and to correlate these alterations with clinical parameters. Sixty-one patients with morbid obesity undergoing LSG and 32 healthy controls were enrolled. Erythrocytes' membranes FA were analyzed using gas chromatography. Clinical parameters were assessed, including BMI, blood pressure, and multiple biochemistry markers. Bariatric intervention reduced BMI (41.1 to 32.0) and fat mass (54.1 to 35.2kg). Also, other anthropometric parameters improved significantly. Favorable changes in FA metabolism post LSG, potentially leading to a reduction in cardiovascular disease (CVD) risk, were observed. The OMEGA-3 Index (1.8 vs 3.0), and the eicosapentaenoic/arachidonic (0.1 vs 0.2) FA ratio increased after surgery. The dynamics of metabolism post-LSG, assessed by exploring the ratios of erythrocytes' FA concentration in baseline and 6 months after the surgery, with the corresponding ratios calculated for clinical parameters, evidenced the impact of linoleic (LA) on obesity reduction. The LA ratios increased along with the reduction of BMI (r=-0.32), fat mass (r=-0.39), and waist circumference (r=-0.33) proportions. The opposite relations of LA were held with Excess Weight Loss percentage (r=0.49), and Excess BMI Loss percentage (r=0.5). The study underscores distinct post-LSG changes in erythrocytes' FA profiles potentially associated with reduced weight and BMI, improved inflammatory status, and lowered CVD risk.

Effect of COVID-19 changes on outcomes and socioeconomic disparities following metabolic and bariatric surgery.

We previously showed worse outcomes among lower socioeconomic status (SES) groups following metabolic/bariatric surgery (MBS). In light of healthcare changes in response to COVID-19, this study aims to evaluate post-pandemic MBS outcomes and determine if prior socioeconomic disparities persisted in the post-COVID era. A retrospective chart review of patients undergoing primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between 2015 and 2022 was performed. Patients were stratified into pre- and post-COVID groups. Post-COVID cohort was further stratified into high (HT) and low (LT) tier status based on Distressed Communities Index, a geocoded composite measure of SES. Preoperative characteristics and postoperative outcomes were compared between pre- and post-COVID cohorts, as well as between post-COVID HT and LT groups. Of 709 patients, 82.9% were pre-COVID and 17.1% were post-COVID. Post-COVID cohort had greater rate of public insurance (46% vs. 37%, p < 0.001), longer wait time to surgery (mean 358 ± 609.8days vs 241.9 ± 368.5days, p = 0.045), and were more likely to undergo RYGB (69% vs. 56%, p = 0.010). Post-COVID patients also had lower risk of any complications on multivariable analysis (OR 0.599, 95% CI 0.372-0.963), had higher follow-up rates at post-discharge (95.8% vs 79.7%, p < 0.005), 6-month (93% vs. 82%, p < 0.001) and 12-month visits (75% vs. 63%, p = 0.005), and lost more weight at 12 months (67% excess weight loss (%EWL) vs. 58%EWL, p = 0.002). Among post-COVID HT and LT cohorts, previously seen disparities in complications were no longer seen. Finally, there were no differences in weight or follow-up rates between post-COVID HT and LT. Post-COVID changes to MBS care have resulted in improved short-term outcomes and reduced disparities for patients of lower SES. Further studies are needed to identify these positive factors to perpetuate practice patterns that optimize care for patients of all socioeconomic status.

Outcomes of Single Anastomosis Sleeve Ileal (SASI) Bypass as an Alternative Procedure in Treating Obesity: An Updated Systematic Review and Meta-Analysis.

