Excess Weight Loss Research Articles

Short-Term Evolution of MASLD Following Roux-en-Y Gastric Bypass: A Focus on Fibrotic MASH.

Metabolic dysfunction-associated steatotic liver disease (MASLD) includes simple steatosis and metabolic dysfuncion-associated steatohepatitis (MASH), with fibrosis in MASH serving as a critical prognostic marker. This study investigates the effects of Roux-en-Y gastric bypass (RYGB) on fibrotic MASH, assessed using the fibrotic NASH index (FNI) and the non-invasive NASH detection score (NI-NASH-DS), as well as provides further data on the diagnostic accuracy of both scores. A retrospective cohort study was conducted involving 104 individuals (91.3% female, mean age 39.4 ± 8.6years) who underwent RYGB. Histopathological evaluations during surgery identified fibrotic MASH, and FNI and NI-NASH-DS values were calculated at baseline and 1year post-surgery. At the time of surgery, participants had a mean BMI of 35.3 ± 2.8kg/m2, which decreased to 27.1 ± 4.0kg/m2 1year after surgery. The mean % total weight loss (%TWL) was 23.8 ± 10.1%, and the mean % excess weight loss (%EWL) was 82.4 ± 37.3%. Fibrotic MASH was present in 17.3% of participants pre-operatively. The mean FNI score significantly decreased after surgery (p < 0.0001). Female gender (p < 0.001) and histological evidence of lobular inflammation (p < 0.001) were independently associated with the improvement of FNI. The FNI demonstrated high diagnostic accuracy (sensitivity: 61.1%, specificity: 96.4%, overall accuracy: 90.2%). NI-NASH-DS had a 60% accuracy in detecting MASH, alongside an 85.9% specificity. RYGB seemingly promotes improvement of fibrotic MASH as evaluated by FNI, highlighting its potential as a therapeutic intervention to mitigate MASLD progression. Both FNI and NI-NASH-DS are helpful and inexpensive tools for assessing MASH.

P1108 Endoscopic Sleeve Gastroplasty for management of Obesity in patient suffer from Inflammatory Bowel Disease

Abstract Background Obesity is a multifactorial, chronic, and relapsing disease, and its prevalence among patients with inflammatory bowel disease (IBD) is increasing, affecting 15–40% of them1,2. Limited data are available on the outcomes of endoscopic sleeve gastroplasty (ESG), a non-malabsorptive, organ-sparing endoscopic procedure, in patients with IBD3,4. Methods We conducted a retrospective review of a prospective dataset of subjects who underwent ESG at a tertiary center, including all subjects affected by IBD. Weight loss and IBD outcomes were assessed during early- and medium-term follow-up. Results Ten subjects (80% women) with IBD (5 with ulcerative colitis and 5 with Crohn’s disease) underwent ESG between October 2019 and May 2024 (mean BMI 37.6 ± 3.75 kg/m², mean age 49.4 ± 12.3 years). Four patients (40%) had previously undergone IBD-related surgery. Seven patients (70%) had received biological therapy, and six (60%) were in clinical remission at the time of ESG. No perioperative adverse events occurred. At the 6-month follow-up, nine subjects experienced total body weight loss (TBWL) of &amp;gt;10%, with a mean excess weight loss (EWL) of 55.9 ± 29.6%. Nine patients reached the 12-month follow-up, with a TBWL of 17.3 ± 10.5% (6 of them with TBWL &amp;gt;10%). At the final follow-up (mean 20.25 ± 3.46 months), the mean TBWL was 12.3 ± 10.2%, and the mean EWL was 38.2 ± 31.8%. Three patients underwent endoscopic revision for recurrent weight gain after a mean of 21 months. Two of these patients reached the 6-month follow-up with a mean TBWL of 9.89 ± 0.15% and EWL of 46.83 ± 1.79%. Overall, eight (80%) patients had no change in their IBD medication, one (10%) required treatment escalation due to loss of response. One subject, affected by chronic kidney disease and with a history of ileocecal resection, required emergency surgery for bowel obstruction caused by an incisional hernia 16 months after ESG. Unfortunately, four months later, he died due to septic shock. At the last follow-up, eight (89%) of the nine patients were in clinical remission, and all patients were in steroid-free remission. Conclusion We present the largest series on ESG in patients with IBD and obesity. Based on these retrospective data, ESG appears to be a promising bariatric procedure for these complex patients due to its safety and efficacy. However, prospective studies and clinical trials are needed to confirm these findings.

