Laparoscopic Gastric Bypass Research Articles

Long-term incidence of bariatric related procedures following laparoscopic gastric bypass: 15 to 20years single institution experience.

Long-term data on the likelihood of undergoing additional related operations after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remain scarce. The aims of this study are to identify the long-term incidence of bariatric related operations, patient's predictive factors, and most common operations in the 15-20years following LRYGB. Single Academic Institution, Center of Bariatric Excellence. We performed a retrospective analysis of all LRYGB performed at Single Institution from 2003 to 2008. All subsequent bariatric related operations performed were manually reviewed, excluding upper endoscopies. Kaplan-Meier analysis was utilized to estimate the time to procedure. Cox regression was used to determine patient's factors associated with time until procedure. Of the 665 patients included, the median follow-up was 14years. There were 248 (37.3%) patients with a related operation. After excluding panniculectomy, 199 (29.9%) had a related operation. The 3 most common operations were panniculectomy [n = 77 (12%)], followed by cholecystectomy [n = 64 (10%)], and internal hernia repair [n = 56 (8%)]. The Kaplan-Meier estimated incidence of related operation at 15years was 43.7% and 35.3% after excluding panniculectomy. Females (HR = 1.77, 95% CI = [1.20, 2.62, p = 0.0039), age < 50 (HR = 1.42, 95% CI = [1.07, 1.88], p = 0.014), and BMI > 60 (HR = 2.77, 95% CI = [1.30, 5.91], p = 0.0083) were more likely to have a related operation. Bariatric related operations are common after LRYGB. Nearly half of patients will eventually undergo a secondary operation as they approach 20years post-LRYGB.

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.

Comparative Safety and Efficacy of Roux-en-Y Gastric Bypass Versus One-Anastomosis Gastric Bypass: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Obesity has become a global epidemic, affecting both developed and developing nations. Despite extensive efforts, historical outcomes of medical interventions for obesity have been unsatisfactory. Bariatric surgeries, including sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB), are now recognized as the primary treatment for severe obesity. However, laparoscopic one-anastomosis gastric bypass (OAGB) has emerged as a promising alternative, offering simplified procedures compared to RYGB. While OAGB's initial outcomes are optimistic, concerns about biliary reflux persist. Our systematic review aims to compare the safety and efficacy outcomes of RYGB and OAGB to inform clinical decision-making in managing obesity. We searched five databases up to February 2024. We included randomized controlled trials (RCTs) comparing RYGB and OAGB in obese patients, focusing on safety and efficacy outcomes. Data extraction covered study details, participant demographics, interventions, and outcomes related to operative details, complications, follow-up results, and weight changes. The risk of bias was assessed using the Cochrane tool. The analysis involved risk ratios for dichotomous data and mean differences for continuous data, using fixed or random effects models based on heterogeneity. Analyses were performed with Review Manager software v5.4. A total of 1057 patients were included in the analysis, sourced from 12 distinct RCTs. The analysis indicated OAGB outperformed RYGB in BMI reduction (MD = -0.69, p = 0.005), whereas RYGB was more effective in excess weight loss (MD = 6.51, p < 0.0001) and excess BMI loss (MD = 3.91, p < 0.0001). OAGB led to shorter operation times (MD = -34.89 minutes, p < 0.0001) and shorter periods of hospital stays (MD = -0.27 days, p = 0.01), along with fewer overall complications (RR = 0.58, p = 0.02) and lower incidence of upper gastrointestinal endoscopy complications (RR = 2.98, p = 0.0001). On the other hand, RYGB showed higher remission rates for dyslipidemia (RR = 0.60, p = 0.0003) and higher remissions of hypertension (RR = 0.83, p = 0.04). The majority of results were homogenous. Both OAGB and RYGB have their respective advantages and limitations. OAGB appears to offer benefits in terms of operation efficiency and early postoperative recovery, making it a potentially preferable option for patients and surgeons focused on these aspects. On the other hand, RYGB might be more suitable for patients prioritizing long-term weight loss and remission of certain comorbidities like hypertension. Ultimately, the choice between OAGB and RYGB should be made on an individual basis, considering the specific needs, conditions, and goals of each patient.