The Single Anastomosis Sleeve Ileal (SASI) bypass is a novel bariatric procedure that simplifies Santoro's procedure, balancing functional restriction and neuroendocrine modulation while preserving anatomy. We aim to conduct a single-arm meta-analysis of the SASI bypass to explore its moderate-term efficacy, as this might expand the available choices for surgeons to choose the best bariatric surgery that suits the patient's condition. We conducted a comprehensive search on PubMed, Scopus, EMBASE, and Cochrane to identify studies for the SASI bypass surgery focusing on outcomes such as %EWL, %TWL, remission rate of comorbidities, and complications. The statistical analysis was carried out using RStudio version 4.3.2. Heterogeneity was assessed using the Cochrane Q test and I2 statistics. Our findings illuminate SASI's potency by undertaking a single-arm meta-analysis involving 1873 patients across 26 studies. At 12months, we report a noteworthy % Excess Weight Loss (%EWL) (Mean 84.13; 95% CI 78.41-89.85; I2 = 95%), and % Total Weight Loss (%TWL) (Mean 35.17; 95% CI 32.30-38.04; I2 = 97%), highlighting SASI's efficacy on weight loss. Cumulative meta-analyses supported these findings. More weight loss was observed with a 250cm common limb and a greater than 3cm anastomosis. An 88.28% remission rate in type 2 diabetes mellitus (95% CI 79.74-95.03; I2 = 84%) at 12months was observed. Beyond weight outcomes, SASI impacts comorbidities with a good safety profile. Our study positions the SASI bypass as a good alternative option. However, long-term efficacy is yet to be explored in the future.

Weight loss after Roux-en-Y gastric bypass and single anastomosis duodenoileostomy following failed sleeve gastrectomy.

While sleeve gastrectomy (SG) results in sustained weight loss for the majority of patients, some will experience inadequate weight loss or weight regain requiring revision. The objective of this study was to evaluate differences in weight loss over time between patients undergoing Roux-en-Y gastric bypass (RYGB) or single anastomosis duodenoileostomy (SADI) after SG. We queried a single institution's bariatrics registry to identify patients who underwent RYGB or SADI after previous SG over a three-year period. Demographics, operative characteristics, and post-operative complications were evaluated. Interval total body weight loss (TBWL) and excess body weight loss (EBWL) were calculated from available follow-ups within 2years. We identified 124 patients who underwent conversion to RYGB (n = 61) or SADI (n = 63) following previous SG. There were no differences in sex, age, or medical comorbidities between groups. The median initial BMI was higher in the SADI group (44.9 vs. 41.9 for RYGB, p = 0.03) with greater excess body weight (56.7 vs. 64.3kg, p = 0.04). The SADI group had a shorter median operative duration (157 vs. 182min for RYGB, p < 0.01) and lower readmission rates (0 vs. 14.75%, p < 0.01). There was no difference in post-operative complications or need for rehydration therapy between the groups. Among 122 patients (98.4%) that had follow-up weights available, there were no differences in TBWL between groups. RYGB patients had a higher EBWL at 2, 3, and 6months (p < 0.05 for all comparisons), but there were no differences between RYGB and SADI at 1 or 2 years. Both RYGB and SADI conversions proved effective for further weight loss following failed SG at our academic center. While neither demonstrated clear superiority in long-term (> 1year) weight loss, RYGB's restrictive gastric pouch may explain its early weight loss advantage.

Comparative Study for Safety and Efficacy of OAGB and SADJB-SG: A Retrospective Study.

Obesity and related complications are managed by One Anastomosis Gastric Bypass (OAGB) and Single Anastomosis Duodeno-Jejunal Bypass with Sleeve Gastrectomy (SADJB-SG), both of which are adapted from traditional gastric bypass procedures. However, there are no current comparative studies on the safety and efficacy of these two surgical procedures. Preoperative baseline data of patients who had undergone OAGB and SADJB-SG surgeries from June 2019 to June 2021 were retrospectively analyzed at our bariatric facility. Postoperative data, including weight changes, improvement in type 2 diabetes (T2DM), and complication rates were collected over 2 years. This was followed by a comprehensive evaluation of the safety and efficacy of the two surgical procedures. A total of 63 patients completed the follow-up in this study. At the 24-month follow-up, excess weight loss percentage (EWL%) for the OAGB and SADJB-SG was 73.970±5.005 and 75.652±7.953, respectively (P-value = 0.310); total weight loss percentage (TWL%) was 24.006±8.231 and 23.171±6.600, respectively (P-value = 0.665). The diabetes remission rates for the two groups were 71.429% and 69.048%, respectively (P-value = 0.846). The cost for OAGB was 55088.208±1508.220 yuan, which was significantly lower than the 57538.195±1374.994 yuan for SADJB-SG (P-value< 0.001). The two surgical procedures are reliable in terms of safety and efficacy, and each has distinct advantages. While OAGB has reduced operational expenses, SADJB-SG offers a broader range of applicability.