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.

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.

Reversal of Roux-en-Y Gastric Bypass: A Multi-Centric Analysis of Indications, Techniques, and Surgical Outcomes.

Roux-en-Y gastric bypass may present long-term complications that require revisional surgery or even reversal to normal anatomy. Data on the indications, surgical technique, and outcomes of RYGB reversal remain scarce. We identified 48 cases of RYGB reversals with complete 90-day follow-up within a multi-centric international retrospective database of elective secondary bariatric surgery. The operations were performed between 2010 and 2024 in high-volume referral centers in Europe and USA. Data were collected on body weight, associated diseases, and on surgical outcomes up to 1-year postoperatively. Patients were mainly female (81.3%) with a median age of 50 years (IQR 39-56). RYGB reversal was performed 7 years (median) after primary RYGB in patients with a BMI of 23.9 kg/m2 (IQR 20-27). Half of the patients underwent at least 1 bariatric revision before the reversal. Main indications for reversal were dumping syndrome (33.3%), excessive weight loss (29.2%), marginal ulcer (14.6%), malabsorption (12.5%), and abdominal pain (10.4%). Rate of conversion to open surgery was 8.3%, and the postoperative complications during the first year reached 50%, including 31.3% Clavien-Dindo grade I-II, 16.7% grade III-IV complications, and one death. At 1 year, the mean BMI of the cohort increased by 18% to 28.25 kg/m2; only 1 patient reached pre-RYGB BMI. Although RYGB is a theoretically reversible procedure, normal anatomy is re-established only in selected cases which are refractory to medical therapy and often also to revisional bariatric surgery. RYGB reversals entail high morbidity, while the extent of recurrent weight gain at 1-year post-reversal seems to allow patients to remain below the threshold of severe obesity.

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.

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.

Comparative Analysis of Renal Function Outcomes Following Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis.

Obesity is a significant risk factor for chronic kidney disease (CKD), with metabolic bariatric surgery offering potential renal benefits. However, there is limited comparative data on the impact of Roux-en-Y gastric bypass (RYGB) versus laparoscopic sleeve gastrectomy (LSG) on renal function in individuals with obesity without end-stage renal disease (ESRD). The objective of this study was to compare renal function outcomes following RYGB and LSG in patients with obesity, focusing on estimated glomerular filtration rate (eGFR), serum creatinine, albumin-creatinine ratio (ACR), and serum cystatin C. A systematic review and meta-analysis were conducted following Cochrane and PRISMA guidelines. Data from 17 observational studies (n = 3339) were analyzed. Primary outcomes included changes in eGFR, ACR, serum creatinine, and cystatin C. Secondary outcomes included excess weight loss (%EWL) and total weight loss (%TWL). Statistical analysis involved fixed and random-effects models based on heterogeneity levels. RYGB demonstrated significant improvements in eGFR (SMD = - 0.71; 95% CI - 0.89 to - 0.52, p < 0.00001) and serum cystatin C (MD = - 0.10; 95% CI - 0.17 to - 0.03, p = 0.004) compared to LSG. No significant differences were found for serum creatinine (MD = - 1.06; 95% CI - 4.42 to 2.30, p = 0.54) or ACR (MD = 1.95; 95% CI - 0.39 to 4.29, p = 0.10). RYGB also showed greater long-term weight loss, particularly at 5years (%EWL: MD = 22.00; 95% CI 6.56 to 37.44, p = 0.005). RYGB offers similar renal improvements with superior weight loss compared to LSG in individuals with obesity without ESRD. These findings emphasize the need for personalized treatment approaches and further research to validate these outcomes.

Koala Sleeve: innovative technique for enhanced GERD control without sacrificing weight loss.

