Types Of Bariatric Surgery Research Articles

The Effect of Different Types of Bariatric Surgery on Levothyroxine Requirement in Hypothyroid Bariatric Patients.

BackgroundBariatric surgeries are carried out to improve a patient's quality of life, and to reduce respiratory, cardiac, endocrine, and metabolic complications encountered by those with high body mass index (BMI). A complication associated with high hypothyroidism is weight gain, which may lead to obesity. Here, we explore the effect of different bariatric procedures on thyroid function and levothyroxine dosage. MethodsThis is a retrospective review of 887 patients referred to a tertiary bariatric service between 2008 and 2020 and treated for hypothyroidism at the time of referral.The study identified 57 patients on thyroxine replacement. Of these, 22 underwent restrictive bariatric procedures, 16 underwent restrictive/malabsorptive procedures, and 19 did not undergo operative intervention.Comparisons were made among each group throughout the timeline of interest.ResultsOut of 57 patients, 50 (87.7%) were female. The average age for patients was 47.26+/- 8.89 years. The average BMI at baseline was 48.72+/- 8.68 kg/m2. The mean dose of levothyroxine in controls was 115.8+/- 53.5 mcg while that of surgical patients was 149.8+/- 68.4 mcg.There were no statistically significant differences in levothyroxine doses between surgical and control at T0 (baseline), T1 (one-year post-op in surgical patient, or two-year post referral in control patient), T2 (two-year post-op in surgical patient, or three-year post referral in control patient), and T3 (most recent result available). The surgical group was then categorized further into restrictive and restrictive/malabsorptive. When they were compared with the control group, there were no statistically significant differences in doses.A generalized linear mixed model was applied to assess differences in levothyroxine dose with time as a random variable. This was adjusted for age, sex, BMI, T4 level, and hypothyroid cause. Through this assessment, there were several statistically significant differences in levothyroxine dosage between the groups. Control group required on average 28.06 mcg less levothyroxine than the restrictive/malabsorptive group (p=0.015). Also, the restrictive group required on average 23.57 mcg less levothyroxine than the restrictive/malabsorptive group (p=0.033). There were no statistically significant differences observed between the control group and the restrictive group (p=0.67)ConclusionPatients who have bariatric surgery have changes to their anatomy and physiology which may affect both their thyroid hormone homeostasis and levothyroxine pharmacokinetics. Thus, hypothyroid bariatric patients requiring levothyroxine must have their thyroid function monitored regularly. In this study, it was found that hypothyroid patients who underwent restrictive surgery had an overall statistically significant lower levothyroxine requirement to remain euthyroid as compared to the restrictive/malabsorptive group (p=0.033). Additionally, the control group required statistically significantly less levothyroxine than the restrictive/malabsorptive group (p=0.015). These factors may determine the type of surgery chosen by hypothyroid bariatric patients. However, further studies that are randomized, controlled, and multi-center with a higher population are required.

Incidence of Gallbladder Stone Formation After Bariatric Surgery Using Ultrasound Imaging in the Southern Region of Saudi Arabia.

BackgroundBariatric surgery is performed for accomplishing weight loss, which can save patients from diseases associated with morbid obesity. However, rapid weight loss is one of the most important risk factors contributing to the formation of gallbladder stones. The aim of this study is to investigate the prevalence of gallstone formation among patients in the southern region of Saudi Arabia who underwent bariatric surgery and to evaluate the association between several parameters and gallstone development in these patients.MethodsA retrospective study was conducted including 57 patients who did not have gallstones in the preoperative abdominal ultrasound examinations. Demographic data, such as age and gender, were obtained along with other parameters like weight loss after surgery, and time elapsed between the surgery to post-surgery US examination. The findings of the US examinations were collected and analyzed. Data were analyzed to obtain descriptive and inferential statistics. A correlation matrix to investigate the dependence between variables was conducted.ResultsPatients in this study underwent either sleeve gastrectomy (87.7% [n = 50]) or gastric banding procedures (12.3% [n = 7]). The occurrence of cholecystectomy was 46% after sleeve gastrectomy and 71.1% after gastric band procedures. The majority of the patients (57.9%) lost weight after surgery in the range of 20 to 40 kg. The time elapses between the surgery to post-surgery ultrasonography examination varied among patients, where less than one year, one to three years, and three to six years accounted for 47.4%, 43.9%, and 8.8%, respectively. Gallstone formation after the surgery was found in 35 (61.4%) of the total cases. Among patients who developed gallbladder stones after bariatric surgery, 62.9%, 28.4%, and 8.6% were within less than one year, one to three years, and three to six years, respectively. The results suggest a statistically significant correlation betweengallstone formation and​​​ the time elapsed after the surgery (P = 0.008) and the type of bariatric surgery (P = 0.006).ConclusionThe current study found that the overall incidence rate of gallbladder stones after bariatric surgery is 61.4%. The study assumed a possible higher incidence of gallbladder stones following bariatric surgery among the population in the southern region of Saudi Arabia compared to incidence rates reported in the literature. The type of bariatric surgery and the time elapsed after the surgery were found to be of value in predicting the formation of gallstones.