Post-bariatric surgery sarcopenia: risk factors and prevention

Aim. To determine the risk of sarcopenia development and progression in bariatric patients after laparoscopic longitudinal gastric resection and after laparoscopic gastric bypass surgery.Methods. A comprehensive analysis was conducted, incorporating modern scientific literature and clinical guidelines to identify challenges in the diagnosis, treatment selection, and postoperative management of such patients. The study involved 30 patients, each of whom underwent a standardized preoperative outpatient assessment. This assessment included anthropometric measurements, as well as general and biochemical blood tests (such as blood glucose, total protein, albumin, and a lipid profile). To assess the degree of sarcopenia, a method involving computed tomography (CT) scanning of the head and neck was selected.Results. The BMI of the two groups being compared showed no statistical differences, with averages of 37.2 kg/m² and 40.6 kg/m², respectively. At follow-ups conducted 3, 6, and 12 months after surgery, both groups exhibited satisfactory weight loss results. Among the 15 patients who underwent laparoscopic sleeve gastrectomy, sarcopenia was detected preoperatively in 6 patients (40 %), while the remaining 9 patients (60 %) showed no signs of sarcopenia. However, 12 months post-surgery, signs of sarcopenia were observed in 8 out of 15 patients (53.4 %).Conclusion. Bariatric surgery induces significant changes in body composition, affecting not only fat mass reduction but also leading to a decrease in skeletal muscle mass. The progression of sarcopenia was more pronounced in patients who underwent laparoscopic gastric bypass surgery compared to those who had laparoscopic sleeve gastrectomy. Therefore, patients undergoing bariatric surgery may be at increased risk of developing or exacerbating sarcopenia.

Effect of laparoscopic gastric sleeve vs. laparoscopic gastric bypass in Roux-Y on long-term weight loss in obese mexican population.

Compare the weight loss results between long-term procedures up to 5 years, after undergoing MGL and RYGB in Mexican patients with obesity and associated comorbidity. The most common bariatric surgical procedures worldwide are, laparoscopic gastric sleeve (MGL) and laparoscopic Roux-en-Y gastric bypass (RYGB), as a treatment for weight loss and remission of comorbidity associated with obesity; however, they are the long-term weight loss results in the Mexican population are unknown. Retrospective, observational cohort of patients with obesity undergoing MGL or RYGB in a private hospital Medica Sur, in Mexico City, in the period from 2013 to 2021. Instrumental variables analysis and standardized mean differences were used to calculate outcomes up to 5 years at 5 follow-up visits (S1-S5), at 7 days, 2 months, 6 months, 10 months and 2-5 years after surgery, to compare results of the groups. 104 patients were included in two groups: 31 (30.09%) with MG and 73 (70.87%) with RYGB. The last follow-up (S5), the MG group recorded a mean EW 9.61 kg, EW% 12.72% and EWL% 73.50%, and the RYGB group EW 10.1 kg, EW% 14.72% and EWL% 70.41%. No significant difference was found between groups for long-term EW loss (p = 0.082); however, there is a greater decrease in weight loss in RYGB at 6-12 months compared to MGL.

ThP3.13 - Impact of gastrojejunostomy anastomosis diameter on weight loss following laparoscopic gastric bypass: a systematic review

Abstract Introduction Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is a preeminent procedure for achieving significant weight reduction and alleviating obesity-related comorbidities. However, the influence of gastrojejunostomy (GJ) anastomosis diameter on weight loss is not well-elucidated. This review examines the effect of GJ diameter on post-RYGB weight loss outcomes. Methods A meticulous systematic search of the literature, limited to English-language publications, was executed with the assistance of an expert librarian. The search encompassed all studies available up to 3 August 2023, the date of the last search. Study quality was evaluated utilizing the Newcastle-Ottawa Scale. Due to the heterogeneity of the outcomes, a narrative synthesis approach was adopted. Results From 1,026 records screened, 6 studies met the inclusion criteria, demonstrating a range of GJ diameters and follow-up durations (1-5 years). Generally, smaller GJ diameters were associated with more significant weight loss in the short to medium term. There appears to be a threshold for the reduction in diameter; beyond this, the risk of complications such as stenosis may escalate. The studies indicated a moderate to low risk of bias and underscored the importance of accurate GJ area quantification post-operation. Conclusion This review identifies a negative correlation between smaller GJ diameters and weight loss after RYGB. Future investigations should prioritize the standardization of measurement techniques and investigate the potential of intra-operative and artificial intelligence-based methodologies for optimal GJ diameter determination, with the aim of augmenting patient outcomes in bariatric surgery.