Sleeve gastrectomy (SG) is the most frequently performed bariatric surgery worldwide, offering effective weight loss and improvement in metabolic conditions. However, one of its major complications is the exacerbation or development of gastroesophageal reflux disease (GERD), affecting over 30% of patients. While Roux-en-Y gastric bypass (RYGB) is often the preferred alternative for patients with pre-existing GERD, it may not be suitable for all patients due to contraindications or patient preference. This study introduces a novel modification to SG, combining it with horizontal gastroplasty to address GERD symptoms without compromising weight loss outcomes. The procedure involves a standard SG with complete fundus resection, followed by the creation of a horizontal valve at the gastroesophageal (GE) junction using three horizontal mattress sutures. Seven patients with preoperative GERD were selected for this technique. Post-operative outcomes were assessed, including weight loss and GERD symptom resolution. The mean operative time was 76 min, with no procedure-related complications. Three months postoperatively, the average percentage of excess weight loss (%EWL) was 68%. Importantly, none of the patients reported GERD symptoms, indicating effective reflux control. Sleeve gastrectomy with horizontal gastroplasty appears to be a promising, simple, and safe option for patients with GERD undergoing SG. This technique may offer a viable alternative to RYGB for managing GERD in bariatric patients. Further studies are needed to validate these initial findings and assess long-term outcomes.

Weight Loss and Regain After Bariatric Surgery: Importance of the Psychological Therapy in Postoperative Outcomes.

Obesity is a chronic disease constituting a public health issue, and its prevalence is alarmingly on the rise worldwide. This disease represents a chronic and multifactorial condition, one of the factors being related to the psychological aspect of the patients. Bariatric is an effective tool for obesity control, with weight regain observed more frequently between the third and sixth postoperative years. Behavioral and psychological aspects would be one of the main weight loss and weight regaining risk factors in bariatric patients. The objective of the study is to demonstrate the importance of postoperative behavioral follow-up in the weight control of patients who underwent bariatric surgery. The bariatric surgery division database was reviewed, and telephone surveys were performed. A total of 100 patients were included. Overall, 87% of them have a postoperative time of 5 or more years. Weight, percentage of excess weight loss, and percentage of weight regain were evaluated. The group was divided between patients who had or had no behavioral follow-up at 1, 2, 3, and 5 postoperative years. It was observed that weight loss was statistically higher, and weight regain was statistically lower in the group of patients with behavioral follow-up. This tendency was observed after 1, 2, 3, and 5 years. Psychological therapy has been shown to be an enhancer for weight loss as well as a protection against weight regain after bariatric surgery. This manifests the need for a long-term postoperative psychological follow-up.

Prospective, single-arm multicenter, international, observational post-market study to assess the safety and efficacy of a triangulation platform for treating patients requiring endoscopic gastroplasty

Gastric restriction techniques have recently emerged as minimally invasive bariatric procedures. Endoscopic sutured gastroplasty (ESG) with the Endomina (Endo Tools Therapeutics, Gosselies, Belgium) triangulation platform proved to be safe and effective for the treatment of class I and II obesity in prospective studies. In this registry, we aimed to further assess on a larger scale the safety and efficacy of the procedure in routine practice with a dedicated device. This was a multicenter, observational, prospective post-market study including patients with obesity undergoing Endomina ESG. The primary safety outcome was the occurrence of serious adverse device effects (SADEs) at 12 months. The primary efficacy outcome was the technical success defined by completing the procedure without premature abortion owing to technical issues. The rates of procedure-related adverse events, weight loss outcomes, and quality of life changes were collected. A total of 142 patients underwent ESG in 3 centers from July 2020 to March 2023. Of these, 67 (mean body mass index, 38.5 ± 6.3 kg/m2) reached at least 12 months of follow-up up to October 2022. Technical success was 100%. No SADEs occurred. Seven mild procedure-related adverse events were reported overall. Mean percentage of excess weight loss and total body weight loss at 12 months' follow-up were 48.5% ± 38.6 and 15.3% ± 10.6, respectively (n= 67). Improved quality of life was observed following ESG. ESG is safe and effective, thus offering a satisfactory therapeutic option for a wide range of obese patients on a large scale.

The Full Range of Weight Status by Race and Ethnicity in Children with and without Autism: A Cross-sectional Study of US Children.

