Predicted weight loss result of laparoscopic sleeve gastrectomy: Review of the first 82 consecutive patients in an Asian bariatric unit

Impact of Patient- and Surgeon-Related Factors on Weight Loss after Laparoscopic Sleeve Gastrectomy-A Single-Center Study

Background and Objectives: Surgical treatment for obesity is becoming increasingly popular. Surgeons have been trying to find a simple way to predict the type of surgical intervention that is best for a specific patient. This study aimed to determine the patient- and surgeon-related factors that affect weight loss after laparoscopic sleeve gastrectomy (LSG). Materials and Methods: A total of 129 patients underwent LSG in one surgical department. The following factors were analyzed: gender; age; highest preoperative and 6-month postoperative weight; the occurrence of obesity-related diseases, such as type 2 diabetes and hypertension; the number of surgeons involved in the surgery; and who performed the surgery, a resident or specialist. The outcomes also included length of hospital stay, operative time and complications. Statistical significance was defined as p ≤ 0.05. Results: A total of 129 patients (94 female) with a median age of 43 years and BMI of 43.1 kg/m2 underwent LSG, while a total of 109 (84.5%) patients achieved ≥50% of excess BMI loss (%EBMIL). Preoperative weight loss had no impact on %EBMIL (p = 0.95), operative time (p = 0.31) and length of hospital stay (p = 0.2). Two versus three surgeons in the operating team had no impact on surgery time (p = 0.1), length of stay (p = 0.98) and %EBMIL (p = 0.14). The operative time and length of hospital stay were similar for specialists and surgeons in training. %EBMIL was higher in the residents' surgery without statistical significance (p = 0.19). Complications occurred in 3.9% without mortality or leaks. Conclusions: Preoperative comorbidities, surgeons' experience and the number of surgeons in the operating team do not impact the complication rate, length of hospital stay, operative time and postoperative weight loss after LSG.

Development and Validation of the GAASThyriC Model for Predicting Patients with Suboptimal Clinical Response After Laparoscopic Sleeve Gastrectomy and a Practical Calculator: A Retrospective Cohort Study

BACKGROUND

It might not be possible to achieve the desired outcome in every patient following bariatric surgery, even though every patient is thoroughly examined before surgery. This study aimed to develop a regression model based on parameters that affect weight loss success in patients scheduled for laparoscopic sleeve gastrectomy (LSG) and thus preoperatively predict whether the patients will have an optimal clinical response in terms of weight loss at the end of the first year.

MATERIALS AND METHODS

Between January 2018 and August 2022, patients who underwent LSG were analyzed retrospectively. Age, sex, comorbidities, smoking status, alcohol use status, preoperative weight, preoperative body mass index (BMI), preoperative laboratory data, weight, and total weight loss (TWL)% values at the end of the first year were recorded. At the end of the first year following LSG, patients with TWL% above 20% were defined as having an optimal clinical response in terms of weight loss. This study is designed, conducted, and reported regarding the "transparent reporting of a multivariable prediction model for individual prognosis or diagnosis" (TRIPOD) statement. The final model was used to construct an Excel-based calculator.

RESULTS

Four hundred thirty-eight patients underwent the sleeve gastrectomy procedure, and 38 of them were excluded from the study because of a lack of 1-year follow-up information, resulting in 400 eligible patients for our study. Age, glucose, thyroid stimulating hormone (TSH), alcohol consumption, systemic immune inflammation index (SII), and tobacco were the independent predictors of optimal clinical response ( P <0.001, P <0.001, P <0.001, P =0.011, P =0.039, P =0.045, respectively). The model was called the GAASThyriC score. When the final model was tested in the validation cohort, the AUC was 0.875 (95% CI, 0.742-0.999), the sensitivity was 83.3% (95% CI, 51.6-97.9), specificity was 86.4% (95% CI, 77.4-92.8), negative likelihood ratio was 0.19 (95% CI, 0.05-0.68), and accuracy was 86% (95% CI, 77.6-92.1) when the cutoff value was set to the optimal threshold (logit = 0.8451).

CONCLUSION

The GAASThyriC score can be used as an effective auxiliary tool to predict the patient population with suboptimal clinical response in terms of TWL% at the end of the first year after LSG.

Developing a Decision Aid for Clinical Obesity Services in the Real World: the DACOS Nationwide Pilot Study

PURPOSE

The purpose of this study is to develop a decision aid tool using "real-world" data within the Australian health system to predict weight loss after bariatric surgery and non-surgical care.