Long Narrow Pouch Roux-en-Y Gastric Bypass (LN-RYGB) for Recurrent Weight Gain After Sleeve Gastrectomy.

Sleeve gastrectomy (SG) is the most performed metabolic and bariatric surgery (MBS). However, with the increase of SG in different regions, recurrent weight gain after SG is challenging for bariatric surgeons. We introduce a modified operation with a long, narrow pouch in RYGB (LN-RYGB) for weight regain after SG which enhanced the restrictive function in RYGB. The LN-RYGB has a longer and narrow gastric pouch for 10cm. The length of small Roux and biliopancreatic are the same as RYGB. As a revisional surgery, the post-1year excess weight loss percentage (%EWL) was 63.1% and total weight loss percentage (%TWL) was 29.1% in 5 cases. LN-RYGB is an optional treatment for recurrent weight gain after SG; a randomized control trial is needed to verify the long-term effect of LN-RYGB.

Comparing the Efficacy of Robotic Versus Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis.

Laparoscopic sleeve gastrectomy (LSG) has emerged as the predominant metabolic bariatric surgery. With a growing number of studies evaluating the feasibility of robotic sleeve gastrectomy (RSG), it becomes imperative to ascertain whether the outcomes of both techniques are comparable. This study endeavors to synthesize existing evidence and juxtapose the surgical outcomes of LSG and RSG. We collected articles comparing LSG and RSG published between 2011 and 2024. The compiled data included author names, study duration, sample size, average age, gender distribution, geographical location, preoperative body mass index (BMI), bougie diameter, duration of hospitalization, surgical duration, readmission rates, conversion rates, costs, postoperative percentage of excess weight loss (%EWL), postoperative BMI, mortality rates, and complications. We incorporated 21 articles. Both the RSG and LSG cohorts exhibited comparable rates of readmission, conversion, mortality, and incidence of complications (p > 0.05). Moreover, the efficacy of weight loss was similar between RSG and LSG. Nonetheless, RSG was linked to longer operative duration (WMD, -27.50 minutes; 95% confidence interval [CI], -28.82 to -26.18; p < 0.0001), prolonged hospitalization (WMD, -0.15 days; 95% CI, -0.25 to -0.04; p = 0.006), and elevated expenses (WMD, -5830.9 dollars; 95% CI, -8075.98 to -3585.81; p < 0.0001). While both RSG and LSG demonstrated positive postoperative clinical outcomes, RSG patients experienced extended hospital stays, longer operative times, and increased hospitalization costs compared to LSG patients. Using the robotic platform for sleeve gastrectomy (SG) in patients with obesity did not appear to offer any clear benefits.

The Impact of Bariatric Surgery on Weight Reduction and the Resolution of Comorbidities in Older Geriatric Populations of Saudi Arabia: A Retrospective Study.