To identify and characterize how race and ethnicity influence the relationship between autism and weight status, across all categories of weight from underweight to severe obesity. We developed a propensity score-matched cross-sectional dataset of children with and without parent-reported autism in the National Survey of Children Health (NSCH, 2016-2022) and Adolescent Brain and Cognition Development Study (ABCD, 2016-2018). We included non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, and Hispanic children aged 6 to 17 years. Prevalence ratios for autistic and non-autistic children were estimated with multinomial regression models across Centers for Disease Control-defined categories for underweight, healthy weight, overweight, mild-to-moderate obesity, and severe obesity, based on parent-reported height and weight (NSCH) and measured heights and weights (ABCD). Prevalence disparities across racial and ethnic groups were evident and the pattern of prevalence ratios (autistic:non-autistic) showed remarkably consistent U- or J-shaped prevalence ratios. Prevalence ratios were elevated in underweight and severe obesity for autistic Asian, Black, White, and Hispanic children compared with their non-autistic peers of the same race or ethnicity, with the exception of underweight prevalence where autistic and non-autistic Asian children did not differ. The largely consistent pattern of prevalence ratios comparing autistic and non-autistic children for underweight and severe overweight in the 4 major racial and ethnic groups in the US suggests that health care and other providers should be aware of these risks in autistic children, actively monitor their weight status, and intervene early to prevent excess weight loss or weight gain.

Bariatric surgery’s impact on hepatic cirrhosis: a therapeutic bridge in advanced liver disease

Hepatic cirrhosis, compounded by obesity, presents a significant clinical challenge, with limited therapeutic options to improve liver function and survival. Bariatric surgery has emerged as a potential intervention, offering metabolic and hepatic benefits. This study evaluates the impact of bariatric surgery on cirrhotic patients, synthesizing evidence from 20 studies using the PRISMA framework. A systematic review was conducted following PRISMA guidelines, identifying 20 studies that assessed the outcomes of bariatric surgery in patients with hepatic cirrhosis. Key outcomes included changes in liver function (MELD and Child-Pugh scores), survival probabilities, weight loss, and post-operative complications. Data were extracted, analyzed, and synthesized to provide a comprehensive evaluation of bariatric surgery's role in this population. Bariatric surgery was associated with significant improvements in liver function, with MELD scores decreasing by an average of 28.6% and Child-Pugh scores transitioning many patients from Class B to Class A. Survival analysis revealed stabilization of survival probabilities at 70% within the first six months and 55-60% at 12 months. Weight loss outcomes were substantial, with an average excess weight loss of 60-70%. Post-operative complications were observed in 20-30% of patients, with the majority occurring within the first six months. Evidence quality, assessed using the GRADE system, was high for liver function and weight loss outcomes but moderate to low for complications. In conclusion, Bariatric surgery offers a promising therapeutic bridge for cirrhotic patients with obesity, improving liver function, survival, and metabolic health. While the findings are encouraging, careful patient selection and perioperative management are critical to optimizing outcomes. Further research is needed to validate these results and explore long-term benefits.

Resected gastric volume/number of staplers fired ratio as a tool in predicting complication and midterm results in sleeve gastrectomy

Laparoscopic sleeve gastrectomy is a restrictive surgery that aims to decrease the gastric volume of the patient. This study hypothesized that a higher resected gastric volume to the number of fired staplers ratio is associated with improved postoperative 12th-month outcomes. To analyze the effects of resected gastric volume to the number of fired staplers ratio on postoperative results in patients who underwent sleeve gastrectomy. University Hospital, Istanbul, Türkiye. We analyzed the data of 407 patients who underwent laparoscopic sleeve gastrectomy between 2018 and 2022. The primary outcome was the effect of resected gastric volume to the number of fired staplers ratio on excess weight loss at 12 months postoperatively. A total of 407 patients were included in the study. The higher resected gastric volume to the number of fired staplers ratio was associated with higher excess weight loss in the postoperative 12th month, while no significant effect was found on complications (p = 0.001 and p = 0.785, respectively). This study revealed resected gastric volume to the number of fired staplers ratio could be used to predict weight loss. Further studies should examine the effect of resected gastric volume to number of fired staplers ratio on postoperative complications.

Laparoscopic Reversal of Roux-en-Y Gastric Bypass with Hand-Sewn Gastro-Gastrostomy and Resection of the Alimentary Limb.