Time impact on the antidiabetic effects of key bariatric surgeries:anetwork meta-analysis of randomized controlled trials with meta-regression.

Few studies compare the efficacy of the key bariatric procedures in type 2 diabetes management over the long term. None offer a reliable comparison of their respective efficacy loss over time. To analyze and compare the time evolution of the antidiabetic effects of the key bariatric procedures. Obesity surgery departments in America, Europe, and Asia. All the randomized clinical trials assessing the efficacy of bariatric surgery in type 2 diabetes management with 1-5 years of follow-up were reviewed. A network meta-analysis with meta-regression was performed to compare the effectiveness of each technique and its respective efficacy loss temporal dynamics. Thirty-one trials involving 1906 patients were included. In comparison to Roux-en-Y gastric bypass, the 5-year complete or partial diabetes remission rates were inferior with medical treatment (odds ratio [OR] = .05; 95% credible interval [CrI]: .02-.13) and gastric banding (OR= .38; 95% CrI: .16-.87), equivalent with sleeve gastrectomy (OR = 1.08; 95% CrI: .59-1.97), and superior with 1 anastomosis gastric bypass (OR = 3.00; 95% CrI: 1.12-8.33) and biliopancreatic diversion and its affiliated techniques (OR = 3.71; 95% CrI: 1.16-12.55). However, remission rates and glycemic control progressively decreased whatever the treatment option evaluated. Moreover, this loss of efficacy followed a statistically comparable temporal dynamic to those of Roux-en-Y gastric bypass regardless of the therapeutic strategy implemented. No therapeutic modality offered stable antidiabetic effects. The gap observed between the techniques after a 5-year follow up concerning remission rates and glycemic control could depend essentially on the magnitude of the effects initially obtained. However, these results need to be confirmed over longer follow-up periods.

Predictors of Nutritional Deficiencies After Bariatric Surgery in the United States: Analysis of Real-World Data

ObjectivesBariatric surgery can lead to postoperative nutritional deficiencies due to restrictive and malabsorptive mechanisms, but there is limited literature quantifying this risk.MethodsPatients who underwent Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) in the IBM® MarketScan® Commercial Database (2006–2016) were identified. Nutritional deficiencies (anemia, protein malnutrition, vitamin B12 deficiency, vitamin D deficiency, other) were assessed at 1 year prior to surgery and at 3 years post-surgery. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) across bariatric surgery types after adjusting for potential confounders (demographics, lifestyle, and comorbidities). Interactions of bariatric surgery types with age, sex, and baseline nutritional deficiencies in relation to post-surgery nutritional deficiencies risk were assessed by likelihood ratio tests.ResultsA total of 82,885 patients (mean (SD) age of 44.5 (9.5) years) were identified with 38.8% (n = 32,190) undergoing RYGB, 33% (n = 27,388) undergoing SG, and 28.1% (n = 23,307) undergoing LAGB. The most common 3-year postoperative nutritional deficiencies were anemia (28%), vitamin D (24%), protein malnutrition (9%), and vitamin B12 (9%). Relative to the LAGB group, the adjusted OR of developing any 3-year nutritional deficiency postoperatively was 3.03 (95% CI, 2.92–3.15) for the RYGB group and 2.45 (95% CI, 2.36–2.55) for the SG group. These associations were stronger among patients younger than 45 years, men, and those without baseline nutritional deficiency (P‐interaction < 0.05 for all). Baseline nutritional deficiencies were independently associated with higher odds of postoperative nutritional deficiencies. Similar results were observed for anemia, protein malnutrition, and vitamin B12 deficiency.ConclusionsRYGB and SG were associated with two- to three-fold odds of developing postoperative nutritional deficiencies compared to LAGB, independent of baseline nutritional deficiency status. Pre- and postoperative nutritional assessment are recommended for all bariatric surgery patients to optimize postoperative outcomes.Funding SourcesNone.