Short Term outcome of Laparoscopic Sleeve Gastrectomy versus Gastric Bypass on Body Weight and Common Associated Comorbidities: Randomized Controlled Study

Short Term outcome of Laparoscopic Sleeve Gastrectomy versus Gastric Bypass on Body Weight and Common Associated Comorbidities: Randomized Controlled Study

787. THE CHALLENGE OF GASTRO-ESOPHAGEAL ONCOLOGICAL SURGERY AFTER BARIATRIC PROCEDURES: EXPERIENCE OF A REFERRAL HIGH-VOLUME UPPER GI SURGICAL CENTER

Abstract Background The effectiveness of bariatric surgery for weight loss in morbidly obese patients has been well established and it's becoming more common as many surgeons are trained to perform them safely, even in older patients. Obesity is associated with reflux and hormonal imbalances that increase the risk of Barrett's esophagus, esophageal adenocarcinoma and gastric cancer. Bariatric procedures alter gastric anatomy, vascularization and lymphatic drainage and render subsequent upper gastrointestinal surgery for malignancies a technical challenge, that will present more and more in the future. We present laparoscopic sleeve gastrectomy, gastric bypass and gastric banding conversion to oncological respective surgeries. Methods We retrospectively reviewed the medical records of our referral high-volume center for upper gastrointestinal surgery and identified patients who underwent upper gastrointestinal oncologic surgery from January 1998 to May 2024. We selected all patients who had previously undergone bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic gastric bypass, gastric banding, or other less common procedures). Three patients met our criteria, and we recorded: demographic characteristics, surgical technique, oncologic surgical outcome, postoperative complications, long-term complications, and oncologic follow-up. Results A hybrid IvorLewis esophagectomy was performed years after a sleeve gastrectomy for distal esophageal adenocarcinoma. The sleeve was used for gastric pull-up, adequately vascularized by the right gastroepiploic artery as demonstrated by intraoperative indocyanine green. A patient developed adenocarcinoma of the cardia after Roux-en-Y gastric bypass, infiltrating the gastric pouch, the gastric remnant and liver S2. After neoadjuvant chemotherapy, an open Ivor-Lewis esophagectomy was performed using the gastric remnant for a pull-up. In a third patient, a locally advanced adenocarcinoma of the stomach developed after gastric banding. After neoadjuvant chemotherapy, an open total gastrectomy with Roux-en-Y esophagojejunostomy was performed. Conclusion We report three cases of successful esophago-gastric oncological surgery in patients with altered anatomy and vascularization due to previous bariatric surgery, without major postoperative complications or mortality. Oncologic benchmarks for both esophageal and gastric surgery were met as a high lymph node yield and oncologic margins were maintained. Our heterogeneous series suggests that sleeve gastrectomy, gastric bypass, and gastric banding surgery can be successfully converted to resective surgeries after a metachronous neoplasia diagnosis in high-volume upper gastrointestinal centers. These and similar modified reconstructive techniques are likely to be used in the future as metabolic surgery and esophago-gastric cancer are increasing.

Short Term Impact of Laparoscopic Sleeve Gastrectomy versus Gastric Bypass on Body Weight and Common Associated Comorbidities: Review Literature

Short Term Impact of Laparoscopic Sleeve Gastrectomy versus Gastric Bypass on Body Weight and Common Associated Comorbidities: Review Literature

Conversion of sleeve gastrectomy to Roux-en-Y laparoscopic gastric bypass: a comprehensive 14-year follow-up study on efficacy and outcomes

