Laparoscopic Sleeve Gastrectomy Research Articles

Surgical treatment for obesity- metabolic surgery

Over the past 20 years, surgical treatment of obesity, or metabolic surgery, has established itself as an extremely efficient and sustainable therapy for treating severely overweight patients. Compared to non-surgical weight reduction procedures, surgical techniques have been shown to be superior in all studies, both in terms of short-term and long-term effectiveness. On the other hand, the invasiveness of the procedures is something that many patients view critically. Many years of experience with the two most commonly used procedures, laparoscopic sleeve gastrectomy and minimally invasive gastric bypass, show that both procedures are associated with very low morbidity. The comparatively high costs of the surgical procedure are more than offset by the long-term savings in other therapeutic needs (diabetes mellitus, hepatic steatosis, arthritis, osteoarthritis, etc.). The S3 guideline for carrying out metabolic surgical procedures has clear specifications for the criteria to be met. Embedding in a multi-modal concept both pre- and post-operatively is obligatory. The following article provides an overview of the indications, treatment, and aftercare in the field of metabolic surgery.

The effect of two different surgical positions on pulmonary functions ın laparoscopic sleeve gastrectomies: reverse Trendelenburg vs beach chair.

The aim of our study is to compare the effect of the 30° reverse Trendelenburg position combined with the beach chair position on respiratory parameters in laparoscopic sleeve gastrectomy (LSG) with the 30° reverse Trendelenburg position alone. Fifty patients with body mass index > 30 were included in the study. The patients were divided into two groups; in the control group, the standard 30° reverse Trendelenburg. In the beach chair group, the feet were positioned at 30° flexion from the hips after a 30° RTP. For both positions, blood pressures, pulses, saturations, EtCO2, respiratory rate, inspiratory pressure (Pins), positive end-expiratory pressure (PEEP), minute volume, tidal volume, peak airway pressure (Ppeak), and dynamic compliance were recorded. In addition, the general surgeon was asked about his satisfaction with the intra-abdominal operation site view and whether he was uncomfortable with the position. Regardless of the group, the average age of the cases was 36.7 ± 12.1years. There was no difference between the groups in terms of age, gender, BMI, operation time, blood pressures, heart rates, EtCO2, respiratory rate, PEEP, minute volume, tidal volume, and postoperative oxygen saturation (p > 0.05). Inspiratory and peak pressure were lower and dynamic compliance was higher in the beach chair position (p < 0.05). It was observed that the beach chair position decreased inspiratory and peak pressures and increased dynamic compliances in patients with a BMI between 35.1 and 40 (p < 0.05). Surgical satisfaction was high for both positions and there was no discomfort with the position. It was determined that the beach chair position in LSGs reduced inspiratory and peak pressures and increased dynamic compliance. These parameters were related to BMI, and the beach chair position was more positive in terms of intraoperative lung pressures and dynamic compliance, especially in patients with a BMI between 35.1 and 40. gov ID: NCT06402474.

Analgesic efficacy of the external oblique intercostal fascial plane block on postoperative acute pain in laparoscopic sleeve gastrectomy: a randomized controlled trial.

Laparoscopic sleeve gastrectomy (LSG) causes significant postoperative pain, necessitating effective multimodal analgesia strategies. This study evaluated the efficacy of the external oblique intercostal block (EOIB) in this context. This prospective, randomized, controlled, single-blind study conducted between April and December 2023 included 60 patients who underwent LSG. Patients were divided into the EOIB (30 ml 0.25% bupivacaine/side) and control (no block) groups. The primary outcome was the cumulative intravenous (IV) morphine milligram equivalent (MME) consumption in the first 24 h postoperatively. Secondary outcomes included 12-h MME consumption, pain scores, intraoperative remifentanil use, rescue analgesia requirements, time to first analgesic request, nausea/vomiting scores, antiemetic use, and American Pain Society Patient Outcome Questionnaire-Revised Turkish Version (APS-POQ-R-TR) scores. The control group had significantly higher median opioid consumption than the EOIB group at 12 (14.4 vs. 5.8 mg; P < 0.001) and 24 h (25.9 vs. 10.6 mg; P < 0.001) postoperatively. The need for rescue analgesics did not differ significantly (43.3 vs. 23.3%: P = 0.1). The EOIB group exhibited significantly higher patient satisfaction (APS-POQ-R-TR score 2.91 vs. 4.42; P < 0.001) and consistently lower pain scores across all time points (P < 0.001) The EOIB group had lower nausea/vomiting scores (P < 0.001), fewer patients requiring antiemetics (16.7% vs. 40%; P = 0.045), longer time to first morphine request (57.5 vs. 25 min; P < 0.001), and lower remifentanil use (850 vs. 1050 μg; P < 0.001). The preoperative EOIB, as a part of multimodal analgesia, provides effective analgesia for acute pain in patients undergoing LSG.