Background Obesity is a significant health concern among older adults, leading to various comorbidities and reduced quality of life. Bariatric surgery (BS) has emerged as a potential intervention, but its efficacy in geriatric populations, particularly in Saudi Arabia, is not well-established. Aims This retrospective study aims to evaluate the impact of BS on weight reduction and comorbidity resolution in Saudi Arabian geriatric populations. Methods A retrospective cohort study was conducted at King Khalid Hospital, Saudi Arabia, involving geriatric patients aged 60 and above who underwent BS between January 2018 and December 2022. Data were collected from medical records and analyzed using descriptive statistics, chi-square tests, t-tests, and multivariate regression analysis. Results The study included a total of 26 patients with a mean age of 64 years. Of these, 18 (69.3%) were females, while eight (30.7%) were males, and 23 (87%) underwent sleeve gastrectomy (SG), while three (13%) hadRoux-en-Y gastric bypass (RYGB). Preoperative comorbidities majorly included diabetes (17, 35.42%), hypertension (11, 22.92%), and anemia (four, 8.33%). The average body mass index (BMI) of the patients decreased significantly from 45.12 to 37.29 at three months and further to 31.36 at six months post surgery. Total weight loss (TWL) was 19.92% at three months and 35.15% at six months, while the percentage of excess weight loss (%EWL) was 33.42% at three months and 57.85% at six months. Results also showed a significant reduction in the number of comorbidities postoperatively. A significant association with gender, preoperative weight, and preoperative height at three and six months and a significant association with preoperative BMI and comorbidity status at six months were recorded. Conclusion The study suggests that bariatric surgery is effective in achieving significant weight loss and improving comorbidities in geriatric patients. Few demographic and clinical features affect the outcome of the weight loss.

Efficacy and safety of duodenal-jejunal bypass liner for obesity and type 2 diabetes: A systematic review and meta-analysis.

This study aimed to evaluate the efficacy and safety of duodenal-jejunal bypass liner (DJBL) for obesity and type 2 diabetes mellitus. A comprehensive search of electronic databases was conducted up to September 15, 2022. Thirty studies involving 1751 patients were included. At 12 months post-implantation, the reduction in body mass index (BMI) was 4.8 kg/m2 (95% CI 4.1, 5.5), with an excess weight loss of 41.3% (95% CI 33.4%,49.2%) and a total weight loss of 13.1% (95% CI 10.1%, 16.0%). Significant decrease was observed in HbA1c and fasting glucose, with a standardized mean difference of - 0.72 (95% CI - 0.95, - 0.48) and - 0.62 (95% CI - 0.82, - 0.42), respectively. However, these improvements in weight loss and glycemic control were only partially sustained after explantation. In situ, DJBL significantly improves blood pressure and lipid levels. The pooled early removal rate was 19%, and the incidence of severe adverse events was 17%, including device migration (6%), gastrointestinal hemorrhage (4%), device obstruction (4%), and hepatic abscess (2%). DJBL offers significant improvement in weight loss and glycemic control, as well as cardiovascular parameters while in situ. Further studies are warranted to better understand the long-term efficacy and safety of DJBL. The benefits of DJBL need to be carefully weighed against the risks in clinical decision-making.

Effectiveness and Safety of the Allurion Swallowable Intragastric Balloon for Short-term Weight Loss: A Systematic Review and Meta-analysis.

Obesity poses a severe health problem worldwide, with an estimated impact on 17.5% of the adult population by 2035. Among the endoscopic applications for treating this comorbidity, intragastric balloons are the most widely used. The new liquid-filled swallowable balloon meets the requirements of major guidelines and allows significant weight loss with few adverse events. This systematic review and meta-analysis aims to demonstrate the efficacy and safety profile of this new device for weight loss. We conducted a search from 2016 to 2024 to assess the efficacy of the swallowable intragastric balloon for weight loss, including improvements in metabolic profiles and anthropometric measurements. Additionally, we evaluated potential adverse events related to the device to demonstrate its safety. Eleven observational studies totalling 2107 patients were included, showing a reduction of 4.75 in BMI (95% CI: -5.02; -4.47), a mean total weight loss of 12.47% (95% CI: -13.77; -11.17), a mean excess weight loss of 48.04% (95% CI: -50.61; -45.48), and a rate of serious adverse events of 0.90%. An improvement in the metabolic profile was observed for three parameters: HDL, triglycerides, and glycaemia. The swallowable liquid-filled intragastric balloon is safe and effective for managing weight loss within a four-month follow-up period.