Bariatric Surgery in Type 1 Diabetes patients: a single centre study

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Body composition changes following different types of bariatric surgery: Interpreting discordant findings from different methodological approaches

Body composition changes following different types of bariatric surgery: Interpreting discordant findings from different methodological approaches

The impact of bariatric surgery on the risk of coronary revascularization.

Metabolic surgery is associated with improved cardiovascular risk profile. Randomized and observational studies exploring the impact of bariatric surgery on follow-up coronary revascularization (CR) as a primary endpoint are limited. To identify the impact of metabolic surgery on the risk of follow-up CR, including percutaneous coronary revascularization (PCI) and coronary artery bypass grafting (CABG) SETTING: Stony Brook Department of Surgery, Stony Brook University Hospital, New York, United States. A retrospective analysis was performed for patients with obesity between 2006 and September 2015. Patients were divided into those with history of metabolic surgery and those without. Patient were also stratified by bariatric surgery type. All study groups were followed till 2018 and for at least 3 years to monitor the development of the primary endpoint-any CR including PCI or CABG. The study population with obesity was 515,307 patients; 95,901 with history of surgery versus 419,406 matched patients without. A total of 12,873 (13.4%) with surgery and 51,478 (12.27%) without were lost to follow-up by 2018. The group with history of surgery had a reduced risk of future CR (hazard ratio [HR], .46; 95% confidence interval [CI]: .42-.50; P < .0001), PCI (HR, .45; 95% CI: .41-.49; P < .0001) and CABG (HR, .49; 95% CI:.42-.56; P < .0001). In subgroup analysis, laparoscopic adjustable gastric banding compared with Roux-en-Y gastric bypass (RYGB) was associated with higher follow-up CR (HR, 1.34; 95% CI: 1.11-1.63; P < .01) and PCI (HR, 1.34; 95% CI: 1.07-1.68; P < .05). Bariatric surgery is associated with reduced risk of future CR, PCI, and CABG. Upon subgroup analysis, RYGB was associated with reduced risk of PCI and CR.

Comparative evaluation of different types of bariatric surgery

Introduction. The use of bariatric surgery as a treatment for obesity has increased dramatically over the past few years. Because the results in obese patients with type 2 diabetes were so impressive, the International Diabetes Federation recommended considering bariatric surgery as an acceptable treatment option in patients with a BMI of 30-35 kg / m2 when diabetes cannot be adequately controlled with traditional therapies.&#x0D; The aim of the study is to compare the results of bariatric surgery in patients with metabolic syndrome according to the dynamics of body mass index and major orexigenic and anorexigenic hormones.&#x0D; Material and Methods. The results of surgical treatment of 19 patients with morbid obesity (5 men and 14 women) aged 44 ± 3.26 years with a body mass index ˃40 kg / m2 were evaluated. The control group consisted of 12 patients with normal body mass index and no manifestations of metabolic syndrome.&#x0D; Results. Our study also demonstrated the positive effect of LGAE on hormonal parameters with a decrease in ghrelin and leptin. This helped reduce BMI by 10.12% after 6 months. At the same time there is an increase in adiponectin and resistin.&#x0D; Conclusions. LGAE in patients with ghrelin-associated obesity is possible as an alternative intervention, given its good tolerability. Or, as the first preparatory stage of comprehensive surgical treatment in obese patients who are not good candidates for standard bariatric surgery.

Effects of bariatric surgery on renal function and associated factors with bivariate analysis: a cohort study