Long-term outcomes of sleeve gastrectomy in a patient group with mainly high BMI: a single-center study.

Since long-term results after laparoscopic sleeve gastrectomy (LSG) are rather scarce, this study aims to add LSG results with a minimum of 5years of follow-up. Prospectively collected data from primary LSG in a tertiary bariatric center from 08/2007 to 12/2018 with follow-up ≥ 5years were analyzed retrospectively. Primary endpoints included total body weight loss (%TBWL) and excess weight loss (%EWL), insufficient weight loss (IWL), weight regain (WR), remission of associated diseases, development of new-onset gastroesophageal reflux disease (GERD), and nutritional deficiencies. Furthermore, the study focused on incidence, time point, and causes of conversion and revision operations. A total of 207 LSG (132 female, mean age 43 (± 10.7) years) entered this study. 33.3% (52 of 156 without conversion) were lost to follow-up for ≥ 5-year data. Perioperative mortality was 0.5% (n = 1). %TBWL was 27.1% (± 12.4) and %EWL 52.5% (± 24.3). IWL or WR was found in 48.8%, new-onset GERD occurred in 27.5% of cases, leading to conversion in 26.6% and revisions in 2%. Nutritional deficiencies were observed in 23.7%, while resolution of associated diseases was sufficient. This patient group with a mean BMI > 50kg/m2 at baseline showed fair results regarding weight loss issues and remission of associated diseases at ≥ 5years postoperatively. Yet, a rate of 48.8% of either IWL and/or WR and 27.5% of new-onset GERD required conversion and revision operations in 28.6%. To better learn about long-term results of LSG, further studies preferably with larger multicenter samples and comparisons with alternative primary procedures, preferably in a prospectively randomized approach, possibly with focus on high BMI patients, are required.

Multicenter Perioperative Results with a New Endoscopic Powered Stapler in Bariatric Surgery: A Retrospective Study.

Background/Objectives: Advancements in surgical stapling devices play a crucial role in improving outcomes for bariatric procedures. This study evaluates the performance and safety of a new endoscopic stapler (EnDrive® BelugaTM) regarding perioperative results across multiple bariatric surgery types. Methods: A retrospective analysis was conducted on 112 patients who underwent bariatric procedures using the Beluga stapler at two centers in the United Arab Emirates and Kenya over a 6-month period (June-December 2023). Procedures included laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB), and revisions. Perioperative outcomes, complications, and hemoglobin changes were assessed. Results: The cohort included 29 males and 83 females, with a mean age of 32.8 years and preoperative body mass index of 41.1 kg/m2. Procedures performed were 88 primary LSG, 3 primary LRYGB, 12 primary OAGB-MGB, and 9 revision surgeries. No conversions, deaths, bleeding, or leaks occurred. Minor complications were observed in 4 patients. One patient required reoperation for intestinal obstruction. The mean hospital stay was 1.5 days. Hemoglobin levels showed minimal change from preoperative (12.8 g/dL) to postoperative day 1 (12.3 g/dL). Conclusions: The new Beluga endoscopic stapler demonstrated safe and effective performance across various bariatric procedures through this retrospective study, with low complication rates and minimal blood loss. Its enhanced articulation capabilities may offer advantages in specific cases. Further studies with larger groups, control groups, and longer follow-up periods are warranted to compare long-term outcomes with established stapling devices.