Comparison of the Effectiveness of Single Anastomosis Sleeve Ileal Bypass and Roux-en-Y Gastric Bypass in Obese Patients with Type 2 Diabetes.

The rapid increase in obesity and related problems has heightened the importance of obesity and metabolic surgery, resulting in a continuing search for the ideal surgical method. This study aimed to compare the effectiveness of Roux-en-Y gastric bypass (RYGB), which is the gold standard method, and the relatively newer method of single anastomosis sleeve ileal (SASI) bypass. The medical records of patients who underwent RYGB and SASI bypass were reviewed and compared regarding excess weight loss (EWL) and HgA1c, fasting glucose, serum iron, ferritin, hemoglobin (Hgb), and vitamin B12 levels. The body mass index was significantly lower (p = 0.003), and the %EWL was significantly higher (p = 0.023) at 6months postoperative in patients who underwent SASI bypass. Both groups had similar results at the other follow-up visits. The mean HgA1c levels at the 6- and 12-month follow-up visits were significantly lower in SASI patients (p = 0.037 and p = 0.012, respectively). At the 24-month follow-up, no difference was detected in HgA1c levels between the groups (p = 0.476). In patients who underwent RYGB, ferritin (p < 0.001), plasma iron (p = 0.001), and Hgb levels (p = 0.001) were significantly lower at 12, 24, and 12months postoperatively, respectively. SASI bypass is effective and comparable to RYGB in terms of EWL and metabolic control and has the advantage of not producing excluded segments and reducing nutritional deficiencies.

Changes in Fat Mass Index and Fat-Free Mass Index Vary Significantly by Age and Sex of the Patient, and by Type of Bariatric Surgery.

The loss of fat-free mass after rapid weight loss following bariatric surgery shows BMI is inadequate for reporting weight loss, emphasizing the need for a more accurate body composition metric. This study assessed changes in fat mass index (FMI), fat-free mass index (FFMI), and dietary intake over 6months after one-anastomosis gastric bypass (OAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) across age and sex groups. This prospective observational study included 151 bariatric surgery candidates. Data on demographics, anthropometric, body composition, and food intake data were collected before and 6months after surgery. SPSS version 22 was used for analysis, employing ANOVA and t-tests to assess group differences. Younger patients (≤ 35years) had higher percent total and excess weight loss (%TWL and %EWL) across all bariatric surgeries, and those undergoing SG experienced more favorable changes in fat-free mass (FFM) and visceral fat compared to other procedures (P = 0.002). Males had higher percent change in fat mass index (%∆ FMI) and visceral fat than females with OAGB and RYGB (P < 0.05). Women undergoing SG and RYGB had a more significant decrease in energy intake compared to OAGB (P < 0.001), and the ≤ 35 and 35-44 age groups demonstrated lower reductions in energy intake following OAGB. Age, sex, and surgery type significantly affect bariatric surgery outcomes. Younger patients achieved greater weight-related improvements, while men undergoing RYGB experienced more substantial fat mass changes than women.

Risk factors for and treatment of anastomotic strictures after Ivor Lewis esophagectomy.