Roux-en-Y gastric bypass (RYGB) reversal might be necessary to alleviate refractory surgical or nutritional complications, such as postprandial hypoglycemia, malnutrition, marginal ulceration, malabsorption, chronic diarrhea, nausea and vomiting, gastro-esophageal reflux disease, chronic pain, or excessive weight loss. The surgical technique of RYGB reversal is not standardized; potential strategies include the following: (1) gastro-gastrostomy: hand-sewn technique, linear stapler, circular stapler; (2) handling of the Roux limb: reconnection or resection (if remaining intestinal length ≥ 4 m). We demonstrate the surgical technique of a laparoscopic reversal of RYGB with hand-sewn gastro-gastrostomy and resection of the alimentary limb with the aim of improving the patient's quality of life. The gastric pouch is horizontally divided proximal to the previous staple line. A hand-sewn end to end anastomosis is created between the distal gastric pouch and the horizontal part of the gastric remnant adjacent to the lesser curve. The posterior wall is sutured in two layers. The anterior layer is closed with continuous 3-0 PDS full-thickness stitches over a 36-French oro-gastric calibration bougie. After evaluation of intestinal limbs and ruling out of hernial defects, the alimentary limb is divided just above the jejuno-jejunal Roux-anastomosis and is resected. Reversal of RYGB is a precious treatment option for otherwise unmanageable postbariatric complications in well-selected cases. The operation should be performed in high volume bariatric centers after multidisciplinary patient preparation. The early and late complications of the reversal are higher than the rates seen in primary MBS; therefore, patients should be informed and monitored accordingly to ensure the best achievable outcomes.

Antral Preserving Versus Antral Resecting Laparoscopic Sleeve Gastrectomy for Patients with Severe Obesity: A Randomized Controlled Trial.

This study aimed to compare outcomes following antral preserving (AP) and antral resecting (AR) laparoscopic sleeve gastrectomy (LSG) in terms of weight loss, gastric emptying time, gastroesophageal reflux disease (GERD), resolution of associated medical problems, and complications. Patients were prospectively randomized into two groups: the AR group (resection starting 2cm from the pylorus) and the AP group (resection at 5cm from the pylorus). Follow-up evaluations included assessments of weight loss using percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL), gastric emptying, GERD symptoms, associated medical problem resolution, residual gastric volume, and complications. Upper gastrointestinal endoscopy, gastric scintigraphy, and residual sleeve volumetry were conducted at 12months. One hundred patients who met inclusion criteria were enrolled, with comparable baseline parameters such as BMI, age, and comorbidities between the groups. Ninety-five patients underwent randomization (49 in AP group and 46 in the AR group), and outcomes were compared. %EWL was higher in the AR group at 12 and 24months, although this difference was not statistically significant (AP vs. AR: 64.5 ± 20.6 vs. 72.9 ± 20.8, p = 0.1, and 66.3 ± 21.8 vs. 74 ± 22.2, p = 0.2, respectively). %TWL at 12months was significantly different between the groups (AP: 28.4 ± 6.4 vs. AR: 32 ± 8, p = 0.01), as was %TWL at 24months (AP: 29.1 ± 8.4 vs. AR: 33 ± 8.3, p = 0.01). Gastric emptying increased postoperatively in both groups, with significantly higher residual gastric volume in the AP group. Reflux symptoms decreased in both groups compared to baseline, and associated medical problem resolution and major complication rates were similar between the groups. AR-LSG leads to better weight loss without increasing reflux symptoms compared to AP-LSG. Both procedures showed similar resolution of associated medical problems and complication rates. CTRI (CTRI/2018/08/015191).