Long-term effect of Roux-en-Y gastric bypass versus sleeve gastrectomy on reflux and Barrett's oesophagus: a randomized controlled trial.

Laparoscopic sleeve gastrectomy (LSG) is a potentially refluxogenic operation while Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is regarded as an anti-reflux procedure. The aim of this study is to compare long-term incidence of Barrett's Oesophagus (BO) and gastroesophageal reflux disease (GORD) following LSG and LRYGB. Participants of a double-blinded randomized controlled trial comparing banded LRYGB and LSG for remission of type 2 diabetes were contacted to take part. A gastroscopy was performed. Primary outcome was endoscopic and histologic evidence of BO. Secondary outcomes included reflux and regurgitation scores, presence of oesophagitis, proton-pump inhibitor (PPI) usage, Body Mass Index (BMI), and percentage excess weight loss (%EWL). Forty-eight of 109 patients were enrolled into the study (LSG 26 vs. LRYGB 22). Mean follow-up was 7.5 years for the LSG group, and 7.4 years for the RYGB group (P = 0.22). 8 LSG patients had BO while 3 LRYGB patients had BO (30.8%vs13.6%, P = 0.19). There was no significant difference in the mean reflux (8.1 ± 9.4(0-36) vs. 9.3 ± 8.8(0-34), P = 0.47) and regurgitation scores (7.7 ± 6.9(0-22) vs. 11.5 ± 10.5(0-44), P = 0.23) for LSG versus LRYGB patients or between those with and without BO. PPI usage before and after surgery was 6/26 (23.1%) versus 13/26 (50.0%) and 8/22 (36.4%) versus 12/22 (54.5%) for LSG and LRYGB patients respectively. PPI usage in patients with and without BO was 7/11 versus 18/37. EWL was significantly greater (P = 0.0013) in the LRYGB group (74.8 ± 28.1%) compared to LSG group (49.7 ± 18.7%). Long-term incidence of BO trended towards but was not significantly higher for LSG compared to LRYGB group. We support routine endoscopic surveillance for bariatric patients.

Efficacy of ursodeoxycholic acid in reducing the necessity of cholecystectomy due to pre-existing and subsequently formed gallstones in patients who underwent laparoscopic sleeve gastrectomy

BackgroundIn this study, we aimed to investigate whether ursodeoxycholic acid (UDCA) would reduce the necessity of cholecystectomy in patients diagnosed with asymptomatic gallstones after laparoscopic sleeve gastrectomy (LSG) and in patients diagnosed with asymptomatic gallstones before LSG.MethodsBetween July 2020 and November 2022, at least 2-year follow-ups of patients who underwent LSG for obesity were retrospectively analyzed. Patients with pre-existing asymptomatic gallstones during preoperative evaluation, those with UDCA treatment (group 1), and observation group (group 2). Patients with newly formed gallstones in postoperative outpatient clinic follow-up, those with UDCA treatment (group A), and those without UDCA treatment (group B).ResultsA total of 425 patients included. At the end of the first year, patients who had newly formed gallstones after LSG had a higher total weight loss percentages (TWL%) (39.8 ± 6.1) compared to those who did not develop gallstones (37.9 ± 7.4), which were statistically significant (p = 0.004). Among patients who developed gallstones postoperatively, UDCA treatment was associated with a significantly lower cholecystectomy rate in patients with newly formed gallstones postoperatively (p = 0.025), while no significant difference was shown in patients with preoperative gallstones (p = 0.631).ConclusionUDCA is a promising option for reducing the need for cholecystectomy in patients with post-LSG gallstones, but it appears ineffective for pre-existing gallstones.

Exploring the link between inflammation and brain function after metabolic-bariatric surgery: A year-long fMRI study.