BackgroundFailed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain and by reflux and structural complications, can be treated by a laparoscopic conversion to Roux-en-Y gastric bypass (RYGB). ObjectivesTo examine the efficacy and outcomes of conversion surgery over a 14-year follow-up period. SettingGovernment and private medical centers in university settings. MethodsWe conducted a cohort study of 58 patients who underwent conversion of SG to RYGB for 2 indications: invalidating reflux or weight recurrence during 2009–2023. Weight dynamics analysis was performed with 2 references of weight: before SG (with intention to treat) and before conversion. ResultsAt conversion surgery, the mean weight, body mass index (BMI), percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL) (calculated with intention to treat, from the weight before SG) were 92.2 ± 25.2 kg, 34.3 ± 8.0 kg/m2, 55.2% ± 39.9%, and 22.8% ± 15.2%, respectively. Mean nadir weight, BMI, %EWL, and %TWL after conversion (calculated from the weight before SG) were 71.1 ± 18.4 kg, 26.7 ± 5.5 kg/m2, 96.5% ± 30.5%, and 40.2% ± 10.6%, respectively. At follow-up, the mean weight, BMI, %EWL, and %TWL (calculated from the weight before SG) were 80.4 ± 17.7 kg, 29.6 ± 5.4 kg/m2, 78.9% ± 26.8%, and 33.3% ± 11.2%, respectively. The mean percentages of %EWLio and %TWLio (calculated from the weight before conversion = EWL from index operation) at nadir were 73.2% ± 92.7% and 20.1% ± 12.2% after conversion, respectively, and decreased to 41.9% ± 94.0% and 13.2% ± 15.2% at last follow-up (mean 6.6 yr), respectively. ConclusionsSG to RYGB conversion provides moderate to low complementary weight loss in the short term. By 3–4 years, there is a clear trend toward weight gain.

Use of proton pump inhibitors after laparoscopic gastric bypass and sleeve gastrectomy: a nationwide register-based cohort study

Background/ObjectivesL-RYGB and L-SG are the dominant bariatric procedures worldwide. While L-RYGB is an effective treatment of coexisting gastroesophageal reflux disease (GERD), L-SG is associated with an increased risk of de-novo or worsening of GERD. The study aimed to evaluate the long-term use of proton pump inhibitors (PPI) following laparoscopic Roux-en-Y gastric bypass (L-RYGB) and sleeve gastrectomy (L-SG).Subjects/MethodsThis nationwide register-based study included all patients undergoing L-RYGB or L-SG in Denmark between 2008 and 2018. In total, 17,740 patients were included in the study, with 16,096 and 1671 undergoing L-RYGB and L-SG, respectively. The median follow up was 11 years after L-RYGB and 4 years after L-SG. Data were collected through Danish nationwide health registries. The development in PPI use was assessed through postoperative redeemed prescriptions. GERD development was defined by a relevant diagnosis code associated with gastroscopy, 24 h pH measurement, revisional surgery or anti-reflux surgery. The risk of initiation of PPI treatment or GERD diagnosis was evaluated using Kaplan–Meier plots and COX regression models. The risk of continuous PPI treatment was examined using logistic regression modeling.ResultsThe risk of initiating PPI treatment was significantly higher after L-SG compared with L-RYGB (HR 7.06, 95% CI 6.42–7.77, p < 0.0001). The risk of continuous PPI treatment was likewise significantly higher after L-SG (OR 1.45, 95% CI 1.36–1.54, p < 0.0001). The utilization of PPI consistently increased after both procedures. The risk of GERD diagnosis was also significantly higher after L-SG compared with L-RYGB (HR 1.93, 95% CI 1.27–2.93, p < 0.0001).ConclusionsThe risk of initiating and continuing PPI treatment was significantly higher after L-SG compared with L-RYGB, and a continuous increase in the utilization of PPI was observed after both procedures.

A clinical case: gastric cancer after gastric bypass

Introduction: Gastric cancer is one of the most common oncological diseases in the world, occupying the 5th place of morbidity and the 3rd place in the structure of mortality from oncological diseases. For a long time, issues affecting the risk of developing cancer after bariatric surgery remain relevant. Our observation is devoted to the diagnosis and treatment of a patient with gastric cancer after gastric bypass. Description of the clinical case: A 62‑year‑old patient was operated on 13. 07. 2016 – laparoscopic Roux gastric bypass for morbid obesity, 11. 09. 2019 – laparoscopic installation of the Cardioplant plate on a small stomach due to recurrent weight gain. Since 2020 the patient had the phenomena of anastomositis, dysphagia and gastroesophageal reflux. Courses of conservative therapy, sessions of balloon dilation of gastroenteroanastomosis and anastomosis resection failed to show a significant effect. The patient underwent comprehensive examinations at each treatment, including abdominal MSCT, cancer markers and studies of biopsy material of the gastric mucosa and gastroenteroanastomosis. As a result of histological studies, no signs of cancer were found. After applying to the Avicenna Medical Center in 2022 a molecular genetic analysis was carried out, in which the mRNA panel most corresponded to a malignant neoplasm. 20. 12. 2022 extirpation of the stomach stump with resection of the esophagus was performed. The cancer diagnosis was confirmed by histological and immunohistochemical studies: low‑grade adenocarcinoma of the stomach with a cricoid component with germination into the esophagus and small intestine, with spread beyond the muscle layer. Conclusion: This clinical case highlights the complexity of oncological verification in patients after bariatric surgery. Prolonged dysphagia, anastomositis and recurrent GERD in such patients determine the need for a more detailed examination, including the latest achievements of molecular genetic analysis.