Anastomotic strictures following esophagectomy occur frequently and impact on nutrition and quality of life. Although strictures are often attributed to ischemia and anastomotic leaks, the role of anastomosis size and pyloroplasty is not well evaluated. Our study aims to assess the rate of and risk factors for anastomotic stricture following esophagectomy, and the impact of treatment with regular endoscopic balloon dilatations. Consecutive patients (n = 207) undergoing Ivor Lewis esophagectomy performed by two surgeons at our institution were included. Data on patient demographics, surgical outcomes and anastomotic strictures were recorded. Relationship of anastomotic strictures with circular stapler size, pyloroplasty and anastomotic leak was analyzed. Treatment of strictures with endoscopic balloon dilatation was reviewed and percentage weight loss at 1 year was evaluated. Anastomotic strictures occurred in 17.4% of patients. Patient demographics between those with and without stricture were similar. Stricture rate was similar in patients with or without pyloroplasty (13.9% vs 21.7%, respectively, p = 0.14) and in those with or without an anastomotic leak (25.0% vs 16.6%, respectively, p = 0.345). Stricture risk increased with smaller sized stapler (25mm = 33.3%, 28mm = 15.3%, 31mm = 4.8%; p = 0.027). The median number of dilatations required to fully treat strictures was 2 (IQR: 1-3). The median length of time from surgery to first dilatation was 2.9 months (IQR: 2.0-4.7) and to last dilatation was 6.1 months (IQR: 4.8-10.0). Median maximum dilatation diameter was 20mm (IQR: 18.0-20.0). There were no complications from dilatations. Percentage weight loss at 1 year in patients with strictures was similar to those without strictures (8.7% vs 11.1%, respectively, p = 0.090). Post-esophagectomy anastomotic strictures are common and not necessarily related to anastomotic leaks or absence of pyloroplasty. Smaller anastomosis size was strongly linked with stricture formation. A driven approach with regular endoscopic balloon dilation is safe and effective in treating these strictures with no excess weight loss at 1 year once treated.

Myosteatosis predicts bariatric surgery response: A longitudinal study in patients with morbid obesity.

Data on the preoperative factors for bariatric surgery response in patients with morbid obesity are limited, and there are no studies on the relationship between myosteatosis and surgery response. We investigated the preoperative factors determining bariatric surgery response and the impact of preoperative muscle fat infiltration on bariatric surgery response. This retrospective longitudinal cohort study included 125 individuals (37 men, 88 women) with morbid obesity who underwent bariatric surgery. Muscle fat infiltration (skeletal muscle fat index [SMFI]) was evaluated using computed tomography-based psoas muscle mass and density at the 4th lumbar level. A bariatric surgery response was defined as ≥50% excessive weight loss at one year postoperatively. Before bariatric surgery, the patient mean body weight and body mass index (BMI) were 107.0 kg and 39.0 kg/m2, respectively. After one year, the mean body weight was 79.6 kg. The mean excessive weight loss at one year was 75.6% and 102 (81.6%) patients were categorized as responders. There were no statistically significant differences in initial BMI, age, sex, or proportion of diabetes between responders and non-responders. Responders were more likely to have lower SMFI and triglyceride and glycated hemoglobin A1c levels than non-responders at baseline (P<0.05). Multiple logistic regression analysis showed that a lower baseline SMFI was associated with bariatric surgery response (odds ratio=0.31, 95% confidence interval=0.14-0.69, P=0.004). Preoperative myosteatosis may determine the response to bariatric surgery.

Reduction in Serum Carotenoid Levels Following One Anastomosis Gastric Bypass.

Given the health benefits of carotenoids, it is crucial to evaluate their levels in patients undergoing malabsorptive procedures like one anastomosis gastric bypass (OAGB). This study aimed to assess serum carotenoid levels before and 6 months following OAGB. Prospectively collected data from patients who underwent primary OAGB were analyzed. Data included anthropometrics, dietary intake assessments, and biochemical tests. Serum samples were analyzed for lipid profile and serum carotenoids, including lutein, zeaxanthin, α-carotene, β-carotene, phytofluene, ζ-carotene, and lycopene. Data from 27 patients (median age 47.0 years and 55.6% female) were available before and 6 months post-OAGB. The median pre-surgical BMI was 39.5 kg/m2, and the median excess weight loss at 6 months post-surgery was 63.9%. Significant decreases in all carotenoid levels were observed over time (p < 0.001 for all). A median relative decline of 65.1% in absolute total carotenoid levels and 12.7% in total cholesterol levels were found. No associations were observed between changes in clinical outcomes and carotenoid levels during the study period. This study reveals significant decreases in carotenoid levels within the first 6 months following OAGB. Nutritional intervention studies are needed to explore how incorporating carotenoid-rich foods affects post-surgery carotenoid levels and clinical outcomes.