Metabolic-bariatric surgery (MBS) transcends weight loss and offers wide-ranging health benefits, including positive effects on brain function. However, the mechanisms behind these effects remain unclear, particularly in the context of significant postoperative changes in the inflammatory profile characteristic of MBS. Understanding how inflammation influences postoperative brain function can enhance our decision-making on patient eligibility for MBS and create new opportunities to improve the outcomes of this popular treatment. To identify brain regions where spontaneous neural activity and functional connectivity are linked with the evolving inflammatory profile following MBS. We investigated the relationship between the perioperative ratio of interleukin (IL)-6 to IL-10 and both the amplitude of low-frequency fluctuation (ALFF) and functional connectivity across 375 brain regions. We examined 36 patients at three time points: 1 week before, and 3 and 12 months after laparoscopic sleeve gastrectomy. Initially, the IL-6/IL-10 ratio increased during the early postoperative period but then decreased to levels lower than the preoperative values 1 year after surgery. We observed that ALFF in four subcortical structures decreased with a rising IL-6/IL-10 ratio and increased with a declining ratio. Conversely, 16 cortical regions displayed the opposite trend. Additionally, functional connectivity between the left insula and bilateral medial prefrontal cortex increased with a rising IL-6/IL-10 ratio and decreased with a declining ratio. Our study is the first to identify brain regions significantly linked to inflammation after MBS. Importantly, many of the discovered areas were previously shown to be involved in the pathogenesis of obesity or are targets of contemporary medical treatments. Consequently, our findings offer valuable insights for future obesity research, especially in the context of potential therapeutic opportunities.

Technical Considerations of Ring-Augmented Laparoscopic Sleeve Gastrectomy: A Step-by-step Guide for Ring Placement by Various Experts.

Technical Considerations of Ring-Augmented Laparoscopic Sleeve Gastrectomy: A Step-by-step Guide for Ring Placement by Various Experts.

Retrospective matched case-control comparison of Totally Robotic Sleeve Gastrectomy (RSG) during the learning curve with Laparoscopic Sleeve Gastrectomy (LSG): why is operative time different?

Robotic approach is slowly rising in metabolic surgery, and laparoscopy is still considered the gold standard for Sleeve Gastrectomy. Aim of our study was to assess and compare outcomes of RSG through a matched comparison with LSG. Retrospective search of prospectively maintained database of our surgical department was carried out find all consecutive patients who underwent RSG from April 2023 to August 2024. Each subject who underwent RSG was matched one-to-one with a patient treated with LSG in the same period. Operative time (docking + console time for the robotic procedures), length of stay, need for rescue drugs, and perioperative complications were recorded calculated and compared. A total number of 50 patients (25 RSG and 25 LSG) were included in the present analysis. Operative time in the LSG group was significantly shorter than in the RSG group (57.8 ± 12.3 VS 80.6 ± 16.6min, p < 0.01), but it was comparable to console time (57.8 ± 12.3 VS 56.9 ± 19.6, p = 0.85). Mean docking time was 23.7 ± 11min. Length of stay, readmissions, conversion to laparoscopy/open surgery, early complications, and rescue drugs administration were comparable between the two groups. Age, sex, and BMI were not good predictors neither of laparoscopic nor robotic operative time. RSG during the learning curve proved as safe as LSG, but it was associated with longer operative time due to the duration of the docking step. Operation length may become comparable once the learning curve plateau is reached. Age, BMI, and sex are not good criteria of choice between the two approaches.

Waist Circumference Is a Strong Predictor of a Positive Outcome Evaluated One Year After Sleeve Gastrectomy.

Bariatric surgeries, such as laparoscopic sleeve gastrectomy (LSG), not only result in significant weight loss but also improve the inflammatory state in obese patients. This study aimed to investigate the effects of LSG on weight loss and inflammation status in bariatric patients 1-year post-procedure. This prospective cohort study was conducted from September 2022 to May 2024. Fifty obese adults were enrolled for LSG. All patients underwent assessments of body measurements, as well as levels of interleukin-6 (IL-6) and interleukin-10 (IL-10) at baseline, and then at 3 and 12months post-surgery. Twelve months post-surgery, body measurements showed a significant reduction, with a median excess weight loss (%EWL) of 56.8%, indicating the clinical success of the bariatric procedure. %EWL showed a strong correlation with waist circumference (R = - 0.738, p < 0.00001). A logistic regression model indicated that a reduction of just 1cm in initial waist circumference increases the likelihood of a positive outcome in laparoscopic sleeve gastrectomy by 12%. Moreover, a significant increase was observed for IL-10 (p < 0.0001), simultaneously with a significant decrease in IL-6 (p < 0.0001). This study provides valuable evidence supporting the benefits of laparoscopic sleeve gastrectomy for both weight loss and reducing inflammation. Waist circumference emerged as a strong predictor of metabolic success 1-year post-surgery, while increased IL-10 levels signaled positive immunological changes.