Background: Obesity is a global pandemic, caused by genetic, biological and social factors, increasing the risk of many chronic diseases, including kidney disease. Bariatric surgery can control associated comorbidities and also improve renal function. Thus, the aim of this study was to evaluate the effect of bariatric surgery on renal function and associated factors, through bivariate analysis. Methods: A cohort, prospective, analytical study was carried out in the Department of surgery and obesity, in Campina Grande - Paraíba, Brazil. Thirty-five obese patients were evaluated in the preoperative period of bariatric surgery and after one year of bariatric surgery. Sociodemographic and anthropometric data were collected, body mass index was calculated, and renal function was estimated through the glomerular filtration rate. Results: Predominantly female (71.4%) and white (77.1%) patients were observed. Regarding the type of bariatric surgery, most patients (65.7%) underwent the sleeve technique. There was no significant difference between the mean levels of cystatin C pre and post bariatric surgery. There was a significant improvement in the mean glomerular filtration rates in the postoperative period (p=0.09). In further analysis of the association between the variables: type of bariatric surgery, diabetes or hypertension outcomes, no association was observed with the outcome improvement in glomerular filtration rate, without statistical significance, respectively (p = 0.312; p =0.217; p = 0.476). Similarly, there was no statistically significant difference between the variable loss of body mass index, under the effect of bariatric surgery, in relation to the outcome of the glomerular filtration rate (p = 0.904). Conclusion: After analyzing the association between outcome of glomerular filtration rate and the studied variables, no association was observed between these variables, under the effect of bariatric surgery, with improvement in glomerular filtration rate. Thus, bariatric surgery is associated with improvement of renal function independently.

Long-term Impact of Laparoscopic Sleeve Gastrectomy on Drug Costs of Japanese Patients with Obesity and Type 2 Diabetes Mellitus.

Laparoscopic sleeve gastrectomy (LSG) is the most common type of bariatric surgery in Japan, and it is the only such procedure covered by national health insurance. The long-term cost of bariatric surgery in Japan has not yet been analyzed. We aimed to evaluate the long-term impact of LSG on the drug treatment costs of patients with type 2 diabetes mellitus (T2DM). We retrospectively analyzed data from 230 patients who had undergone LSG at our institution for their obesity and T2DM between 2007 and 2018. The clinicopathological data included age, sex, body mass index (BMI), as well as preoperative and postoperative medications for T2DM, hypertension, and dyslipidemia. We then calculated the drug treatment costs for T2DM, hypertension, and dyslipidemia before and after LSG; and we evaluated the remission rates of these obesity-related diseases. The median preoperative body weight and BMI of the 230 patients who underwent LSG were 115kg and 40.6kg/m2, respectively. Preoperative drug treatment costs per month per patient for T2DM, hypertension, and dyslipidemia were ¥3795 (¥0-40285), ¥3269 (¥0-14577), and ¥1428 (¥0-19464). Post-operation, the median drug treatment costs for all these diseases became nil. The remission rates of T2DM, hypertension, and dyslipidemia 5years after LSG were 82.8%, 50%, and 43.8%, respectively. In Japan, the cost of an LSG operation corresponds to 4.75years of median drug costs to treat T2DM and hypertension. In the long term, LSG in Japan is effective both physically and cost-wise for patients with obesity and T2DM.

Evaluation of Calcium, Vitamin D and Parathormone Levels in Three Types of Bariatric Surgery; Sleeve Gastrectomy, One Anastomosis Gastric Bypass and Roux-en Y Gastric Bypass before and after surgery: a Mini-review

Due to the increasing prevalence of obesity and increasing the bariatric surgical procedures worldwide as the main treatments for severe obesity and the existence of calcium and vitamin D deficiency in these patients, it is necessary to evaluate and compare these elements in patients before and after bariatric surgery to perform proper treatment. Therefore, considering this necessity, the present review was designed. After searching in PubMed and Scopus database and screening the studies (in terms of quality and relevance), the contents were classified and the most important points were reported in this study.

Body composition changes at 12 months following different surgical weight loss interventions in adults with obesity: A systematic review and meta‐analysis of randomized control trials

SummaryTo determine relative lean mass and fat mass changes in adults with obesity following surgical weight loss interventions, a systematic review and meta‐analysis was conducted. The Cochrane Central Register of Controlled Trials, PubMed, Web of Science, EMBASE, and Scopus were screened for eligible studies. Inclusion criteria included randomized controlled trials (RCTs) performed in populations with obesity (body mass index ≥30 kg/m2) aged over 18 years, who underwent any type of bariatric surgery and reported body composition measures via dual‐energy X‐ray absorptiometry or bio‐electrical impedance analysis. Authors conducted full text screening and determined that there were six RCTs eligible for inclusion, with data extracted at 12 months post‐surgery. Meta‐analysis revealed that, relative to gastric banding, Roux‐en‐Y gastric bypass (RYGB) led to greater total body mass loss (mean difference [MD]: −9.33 kg [95% CI: −12.10, −6.56]) and greater fat mass loss (MD: −8.86 kg [95% CI: −11.80, −5.93], but similar lean mass loss (MD: −0.55 kg [95% CI: −3.82, 2.71]. RYGB also led to similar changes in total body mass, fat mass, and lean mass compared with sleeve gastrectomy. RYGB results in greater 12‐month weight and fat loss, but similar changes in lean mass, compared with gastric banding. Further RCTs comparing body composition changes following different bariatric surgery procedures are required.