The combined effect of medicinal plant extract and sulfonylurea agent: a preliminary study to evaluate anti-diabetic potential in experimental animals

Chronic metabolic diseases like diabetes mellitus have a huge terrible effect on a society's health and monetary system. because there are various issues with the treatment this is now available. it is important to search for trade remedies. A aggregate of natural and allopathic remedy can be an effective remedy as an possibility to available treatment. therefore, the purpose of this take a look at have turn out to be to take a look at the combination anti-diabetic outcomes of Glibenclamide and “aloe vera” extract in experimental animals. The antihyperglycemic pastime turned into assessed using an oral glucose tolerance take a look at and diabetes brought about using manner of the use of streptozotocin (STZ) &amp; excessive fat weight loss plan (HFD) version in rats. Wister rats were divided into 5 organizations. business enterprise I was dealt with with a normal pallet diet regime. group II come to be given HFD and streptozotocin. employer III has come to be given HFD &amp;Streptozotocin and treated with Glibenclamide. organization IV was modified into given HFD &amp; Streptozotocin and dealt with with “aloe vera” extract. agency V modified into given HFD &amp; Streptozotocin and handled with a way containing “aloe vera” extract and Glibenclamide. Physiological parameters which incorporate body weight and biochemical parameters consisting of blood glucose, HbA1c level, lipid profiles, and oxidative strain parameters collectively with glutathione (GSH) &amp; malondialdehyde (MDA) degree were used to assess the antidiabetic potential of a method containing “aloe vera” extract and glibenclamide. approach containing “aloe vera” extract and Glibenclamide. device containing “aloe vera” extract and Glibenclamide has a good-sized effect in controlling blood glucose ranges. lower in HbA1c degree, and lipid profiles (besides HDL stage)verify effective anti-diabetic remedy of the test system. similarly, massive adjustments in GSH &amp; MDA tiers propose a functionality synergistic anti-oxidant impact of the mixed remedy. the existing take a look at observed out that a technique containing “aloe vera” extract and Glibenclamide confirmed a good sized antidiabetic ability, via the reversing of hyperlipidemia, and oxidative pressure fame in non-diabetic &amp; diabetes rats.

Endoscopic Band Ligation for Weight Loss: A Clinical Trial

Background and Study AimWe previously reported the utility of endoscopic band ligation (EBL) in weight loss in a female patient with obesity. This study aimed to evaluate the safety of weight loss using EBL in a larger cohort.Patients and MethodsThis prospective cohort study included 13 female patients aged ≥ 18 years with a body mass index of ≥ 30 kg/m2 who were unwilling to undergo bariatric surgery. Patients with obesity-related comorbidities such as diabetes, hypertension, dyslipidemia, and cardiovascular disease were included. Patients with a history of bariatric surgery and those with clinical manifestations of gastroparesis, portal hypertension, liver cirrhosis, and coagulopathies were excluded. Primary study outcomes were technical feasibility and safety, and secondary study outcomes were the percentage of total weight loss, excess weight loss, and the change in gastroparesis clinical symptom index at 1 month after surgery.ResultsNo serious complications occurred during the endoscopy or immediately after that. All patients experienced epigastric pain, nausea, and vomiting for the first 3 days, with one patient developing mild hematemesis on the second day that stopped spontaneously and revealed no abnormalities on endoscopy. At 1 month after EBL, the mean percent excess weight loss and total weight loss were 22.3% ± 9.9% and 7.8% ± 2.5%, respectively.ConclusionsEBL is an effective and safe intervention for obesity management. Further studies with larger cohorts are warranted to comprehensively evaluate of the long-term efficacy and safety of EBL for obesity management.

Revealing the Exceptional: A Neonate’s Struggle with Bartter Syndrome – A Case Report

Neonatal Bartter syndrome is a rare genetic condition that impacts the renal tubules, resulting in hyponatremia, hypokalemia, hypochloremic metabolic alkalosis, sodium, potassium, calcium, and chloride loss through the urine. We present a case of neonatal Bartter syndrome in a premature boy of 33 weeks gestation who required amnioreduction due to antenatal polyhydramnios. He developed polyuria, excessive weight loss, and classic blood parameters suggestive of Bartter syndrome shortly after birth. Upon genetic testing, we were able to confirm our diagnosis of Bartter syndrome type 1. The SLC12A1 gene contained two pathogenic variants, c.1432G&gt;A and c.2873_2873+1delCT. The patient was administered treatment consisting of indomethacin, aggressive fluid replacement, and electrolyte correction. With indomethacin, his electrolyte levels remained within normal limits despite his suboptimal weight gain during follow-up. We advise genetic testing for the purpose of confirming the diagnosis, as well as for early detection and intervention to mitigate the risk of complications.