Excess Weight Loss at 6 Months Following Laparoscopic Sleeve Gastrectomy Correlates with the Remission of Hyperuricemia.

Hyperuricemia is a metabolic disorder associated with obesity. Many studies have reported the effect of bariatric surgery on the decrease of serum uric acid level in patients with hyperuricemia. However, since the update of diagnostic criteria of hyperuricemia, the correlation between preoperative body mass index, postoperative weight changes, and the remission of hyperuricemia in patients with obesity after sleeve gastrectomy requires consensus. One hundred and ninety-three patients with obesity and hyperuricemia who underwent laparoscopic sleeve gastrectomy were enrolled. All patients were followed up for 6months postoperatively. Subgroup analysis was performed using the tertiles of preoperative body mass index, total weight loss, and excess weight loss to investigate the correlation with the remission of hyperuricemia after sleeve gastrectomy. A total of 193 patients were included in this study. Among them, 123 patients were female and 70 were male. And the mean age was 30.2 ± 7.8years, preoperative body weight was 116.1 ± 23.3kg, and the preoperative BMI was 40.5 ± 6.7kg/m2. 59.1% (114/193) patients achieved remission of hyperuricemia 6months after sleeve gastrectomy. The TWL% and EWL% were 25.6% ± 5.4% and 75.9% ± 28.2%, respectively. Female patients had a significantly higher remission rate than that of male patients (p < 0.05). Correlations were found between EWL%/preoperative BMI with the remission of hyperuricemia (p < 0.05). Sleeve gastrectomy had a positive effect on the remission of hyperuricemia in patients with obesity. EWL% may play a significant role in the remission of hyperuricemia.

Role of Endoluminal Functional LumenImaging Probein Bariatric Surgery and Bariatric Endoscopy.

Obesity is associated with significant morbidity, with an estimated prevalence of 42.4% in the USA. Treatment of severe obesity often involves Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. More recently, endoscopic sleeve gastroplasty has emerged as a minimally invasive option for patients with mild to moderate obesity. Endoluminal functional luminal impedance planimetry (EndoFLIP) uses impedance planimetry to assess tissue distensibility and geometric changes across an area but its role in bariatric surgery and bariatric endoscopy has not been fully elucidated. EndoFLIP has some utility in measuring gastric sleeve pouch size during sleeve surgery, assessing gastric sleeve stenosis, predicting the risk of post-sleeve GERD and response to endoscopic dilation, assisting in intraoperative gastric bands adjustment, and evaluating gastrojejunal anastomosis to predict weight regain after gastric bypass.

Analysis of the Efficacy of Different Obesity Surgeries in Patients with Metabolic Syndrome.

To investigate the effectiveness of different bariatric metabolic surgeries in improving metabolic syndrome indicators in patients. A retrospective analysis was conducted on obese patients who underwent laparoscopic sleeve gastrectomy (LSG), laparoscopic sleeve gastrectomy + jejunojejunal bypass (LSG + JJB), and laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients were categorized into groups based on their surgical procedure: LSG (N = 199), LSG + JJB (N = 242), and LRYGB (N = 288). Successful laparoscopic bariatric metabolic surgery was achieved in 729 patients. Indicators related to body mass, glucose metabolism, insulin resistance, lipid metabolism, and kidney function showed significant improvement compared to the preoperative period. LSG, LSG + JJB, and LRYGB all demonstrate significant effectiveness in promoting weight loss and improving glycolipid metabolism in the short term. Post-surgery, symptoms of metabolic syndrome improved compared to the preoperative period, with LRYGB showing superior effectiveness over LSG + JJB and LSG.