The associations between bariatric surgery and hip or knee arthroplasty, and hip or knee osteoarthritis: Propensity score-matched cohort studies

ObjectiveTo investigate the associations between bariatric surgery and hip or knee arthroplasty, and secondary care hip or knee osteoarthritis (OA). MethodsWe performed cohort studies using data from Swedish nationwide healthcare registries. Patients aged 18–79 years who underwent bariatric surgery between 2006 and 2019 were matched on their propensity score (PS) to up to 2 obese patients (“unexposed episodes”) in risk-set sampling. After a 1-year run-in period, episodes were followed in an “as-treated” approach. Using Cox proportional hazard regression, we calculated hazard ratios (HR) with 95% confidence intervals (CIs) of hip or knee arthroplasty overall and in subgroups of age, sex, joint location, arthroplasty type, bariatric surgery type, and by duration of follow-up if proportional hazard assumptions were violated. In a secondary cohort, we assessed the outcome incident secondary care hip or knee osteoarthritis (OA). ResultsAmong 39‘392 bariatric surgery episodes when compared to 61’085 ​PS-matched unexposed episodes (47′594 unique patients), the risk of hip or knee arthroplasty was strongest increased within the first three years of follow-up (HR 1.79, 95% CI 1.56–2.07), decreased thereafter, but remained elevated throughout follow-up. In a secondary cohort of 37′929 exposed when compared to 58′600 ​PS-matched unexposed episodes, the risk of hip or knee osteoarthritis was decreased (HR 0.84, 95% CI 0.79–0.90). ConclusionBariatric surgery is associated with increased risks of hip or knee arthroplasty, but also with decreased risks of secondary care OA. This contradiction supports the hypothesis that bariatric surgery may act as an enabler for hip or knee arthroplasty.

Short-Term Changes on Body Composition After Sleeve Gastrectomy and One Anastomosis Gastric Bypass.

Introduction: Changes in body composition after different bariatric surgeries have been studied extensively, but most of them have emphasized on Roux-en-Y gastric bypass. Only a few studies have assessed the effects of sleeve gastrectomy (SG). Also, the effect of one anastomosis gastric bypass (OAGB) on body composition is not fully apprehended. Furthermore, there is no agreement on how much fat-free mass (FFM) loss is tolerable in weight loss interventions. Therefore, we decided to assess the reduction in fat mass (FM) and FFM at 1, 3, 6, and 12 months after two types of bariatric surgery in a single center. Methods: In the current retrospective cross-sectional study, the patients' hospital records were analyzed. We included patients who had SG or OAGB and a complete 1-year follow-up record. We recorded demographic data as well as weight, body mass index (BMI), FM, and FFM before and at 1, 3, 6, and 12 months after surgery in a predesigned checklist. Results: We analyzed 311 patients (43 males and 268 females) in the SG (N = 192, 61.7%) and OAGB (N = 119, 38.3%) groups. Both the SG and OAGB groups demonstrated a statistically significant reduction in weight, BMI, FM, and FFM indices at 12 months after the intervention (P < .001). Moreover, no statistically significant difference was observed between the SG and OAGB groups regarding the mean of all body composition indices at 3, 6, and 12 months after the intervention. Conclusion: We found that SG and OAGB effectively decreased weight and body composition indices, comprising FM and FFM, with no significant difference between each other.