Low-Density Lipoprotein Cholesterol Improvement Is Greater After Laparoscopic Sleeve Gastrectomy as Compared with Laparoscopic Gastric Bypass—a Registry-Based Study with 1-Year Follow-Up

Low-Density Lipoprotein Cholesterol Improvement Is Greater After Laparoscopic Sleeve Gastrectomy as Compared with Laparoscopic Gastric Bypass—a Registry-Based Study with 1-Year Follow-Up

Remission of Diabetes Mellitus Type 2 after Mini Gastric Bypass In BMI Less Than 40 (Meta-Analysis)

Abstract Background Obesity is a potent risk factor for the development and progression of type 2 diabetes, and weight loss is a key component of diabetes management. Bariatric surgery results in significant weight loss and remission of diabetes in most patients. After surgery, glycemic control is restored by a combination of enforced caloric restriction, enhanced insulin sensitivity, and increased insulin secretion. Aim and Objectives to review the currently available evidence for the effect of laparoscopic mini gastric bypass in obese patients on remission of diabetes type 2. Subjects and Methods This was a systematic review, including all available studies meeting the eligible criteria: well conducted descriptive studies, case reports and series, cohort, articles, accepted manuscripts, clinical trials, analytic studies and literature of reviews. Excluding other systematic reviews, technical notes, letters, and comment. Intervention done in all the studies concerning this subject including laparoscopic mini gastric bypass. Result Mean number of Improved, % (no.) [HbA1c &amp;lt;7%] were 64%, mean Partial remission, % (no.) [HbA1c &amp;lt;6.5%] was 77% and mean Complete remission, % (no.) [HbA1c &amp;lt;6.0%, glucose &amp;lt;110 mg/dl] was 50.5%. Conclusion GB surgery is an effective treatment strategy for diabetes remission and control of metabolic syndrome. Duodenum exclusion plays a role in the mechanism of diabetes mellitus remission.

Effect of Intraoperative Lung Recruitment and Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery on Postoperative Lung Functions: A Randomized Controlled Study

Abstract Background Morbid obesity may cause a restrictive condition. general anesthesia (GA) and supine posture both result in a decrease in lung capacity and Functional residual capacity (FRC), encouraging the development of atelectasis, altering the ventilation/perfusion ratio and raising the pulmonary shunt. This study evaluated the impact of recruitment maneuver (RM) and Transversus Abdominis Plane (TAP) block performed during laparoscopic bariatric surgery on spirometry, oxygenation, hemodynamic variables, opioid requirements and pain score assessed after surgery. Methods This pilot prospective randomized controlled study included 80 patients scheduled for elective laparoscopic bariatric surgeries (e.g., laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass) under GA. Patients were divided into four equal groups. All patients had received standardized postoperative analgesia regimen, group I (control group), group II received TAP block after intubation and before surgical incision, group III received RM after intubation and after pneumoperitoneal exsufflation, and group IV received RM after intubation and after pneumoperitoneal exsufflation and TAP block after intubation and before surgical incision. Results Forced Vital Capacity “FVC”, Forced Expiratory Volume “FEV1” were found to be significantly higher after operation in group IV compared to other groups. FEV1/FVC was insignificantly different among the four groups before and after operation. Intraoperative PaO2, PaO2/FiO2 were significantly higher in group III and IV compared to other groups. Numerical rating scale (NRS) at 1, 2, 4, 6 and 12hr had significantly decreased in group II and IV compared to other groups. Heart rate (HR) and mean arterial blood pressure (MAP) were insignificantly different among the four groups. Morphine consumption was significantly lower in group II and IV compared to other groups. Conclusions TAP block combined with RM group exhibited better postoperative pulmonary function tests (PFTs). Intraoperative oxygenation was higher in RM groups. NRS and opioid consumption were lower in TAP groups in postoperative period.