Sleeve gastrectomy with antral resection provides more effective weight loss in patients with super obesity

BackgroundObesity is a growing health issue that contributes to numerous diseases and lowers quality of life. In patients with super obesity (BMI > 50 kg/m²), bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), is a common treatment option. However, the role of antral resection (AR) in LSG remains unclear, especially in this high-risk population. This study aims to compare the effectiveness of LSG with antral resection (LSG-AR) and LSG with antrum preservation (LSG-AP) on weight loss and postoperative complaints in patients with super obesity.MethodsThe medical records of patients with a BMI > 50 kg/m² who underwent LSG between 2016 and 2022 were retrospectively reviewed. Weight data were collected at admission, and at the first, second, and fifth-year follow-up. Patients were divided into two groups based on LSG-AR or LSG-AP procedures.ResultsSeventy-two patients were included. No significant difference was found in postoperative vomiting complaints between the groups (p = 0.67). First-year outcomes showed no significant differences in weight, BMI, or % Total Weight Loss (%TWL). However, second and fifth-year %TWL values were significantly higher in the LSG-AR group (p = 0.003 for both).ConclusionLSG-AR provides more effective long-term weight loss in patients with super obesity. Early postoperative vomiting complaints diminish over time, suggesting LSG-AR as a viable one-stage procedure for this patient population.

Immunometabolic Changes Following Gastric Bypass and Sleeve Gastrectomy: A Comparative Study.

Immunometabolism is the interaction between immune system and nutrient metabolism. Severe obesity is considered a state of meta-inflammation associated with obesity that influences the development of chronic-degenerative diseases. We aimed to establish the immunometabolic differences in bariatric patients and to determine whether cellular immunity is associated with metabolic changes. We conducted an observational study in patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). We explored the differences in the immunometabolic profile before and after surgery in the study group, by surgical technique, and we evaluated the changes in immunological variables as a function of metabolic variables with correlation analysis. The follow-up rate was 88.7%. After the intervention, there were changes in cellular immunity, with a decrease in effector T lymphocytes (CD8+CD28-) and an increase in B lymphocytes, memory helper T cells, and cytotoxic T lymphocytes. LSG resulted in a greater decrease in (CD4+CD62-) T lymphocytes compared with LRYGB. Patients who underwent surgery with LRYGB presented greater clinical and metabolic improvements, as well as improvement of obesity-associated medical problems. Women who underwent LRYGB showed a greater reduction in fat-free mass compared with women who underwent LSG. Bariatric surgery, mainly LRYGB, leads to immunometabolic changes and improves associated medical problems.

Early Reinitiation of Obesity Pharmacotherapy Post Laparoscopic Sleeve Gastrectomy in Youth: A Retrospective Cohort Study.