Timing and Type of Bariatric Surgery Preceding Total Knee Arthroplasty Leads to Similar Complications and Outcomes

BackgroundNo consensus exists regarding the appropriate timing of bariatric surgery (BS) or the complication profiles between Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy (SG) prior to total knee arthroplasty (TKA). We sought to compare 90-day medical and up to two-year surgical complications and revisions among (1) BS performed 6 months and 1 year prior to TKA; (2) between BS types (RYGB and SG) prior to TKA; and (3) with comparison to 2 non-BS cohorts of morbidly and nonmorbidly obese patients. MethodsWe queried a national database to identify patients undergoing BS (RYGB and SG) prior to TKA from 2010 to 2020. Timing (six-month and one-year intervals) and type of BS (RYGB and SG) were identified. Cohorts without prior BS served as comparators: BMI, kg/m2 > 40 and 20-35. Ninety-day to two-year medical/surgical complications and revisions were assessed. Multivariate regression analyses examined the risk factors for prosthetic joint infections (PJIs) and revisions. ResultsThe timing of BS (6 months and 1 year) had similar incidences of medical/surgical complications and revisions, with both lower than the BMI > 40 cohort (P < .001). Differences between types of BS were also lower than the BMI > 40 cohort (P < .001). The BMI 20-35 had lower complications and revisions among all cohorts. No differences were observed between BS timing or type as risk-factors for PJIs and revisions. ConclusionTiming (6 months or 1 year prior to TKA) and type of BS shared similar complication profiles, lower than BMI > 40 and higher than BMI 20-35. These findings support a surgeon’s decision to proceed with TKA at six months post-BS if indicated.

The association between bariatric surgery and cataract: a propensity score-matched cohort study

Obesity is considered a risk factor for cataracts. The association between weight loss and a cataract among patients with obesity has not been assessed to date.To assess the association between weight loss following bariatric surgery and cataracts.Nationwide Swedish healthcare registries between 2006 and 2019.We performed a population-based cohort study. Patients aged 40-79 years who underwent bariatric surgery were matched on their propensity score (PS) to up to 2 patients with obesity ("unexposed patients"). Cox proportional hazard regression analyses calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of developing cataracts following bariatric surgery, compared with unexposed patients. Subgroup analyses by age, sex, bariatric surgery type, and duration of follow-up were conducted.In total, 22,560 bariatric surgery patients were PS-matched to 35,523 unexposed patients. The risk of cataracts was decreased in bariatric surgery patients compared with unexposed patients (HR .71, 95% CI .66-.76). We observed the lowest risk of cataracts among bariatric surgery patients aged 40-49 years (HR .52, 95% CI .44-.75) but a null result for patients aged ≥60 years. Gastric bypass or duodenal switch were associated with decreased risks of cataracts, whereas sleeve gastrectomy yielded a null result. Subgroups of sex and duration of follow-up showed no evidence of effect modification (hazards were proportional throughout follow-up).Our results suggest that substantial weight loss following bariatric surgery is associated with a decreased risk of cataracts, especially if bariatric surgery was performed before age 60.

"The use of Autologous Flaps in Breast Reshaping After Massive Weight Loss: A Systematic Review".

Massive weight loss (MWL) has a positive impact on the comorbidities associated with obesity but leaves patients with ongoing body issues due to skin excess. Almost all patients present some degree of breast ptosis and breast volume deficiency, which can be addressed with different techniques including autologous flaps. A literature search was conducted by using PubMed, Google Scholar, and Cochrane databases. Patient's characteristics, type of bariatric surgery, amount of weight loss, flap size and design, simultaneous breast and extra-breast procedures were analyzed. Aesthetic and patient-reported outcomes, postoperative complications, revision rate, and donor site morbidity were also registered. Twelve articles fulfilled inclusion criteria, and 79 patients were included, for a total of 157 flaps. Different flap designs and flap combinations were described; those originating from lateral chest wall area were the most commonly used. Simultaneous breast procedures were reported in 72 patients. Simultaneous extra-breast body contouring (BC) procedure was performed in 40 cases. The overall complication rate was 9.55% and a total of ten revisionary procedures were performed. Satisfaction of the patients was globally quite high. Advantages of the use of autologous tissue in breast reshaping after MWL is the avoidance of implant-related complications and the simultaneous improvement of the silhouette. The complication rate resulted in acceptable, aesthetic, and patient-reported outcomes resulted to be encouraging, even if there was a lack of standardization in the evaluation. A comparative randomized study to confront the use of autologous flaps combined with mastopexy versus the use of implants combined with mastopexy can be useful to confirm the promising results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The impact of bariatric surgery on assisted reproductive technology outcomes: a systematic review protocol