Laparoscopic gastric bypass surgery with a single anastomosis: a comparative analysis of the metabolic and bariatric effects

Objective. To compare the results of the effect of long–loop, distal and mini–gastric bypass surgery with a single anastomosis on the loss of excess body weight, indicators of protein, lipid, carbohydrate metabolism, correction of metabolic syndrome and development of deficiency states after 36 months. Materials and methods. Patients with morbid obesity were divided into 3 groups: Group 1 – 25 patients who underwent long–loop gastric bypass with a biliopancreatic loop length of 200 cm; Group 2 – 25 patients who underwent mini–gastric bypass with a biliopancreatic loop length of 200 cm using laparoscopic access; Group 3 – 25 patients who underwent distal gastric bypass with a total loop length of 250 cm. Results. 36 months after the operation, the loss of excess body weight was (69 ± 1.1)% in group 1, (70.1 ± 1.3)% in group 2 and (72 ± 0.9)% in group 3; remission of dyslipidaemia was observed in 4 (80%) of 5 patients in group 1, 11 (84.6%) of 13 patients in group 2 and 7 (100%) of 7 patients in group 3; remission of type II diabetes mellitus – in 3 (75%) out of 4, 5 (83.3%) out of 6 and 6 (100%) out of 6 patients, respectively, complete remission of arterial hypertension – in 6 (46.2%) out of 13, 7 (50%) out of 14 and 9 (60%) out of 15 patients, respectively. Conclusions. Laparoscopic long–loop gastric bypass with a single anastomosis is effective and safe, does not cause severe deficiency states, and can be used as a primary bariatric surgery.

Is YouTube Reliable to Teach Laparoscopic Gastric Bypass?

The increasing prevalence of obesity has led to the popularity of bariatric surgery. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most complex methods in bariatric surgery. The main steps of LRYGB were determined in the Delphi Consensus. This study investigated the instructiveness and reliability of YouTube videos about LRYGB based on the Delphi Consensus. In February 2024, three different searches were done in the search bar of the YouTube platform with the terms "laparoscopic gastric bypass" "laparoscopic Roux-en-Y gastric bypass" and "laparoscopic RYGB". The first 50 videos in each search were evaluated. Animations, lectures, advertisements, non-English videos, and non-surgical videos (pre-surgery, post-surgery vlog, etc.) were excluded from the study. Delphi consensus steps were used to determine the reliability of the videos. The quality of the videos was measured using the Global Quality Scale (GQS) and modified DISCERN test. Forty-five videos were included in the evaluation. While 14 (31.1%) of these videos were classified as reliable, 31 (68.8%) were not found reliable. In reliable videos, video description, high definition (HD) resolution, GQS, and modified DISCERNwere significantly higher(p-value 0.023, 0.004, 0.017, and 0.025 respectively). The rate of unreliable videos was higher on the YouTube platform. We conclude that YouTube alone is insufficient to learn LRYGB.

Melatonin decreases human adipose tissue insulin sensitivity.

Melatonin is a pineal hormone that modulates the circadian system and exerts soporific and phase-shifting effects. It is also involved in many other physiological processes, such as those implicated in cardiovascular, endocrine, immune, and metabolic functions. However, the role of melatonin in glucose metabolism remains contradictory, and its action on human adipose tissue (AT) explants has not been demonstrated. We aimed to assess whether melatonin (a pharmacological dose) influences insulin sensitivity in human AT. This will help better understand melatonin administration's effect on glucose metabolism. Abdominal AT (subcutaneous and visceral) biopsies were obtained from 19 participants with severe obesity (age: 42.84 ± 12.48 years; body mass index: 43.14 ± 8.26 kg/m2) who underwent a laparoscopic gastric bypass. AT biopsies were exposed to four different treatments: control (C), insulin alone (I) (10 nM), melatonin alone (M) (5000 pg/mL), and insulin plus melatonin combined (I + M). All four conditions were repeated in both subcutaneous and visceral AT, and all were performed in the morning at 8 a.m. (n = 19) and the evening at 8 p.m. (in a subsample of n = 12). We used western blot analysis to determine insulin signaling (using the pAKT/tAKT ratio). Furthermore, RNAseq analyses were performed to better understand the metabolic pathways involved in the effect of melatonin on insulin signaling. As expected, insulin treatment (I) increased the pAKT/tAKT ratio compared with control (p < .0001). Furthermore, the addition of melatonin (I + M) resulted in a decrease in insulin signaling as compared with insulin alone (I); this effect was significant only during the evening time (not in the morning time). Further, RNAseq analyses in visceral AT during the evening condition (at 8 p.m.) showed that melatonin resulted in a prompt transcriptome response (around 1 h after melatonin addition), particularly by downregulating the insulin signaling pathway. Our results show that melatonin reduces insulin sensitivity in human AT during the evening. These results may partly explain the previous studies showing a decrease in glucose tolerance after oral melatonin administration in the evening or when eating late when endogenous melatonin is present.

Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass on Liver Function at 6 Months in Morbid Obesity Patients: A Cross-Sectional Study

Background: Various weight loss surgeries exist, with no absolute superiority; each has pros and cons. Due to rising bariatric surgeries globally, it's vital to investigate comparisons between two-mini gastric bypass and Roux-en-Y gastric bypass (RYGB), especially regarding their impact on liver function. Objectives: The purpose of this study was to "draw comparisons between the effects of mini gastric bypass and laparoscopic Roux-en-Y gastric bypass on liver function at 6 months among patients with morbid obesity." Methods: This cross-sectional study included 90 bariatric surgery candidates (Body Mass Index (BMI) 35 - 50) from 2018 - 2021. Forty-five had laparoscopic mini gastric bypass surgery, while 45 had Roux-en-Y gastric bypass. Demographic, anthropometric, lab, and sonographic tests were conducted at baseline, 3-, and 6-months post-surgery. Data was analyzed using SPSS. Results: In a study of 90 patients (75.6% female, mean age 38.6 ± 10.4 years), both surgeries (Mini gastric bypass (MGB) and RYGB) effectively reduced body weight, BMI, and waist circumference at 3- and 6-months post-surgery. However, MGB showed significantly higher BMI and weight loss compared to RYGB (P = 0.003). In 90 patients, both surgeries reduced weight and BMI. However, MGB showed better BMI/weight loss. LFTs (ALT, AST, ALP) remained stable after MGB but worsened at 3 months after RYGB before recovering by 6 months. Mini gastric bypass also showed better GGT improvement. Both procedures improved fatty liver grading, FBS, and HbA1C levels equally. No significant differences were observed in blood pressure, platelet count, hemoglobin, or MCV. Ferritin levels increased in both groups but were higher in RYGB. CRP was higher in RYGB at 3 months. Conclusions: Roux-en-Y gastric bypass temporarily exacerbated liver enzymes and inflammation, but MGB resulted with more weight reduction. In comparison to RYGB, MGB improved LFTs more consistently.

Laparoscopic Roux-Y-gastric bypass versus laparoscopic one-anastomosis gastric bypass for obesity: clinical & metabolic results of a prospective randomized controlled trial.

One anastomosis gastric bypass (OAGB) has been proposed as an effective alternative to the current standard procedure in Switzerland, Roux-en-Y gastric bypass (RYGB). Prospective data comparing both procedures are scarce. Therefore, we performed a non-inferiority randomized controlled trial assessing the effectiveness and safety of these 2 operative techniques. Eighty patients were randomized 1:1. OAGB consisted of a very long gastric pouch with a 200cm biliopancreatic limb, RYGB of a 150cm ante-colic alimentary and a 60cm biliopancreatic limb, respectively. Primary endpoint was the percent excess weight loss (%EWL) at 12months after surgery. Mean %EWL at 12months was 87.9% (SD24.4) in the RYGB group and 104.1% (SD24.6) in the OAGB group (p = 0.006). There was no mortality. The rate of marginal ulcers was higher in patients with OAGB compared to those with RYGB (p = 0.011), while the total number of late complications did not statistically differ between the two groups. Except for the remission of GERD, which was higher in the RYGB group compared to OAGB, there was no difference between the groups regarding the remission of comorbidities. OAGB showed improved glucose control compared to the RYGB after 1 year (p = 0.001). Furthermore, glucagon-like peptide-1 increase was significantly higher in OAGB at 6 weeks (p = 0.041) and 1 year after surgery (p = 0.029). Quality of life improved after both surgeries, without differences between the groups. %EWL 1 year after surgery was higher in OAGB than in RYGB. A better glycemic control with a higher increase in GLP-1 was observed after OAGB compared to RYGB. This trial is registered on ClinicalTrials.gov under the identifier NCT02601092.