A Study of Omentum Reduction on the Improvement of Nausea and vomiting and Gastroesophageal Reflux Symptoms After Laparoscopic Gastric Sleeve Resection.

To investigate the effect of omentum reduction in laparoscopic sleeve gastrectomy (LSG) on the improvement of postoperative nausea and vomiting and gastroesophageal reflux symptoms. A retrospective study was performed on the case data of 198 obese patients who underwent LSG in the Department of Obesity and Metabolic Diseases of Xiaolan People's Hospital of Zhongshan from March 2021 to March 2022 and were divided into omentum reduction group and control group, with 99 cases in each group, and the preoperative body mass index (BMI) of the patients was recorded. Age, gender, comorbidities, and comparative analysis of operation time, blood loss, length of hospital stay, postoperative nausea and vomiting score, gastroesophageal reflux GerdQ score, postoperative pain score, weight, and postoperative complications were analyzed. There were no significant differences in preoperative BMI, age, gender and comorbidities between the two groups (P > 0.05), but there were significant differences in intraoperative blood loss and operation time (P < 0.05). There were differences in postoperative nausea and vomiting scores and VAS pain scores between the two groups (P < 0.05). The GerdQ scores of the omental reduction group were 8.11 ± 2.84 points at 1year, and those in the control group were 7.56 ± 2.67 points, which were 3.97 ± 4.09 points higher than those in the preoperative omentum reduction group and 3.42 ± 3.41 in the control group, with no significant difference (P > 0.05). There was no significant difference in the postoperative excess weight loss rate %EWL and postoperative complications (p > 0.05). Omentum reduction can improve short-term nausea and vomiting after LSG, but it cannot significantly improve long-term reflux symptoms.

Spanish Experience with Latero-Lateral Duodeno-Ileostomy + Sleeve Gastrectomy with Magnet Anastomosis System.

The partial diversion of intestinal contents facilitates achieving and maintaining weight loss and improving glycemic control in patients with obesity and with or without T2DM. The purpose of this study is to report our experience and 1-year follow-up with novel modification of SADI-S. This study is a part of a multicentric trial of patients that underwent primary side-to-side duodeno-ileostomy and sleeve gastrectomy (SG) with GT metabolic solutions magnetic anastomosis system. Feasibility, safety, and initial efficacy were evaluated. The mean age of the patients included was 48 ± 8.75years and the preoperative BMI was 43.32 ± 2.82kg/m2. The complications were present in 30% of patients. The anastomosis patency was confirmed by the passage of radiological contrast under fluoroscopy at a mean of 17days (17-29days), and the mean expulsion time was 42days (32-62). The mean diameter of the anastomosis after the magnet expulsion was 13.8 × 11.4mm. The percentage of total weight lost at 1year was 38.68 ± 8.48% (p < 0.001). The percentage of excess weight loss 82.5 ± 18.44% (p < 0.001) and improvements in glucose profiles were observed. Mean baseline HbA1c 5.77 ± 0.31% was reduced to 5.31 ± 0.26% (p < 0.024). Latero-lateral duodeno-ileostomy + SG with magnetic duodenal bipartition is afeasible and reasonably safe technique and induces weight loss in patients with obesity and improvement of glycemic control. This modification could be considered as an option to standard SADI-S or as a first step in two stages procedure. However, larger studies are needed. Clinicaltrials.gov Identifier: #NCT05322122.

Characteristics of Patients Undergoing Bariatric Surgery in an Inner-City Minority Population: A Pre and Postoperative Comparison Between Patients With and Without Obstructive Sleep Apnea.