BackgroundIndividuals with obesity are at higher risk of experiencing complications during their pregnancy and may also experience infertility, requiring assisted reproductive technologies (ART) to conceive. The current body of literature demonstrates that bariatric surgery decreases an individual’s risk of developing a variety of obesity-related obstetrical conditions during and after pregnancy. However, the effects of bariatric surgery on ART outcomes are not well understood. Therefore, the paucity in the literature warrants a need to determine these effects.MethodsWe will search electronic databases, including MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), as well as the gray literature and the reference lists of included articles. We will screen all studies published between January 1978 and the present day that explore the impact of bariatric surgery on ART outcomes for women and men. We will include observational studies. Two independent reviewers will assess the studies for inclusion and extract data for each article. The main outcome that will be analyzed is live birth rate. Secondary outcomes such as time to conception, number of rounds of ART, type of bariatric surgery, and length of time between bariatric surgery and initiation of ART will also be recorded. Risk of bias will be conducted using the National Institutes of Health Study Quality Assessment Tools. A random effects model will be used to account for statistical analysis and results will be pooled with forest plots. In the event of statistical and reporting heterogeneity, we will provide a qualitative synthesis and narrative review of the results.DiscussionThis review will provide information on the outcomes of ART following bariatric surgery and may help healthcare professionals make informed decisions about the length of time between bariatric surgery and initiation of ART. The study findings may be of interest to various stakeholders including patients, bariatric surgeons, obstetricians, and gynecologists, and those who specialize in obesity medicine and reproductive endocrinology and infertility. We plan to disseminate our findings through presentations, publications, and social media releases to individuals who are navigating infertility and are interested in undergoing or have undergone bariatric surgery, healthcare professionals, policymakers, and researchers.Systematic review registrationPROSPERO CRD42021252561

Ghrelin, glucagon-like peptide-1, and peptide YY secretion in patients with and without weight regain during long-term follow-up after bariatric surgery: a cross-sectional study.

IntroductionWeight loss after bariatric surgery is attributed, at least in part, to the altered gastrointestinal (GI) hormone secretion, which is thought to be responsible for a number of beneficial metabolic effects.Material and methodsWe conducted a cross-sectional study. Twelve patients who underwent laparoscopic sleeve gastrectomy (SG) and 20 patients who underwent a variant of biliopancreatic diversion with Roux-en-Y gastric bypass and long limbs (BPD/RYGB-LL) were evaluated ≥ 7 years postoperatively. Ghrelin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY) secretion were compared between patients with successful weight loss maintenance (WM group) and patients with weight regain (WR group).ResultsIn both types of surgery, standard liquid mixed meal (SLMM) ingestion did not result in significant changes in fasting GI hormone levels. Fasting ghrelin levels did not differ between the WM group and the WR group in both types of surgery. In SG patients, SLMM ingestion elicited greater suppression of ghrelin levels in the WM group (p = 0.032). No difference in GLP-1 secretion was observed between the 2 groups of patients in both types of surgery. When patients were examined, regardless of the type of bariatric surgery they had undergone, postprandial PYY levels were lower in the WM group (p < 0.05), while fasting and postprandial PYY levels were correlated positively with an increase in body mass index (BMI) in the evaluation (Spearman’s rho ≥ 0.395, p < 0.03).ConclusionsOur data do not support the hypothesis that long-term weight regain after bariatric surgery is associated with an unfavourable GI hormone secretion pattern.

Revisional Surgery After Adjustable Gastric Banding: Sleeve Gastrectomy or Gastric Bypass?

Adjustable gastric banding was the most common type of bariatric surgery performed in Korea prior to 2019. Many patients that have undergone this procedure require revisional bariatric surgery while removing the gastric band, and it is important to select an appropriate revisional procedure. If reoperation is performed owing to insufficient weight loss or weight regain, a 1-step procedure can be considered. However, a 2-step procedure is preferred when complications such as band erosion or stomach perforation have occurred. Previous studies from Western countries have shown that revisional Roux-en-Y gastric bypass (RYGB) can achieve more effective postoperative weight loss than revisional sleeve gastrectomy, although this procedure may also carry a higher risk of morbidity, reoperation, and readmission to hospital. In Korea, the short-term outcomes of the 2 procedures may be similar. However, the potential risk of gastric cancer in the remnant stomach after RYGB must also be considered. The type of revisional surgery should be selected following discussions with the patient regarding the advantages and disadvantages associated with each procedure.