MATERIALS AND METHODS

We analyzed patient record data (aged 16+years) from initial review between 2015 and 2020 with 6-month (n=219) and 9-/12-month (n=153) follow-ups at eight clinical obesity services. Primary outcome was percentage total weight loss (%TWL) at 6 months and 9/12 months. Predictors were selected by statistical evidence (p<0.20), effect size (±2%), and clinical judgment. Multiple linear regression and bariatric surgery were used to create simple predictive models. Accuracy was measured using percentage of predictions within 5% of the observed value, and sensitivity and specificity for predicting target weight loss of 5% (non-surgical care) and 15% (bariatric surgery).

RESULTS

Observed %TWL with bariatric surgery vs. non-surgical care was 19% vs. 5% at 6 months and 22% vs. 5% at 9/12 months. Predictors at 6 months with intercept (non-surgical care) of 6% include bariatric surgery (+11%), BMI>60 (-3%), depression (-2%), anxiety (-2%), and eating disorder (-2%). Accuracy, sensitivity, and specificity were 58%, 69%, and 56%. Predictors at 9/12 months with intercept of 5% include bariatric surgery (+15%), type 2 diabetes (+5%), eating disorder (+4%), fatty liver (+2%), atrial fibrillation (-4%), osteoarthritis (-3%), sleep/mental disorders (-2-3%), and ≥10 alcohol drinks/week (-2%). Accuracy, sensitivity, and specificity were 55%, 86%, and 53%.

CONCLUSION

Clinicians may use DACOS to discuss potential weight loss predictors with patients after surgery or non-surgical care.

Predictive Factors of Gastroesophageal Reflux Disease Symptoms Following Open Sleeve Gastrectomy in Brazil Using Clinical Questionnaire

PURPOSE

To evaluate predictors of symptoms of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) based on a clinical questionnaire.

MATERIALS AND METHODS

This is a cross-sectional study. We included all patients who underwent open SG between May 2013 and March 2017 in a single institution. Patients who could not be contacted or who did not want to participate were excluded. Clinical, demographic, and pre- and postoperative data were collected on medical records. Patients were contacted via telephone and inquired about GERD symptoms postoperatively. Symptoms were quantified using the GERD Questionnaire (GERDq). Patients were divided into three study groups according to GERDq score: asymptomatic (GERDq = 0), mildly symptomatic (GERDq ≤ 8), and severely symptomatic (GERDq > 8). Univariate analysis was performed using ANOVA, Kruskal-Wallis, Dunn, and chi-square tests. A logistic regression model was built for adjusted analysis of the data.

RESULTS

One hundred eighty-nine patients were included. Mean age was 39.7 ± 10.71 years and 45.5% were female. Postoperative median follow-up period was 4.55 years (interquartile range 5.34-3.76). Mean GERDq score was 7.62 ± 10.17. Sixty-four patients were asymptomatic, 63 were mildly symptomatic, and 62 were severely symptomatic. The group of severely symptomatic patients showed a statistically lower preoperative weight when compared to the other groups (p = 0.049), but this association was not observed when analyzing preoperative BMI (p = 0.427). The other variables were not associated with postoperative GERD symptoms, both in univariate and adjusted analysis.

CONCLUSION

No variables were statistically and clinically predictive of GERD occurrence or severity after SG. The pathophysiology of GERD is complex and further studies are needed to elucidate this condition.

Check point to get adequate weight loss within 6-months after laparoscopic sleeve gastrectomy for morbid obesity in Asian population

Purpose of this study is to develope a scoring system to predict the likelihood of excess body weight loss (EBWL) ≥ 50% 6-months after laparoscopic sleeve gastrectomy (LSG). From April 2016 to September 2018, data was collected from 160 patients (BMI ≥ 32) who underwent primary LSG with at least 6-months follow-up. They were separated into score generation (operated by one surgeon, n = 122) and validation groups (operated by 3 different surgeons, n = 38). EBWL at 6-months ≥ 50% was considered adequate weight loss. Independent variables including age, gender, initial body mass index (BMI), comorbidities, life-style habits, percentage of EBWL and percentage of total body weight loss at 1-week, 1-month, and 3-months were analyzed with mutivariate logistic regression to generate the scoring system. The system was applied to internal and external validation groups to determine efficacy. As results, between the score generation and internal validation groups, the only significant difference in patient characteristics was in exercise participation. EBWL at 1-month > 19.5% (1 point) and EBWL at 3-months > 37.7% (2 points) were identified as independent factors to predict EBWL at 6-months ≥ 50%. When scores were > 1, the system had 94.03% positive predictive value (PPV) and 81.82% negative predictive value (NPV) (AUC: 0.923). Internal validation scores > 1 had a 95.83% PPV and 85.71% NPV (AUC: 0.975). External validation results showed 88.59% PPV and 72.00% NPV (AUC: 0.802). We concluded that this scoring system provides a reliable, objective prediction of EBWL at 6-months ≥ 50%. Patients requiring more aggressive clinical follow-up and intervention can be detected as early as 1- to 3-months after LSG.