Background Obese patients are at an increased risk of obstructive sleep apnea (OSA). Bariatric surgery or weight loss surgery is an important therapeutic measure in obese patients for the management of weight and comorbidities. Data are scarce in inner-city Hispanic and Black patients who undergo bariatric surgery, which eventually leads to health disparity in this minority population. Differences between patients with and without OSA have not been assessed in this population. This study aims to answer these questions. Methodology The study was conducted in a high-volume hospital in the Bronx, New York. Before bariatric surgery, patients underwent a preoperative evaluation that included a variety of blood tests, a sleep study, esophagogastroduodenoscopy, and echocardiography. They also underwent basic anthropometric measurements, such as weight, height, and body mass index (BMI), before surgery and 6 months and 12 months postoperatively. Additional calculations were made using these anthropometric measures, namely, total weight loss, excess weight loss, and delta BMI. Results Most patients were Hispanic (85.2%), with a mean age of 41.9 ± 10.8 years. We found that of the 108 patients included in the study, 69.4% (70/108) had OSA.Preoperative BMI in the study was 43.9 ± 13 kg/m2. Postoperatively, the mean decrease in BMI was 12.3 ± 14.5 kg/m2. Total weight loss and excess weight loss were 30.2 ± 14.3 and 52.6 ± 16.6, respectively. Conclusions In this study, no significant difference was noted in patients with or without OSA in either the laboratory or anthropometric parameters.

Revisional bariatric surgery following sleeve gastrectomy: a meta-analysis comparing Roux-en-Y gastric bypass and one anastomosis gastric bypass.

The number of bariatric operations is increasing each year. Sleeve gastrectomy is the most popular procedure; however, it often requires revision surgery because of insufficient weight loss, weight regain or gastro-oesophageal reflux disease (GORD). The most popular revisional procedures are Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB). The primary outcome of this meta-analysis was weight loss after revisional surgery following laparoscopic sleeve gastrectomy and the secondary outcomes were gastro-oesophageal reflux, BMI difference, operative time, bleeding and anastomotic leak. A systematic electronic search was undertaken using PubMed, MEDLINE, Ovid, Cochrane Library and Google Scholar following PRISMA guidelines. The initial search identified 2,546 articles. After screening, seven papers met the inclusion criteria: six retrospective studies and one randomised controlled trial. In total, 802 patients met the inclusion criteria: 390 had an OAGB and a further 412 had an RYBG. All patients previously had a sleeve gastrectomy for weight loss. The length of follow-up was 12 months for our primary outcome. We found no statistically significant difference in excess weight loss (%EWL) between OAGB and RYGB (p = 0.11). The incidence of postoperative reflux was statistically significantly higher in the OAGB group (16% vs 10.1%, p < 0.003). Operative time was statistically significantly lower in the OAGB group (p = 0.04). This meta-analysis showed no statistically significant difference between the two revision bariatric surgery procedures for %EWL. RYGB was superior to OAGB in reducing the incidence of symptomatic GORD, whereas OAGB had a significant shorter operative time.

Impact of Sleeve Gastrectomy on Brain Structural Integrity.

Potential brain structural differences in people with obesity (PwO) who achieve over or less than 50% excess weight loss (EWL) after sleeve gastrectomy (SG) are currently unknown. We compared measures of gray matter volume (GMV) and white matter (WM) microstructural integrity of PwO who achieved over or less than 50% EWL after SG with a group of controls with obesity (CwO) without a past history of metabolic bariatric surgery. Sixty-two PwO underwent 1.5T MRI scanning: 24 who achieved more than 50% of EWL after SG ("group a"), 18 who achieved less than 50% EWL after SG ("group b"), and 20 CwO ("group c"). Voxel-based morphometry and tract-based spatial Statistics analyses were performed to investigate GMV and WM differences among groups. Multiple regression analyses were performed to investigate relationships between structural and psychological measures. Group a demonstrated significantly lower GMV loss and higher WM microstructural integrity with respect to group b and c in some cortical regions and several WM tracts. Positive correlations were observed in group a between WM integrity and several psychological measures; the lower the WM integrity, the higher the mental distress, emotional dysregulation, and binge eating behavior. The present results gain a new understanding of the neural mechanisms of outcome in patients who undergo SG. We found limited GMV changes and extensive WM microstructural differences between PwO who achieved over or less than 50% EWL after SG, which may be due to higher vulnerability of WM to the metabolic dysfunction present in PwO.