Bariatric surgery is the most effective intervention for severe pediatric obesity, but a subset of youth experience suboptimal weight loss and/or recurrent weight gain. Early re-initiation ofobesity pharmacotherapy postoperatively may improve outcomes, though this has not been evaluated in pediatric populations. A retrospective cohort study at a tertiary care children's hospital evaluated the safety and efficacy of reintroducing obesity pharmacotherapy within six weeks afterlaparoscopic sleeve gastrectomy (LSG). Youth were offered obesity pharmacotherapy reinitiation at their 2-week postoperative visit. The study compared outcomes between 25 youth who chose early obesity pharmacotherapy reinitiation and 21 who received standard care without restarting medication. Primary outcomes included weight trajectory, eating behaviors, complications, readmissions, and reoperation rates, analyzed using independent t-tests, Chi-squared tests, and logistic regressions. Between November 2023 and July 2024, 53 youth had surgical consults, and 46 (86% conversion rate; mean age 16.5 ± 1.9years, mean BMI 53 ± 9.7kg/m2; 70% (32/46) female, 80% (37/46) Hispanic, 87% (40/46) publicly insured) underwent LSG, with 93% (43/46) using obesity pharmacotherapy preoperatively. Mixed-effects multivariate regression, adjusting for baseline BMI, age, and sex, revealed that early reinitiation (5.1weeks [IQR 3.7, 8.4]) significantly reduced BMI, percent BMI, percent total weight loss (TWL), and percent excess weight loss (EWL) at 3 and 6months compared to standard care, with no significant differences in complications or readmissions. At 6months, the mean differences were: %BMI: -6.5% (95% CI: -9.13, -3.86), p < 0.001; %TWL: -5.9% (95% CI: -8.52, -3.25), p < 0.001; %EWL: Reinitiators: -45.5% vs. standard care: -39.4%; meandifference: -8.2% (95% CI: -14.69, -1.63), p < 0.001. Early reinitiation also resulted in a significant reduction in emotional overeating at 3 and 6months compared to standard care, with mean differences of -2.5points (95% CI: -3.29, -1.76), p < 0.001, and -3.5points (95% CI: -4.38, -2.69), p < 0.001, respectivelyon self-reported eating behavior questionnaires. Early obesity pharmacotherapy reinitiation after LSG was safe and well tolerated, improving weight outcomes without negatively impacting complication or readmission rates.

Position statement and guidelines about Endoscopic Sleeve Gastroplasty (ESG) also known as "Endo-sleeve".

IS ESG EFFECTIVE IN THE TREATMENT OF OBESITY AND ASSOCIATEDCOMORBIDITIES?: Endoscopic Sleeve Gastroplasty (ESG) is more effective than lifestyle modifications alone for weight loss and improving obesity-related comorbidities. While it has less effect on weight loss compared to Laparoscopic Sleeve Gastrectomy (LSG) in the short to medium term, it offers similar comorbidities resolution to LSG. IS ESG A SAFE PROCEDURE, AND WHAT ARE ITS RISKS?: The safety profile of ESG is consistently supported in the literature. Surgical complications after ESG, ranging from 1.5 to 2.3%, such as bleeding, perforation, fistula, or upper bowel obstruction, are rare and typically managed endoscopically. The incidence of new-onset gastro-esophageal reflux disease (GERD) is deemed negligible and occurs less frequently after ESG compared to SG. WHAT ARE THE INDICATIONS AND MANAGEMENT METHODS?: Multidisciplinary care for patients undergoing ESG should be provided in an accredited center authorized to perform bariatric and metabolic surgery, with validation through a multidisciplinary consultation meeting (RCP). Perioperative management should be personalized and ideally modeled after the protocols already in place for bariatric and metabolic surgery to ensure satisfactory and lasting weight and metabolic outcomes. Adherence to follow-up visits is a significant predictor of successful weight loss outcomes after ESG. Additionally, all endoscopic surgical procedures should be documented in a registry affiliated with a recognized scientific society, as is standard for other bariatric surgical procedures. WHICH HEALTHCARE PROFESSIONALS CAN PERFORM ESG?: ESG must be performed by a practitioner trained in endoscopy and obesity management, capable of ensuring thorough preoperative care and comprehensive postoperative follow-up, supported by an experienced multidisciplinary team. In France, Notice No. 2021.0040/AC/SEAP of June 10, 2021, issued by the Haute Autorité de santé (HAS) college, specifies that "the technology of ESG via the trans-oral approach, involving wide plication of the greater gastric curvature […] with an endoscopic suture placement device, enables a gastroenterologist or a visceral and digestive surgeon to perform gastric plication through digestive endoscopy by placing sutures in the stomach". Ideally, this should take place in an accredited center authorized to perform bariatric and metabolic surgery, such as those approved by the Agence régionale de santé (ARS), in accordance with Article R6123-212 of December 2022 of the French Public Health Code. WHAT ARE THE RECOMMENDATIONS AND VIEWS OF OTHER INTERNATIONAL SCIENTIFICSOCIETIES?: ESG is an integral part of the therapeutic arsenal available to bariatric and metabolic surgeons, offering an effective and valuable treatment option for obesity in specific patient populations. The International Federation for the Surgery of Obesity (IFSO) Bariatric Endoscopy Committee, following a comprehensive systematic review and meta-analysis, endorsed ESG as an effective and valuable treatment for obesity. ESG is particularly beneficial for patients with class I and II obesity, as well as for those with class III obesity who are not suitable candidates for metabolic bariatric surgery. Additionally, it can be proposed as an addition to lifestyle interventions in adolescent patients with class II obesity. The SOFFCOMM endorses endoscopic sleeve gastroplasty (ESG) as an effective and valuable treatment for obesity and highlights the importance of appropriate patient selection, coupled with rigorous evaluation of long-term outcomes, to refine its indications further.

Evaluation of Pulmonary Function in Long-Term Follow-Up After Laparoscopic Sleeve Gastrectomy.

Obesity is one of the most important health problems in the world. It affects all systems, especially the respiratory and cardiovascular systems. Laparoscopic sleeve gastrectomy is an effective method in the treatment of obesity and can improve respiratory functions. We aimed to evaluate the effects of surgery on pulmonary function in patients with obesity. A retrospective analysis was conducted on a group of patients who underwent sleeve gastrectomy. This study assessed pre-operative and long-term pulmonary function in patients who underwent laparoscopic sleeve gastrectomy between 2009 and 2015, with a minimum follow-up of 10years. Patients were stratified based on smoking status and presence of comorbidities. The study included 51 patients (82.4% female) with a mean age of 51.90 ± 11.57years. Significant weight loss and reductions in BMI were observed postoperatively. Mean pre-operative BMI was 47.53 ± 6.95 and significantly decreased to 37.75 ± 6.02 post-operatively, BMI reduction rate was %22 (p < 0.001). Pulmonary function tests demonstrated significant improvements in FEV1 (2.65 ± 0.69 to 2.76 ± 0.67, p = 0.044), FEV1% (92.07 ± 15.31 to 97.98 ± 14.45, p = 0.001), PEF (74.01 ± 18.12 to 91.53 ± 24.16, p < 0.001), and MEF25-75 (77.17 ± 22.07 to 108.57 ± 28.11 p < 0.001) after surgery. These improvements were consistent across different subgroups, including smokers, non-smokers, and patients with and without comorbidities. Non-smokers exhibited a greater percentage increase in FEV1 compared to smokers. While there was an increase in FEV1 among patients with comorbidities, this difference was not statistically significant. Conversely, patients without comorbidities demonstrated a significant improvement in FEV1. Bariatric surgery is associated with significant improvements in pulmonary function in obese patients, regardless of smoking status or comorbidities.

Efficacy of Revisional Endoscopic Sleeve Gastroplasty After Laparoscopic Sleeve Gastrectomy.

Recurrent weight gain after laparoscopic sleeve gastrectomy (LSG) is common. Revisional endoscopic sleeve gastroplasty (r-ESG) has been shown to be a promising endoscopic bariatric therapy (EBT) to treat weight recurrence after LSG. However, to date, weight loss outcomes beyond 1-year follow-up are unknown. Our study aims as follows: (1) examine 1year, 18-month, and 24-month weight loss outcomes post-r-ESG and (2) determine if weight loss outcomes post-LSG predict clinical outcomes post-r-ESG. This was a retrospective cohort data of patients who completed r-ESG from December 2020 to November 2023. The primary outcome was percentage of total body weight loss (TBWL) at 1-year post-r-ESG. Secondary outcomes included TBWL at 18- and 24-month post-r-ESG. Multivariable logistic regression analysis was used to determine predictors of weight loss ≥ 5% at 12months. A total of 55 patients completed r-ESG. TBWL post-r-ESG at 12months was 8.6% (n = 37), at 18months was 10.7% (n = 31), and at 24months was 12.6% (n = 18) (Table2). There were no statistically significant variables associated with weight loss ≥ 5% at 12months (Table3). Our study demonstrates that r-ESG is an effective and durable EBT for post-LSG weight recurrence. Further research is needed to determine optimal timing of r-ESG for weight recurrence as well as the adjunctive role of anti-obesity medications.