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Chen S, Chiang J, Ghanem O, Ferzli G. Decision-making Considerations in Revisional Bariatric Surgery. Surg Laparosc Endosc Percutan Tech 2024:00129689-990000000-00248. [PMID: 38963277 DOI: 10.1097/sle.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/16/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE With drastic variations in bariatric practices, consensus is lacking on an optimal approach for revisional bariatric surgeries. MATERIALS AND METHODS The authors reviewed and consolidated bariatric surgery literature to provide specific revision suggestions based on each index surgery, including adjustable gastric band (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), single anastomosis duodenal-ileal bypass with sleeve (SADI-S), one anastomosis gastric bypass (OAGB), and vertical banded gastroplasty (VBG). RESULTS AGB has the highest weight recurrence rate and can be converted to RYGB, SG, and BPD-DS. After index SG, common surgical options include a resleeve or RYGB. The RYGB roux limb can be distalized and pouch resized in context of reflux, and the entire anatomy can be revised into BPD-DS. Data analyzing revisional surgery after a single anastomosis duodenal-ileal bypass with sleeve was limited. In patients with one anastomosis gastric bypass and vertical banded gastroplasty anatomy, most revisions were the conversion to RYGB. CONCLUSIONS As revisional bariatric surgery becomes more common, the best approach depends on the patient's indication for surgery and preexisting anatomy.
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Affiliation(s)
- Sheena Chen
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
| | - Jessica Chiang
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
| | - Omar Ghanem
- Department of General Surgery, Mayo Clinic, Rochester, MN
| | - George Ferzli
- Department of General Surgery, New York University Langone Health, Brooklyn, NY
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2
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Scott JD. Comment on: Performance of a predictive weight loss model in terms of rapid detection of inadequate weight loss after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2024; 20:677-678. [PMID: 38594092 DOI: 10.1016/j.soard.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/03/2024] [Indexed: 04/11/2024]
Affiliation(s)
- John D Scott
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
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3
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Pugin F, Burgard M, Cherbanyk F, Egger B. Performance of a predictive weight loss model in terms of rapid detection of inadequate weight loss after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2024; 20:670-676. [PMID: 38461056 DOI: 10.1016/j.soard.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/24/2023] [Accepted: 01/28/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Predictive weight loss models can help patients meet their expectations after bariatric surgery and assist physicians in responding to deviations from the predicted weight. A model published by Seyssel et al. appears to accurately predict postoperative body mass index. OBJECTIVES We aimed to demonstrate this model's performance in terms of rapid detection of insufficient weight loss (surgical nonresponse). SETTING Cantonal Hospital, Switzerland. METHODS We retrospectively analyzed weight and body mass index deviations at 2 years postoperatively, based on values predicted by the model of Seyssel et al. The primary outcome was the timing of detection of surgical nonresponse. The secondary outcome was how patients' weight loss expectations influenced their real weight loss. RESULTS Between 2016 and 2019, 190 patients underwent Roux-en-Y gastric bypass. Of these patients, 36 were lost to follow-up and 154 were included in this study. At 24 months, 16 patients had surgical nonresponse, defined as a real weight of +1 standard deviation higher than that predicted. Among these patients, 44% had a weight of ≥+1 standard deviation higher than predicted at 3 months, and 63% at 12 months. The positive and negative predictive values at 12 months were 59% and 95%, respectively. Patients with a lower hypothetically wanted weight (38.5%) exhibited greater weight loss (P < .05). CONCLUSIONS The predictive weight loss model of Seyssel et al. enables rapid detection of surgical nonresponse, allowing physicians to react as early as 3 months postsurgery. Patients' overestimation of postoperative weight loss was positively correlated with the actual weight loss achieved.
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Affiliation(s)
- Francois Pugin
- Department of Surgery, HFR Fribourg-Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | - Marie Burgard
- Department of Surgery, HFR Fribourg-Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | - Floryn Cherbanyk
- Department of Surgery, HFR Fribourg-Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | - Bernhard Egger
- Department of Surgery, HFR Fribourg-Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland.
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4
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Samuels JM, Niswender KD, Roumie CL, Spann MD, Flynn CR, Ye F, Blankush J, Irlmeier R, Funk LM, Patel MB. Adverse event comparison between glucagon-like peptide-1 receptor agonists and other antiobesity medications following bariatric surgery. Diabetes Obes Metab 2024. [PMID: 38934217 DOI: 10.1111/dom.15737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
AIM To compare the incidence of adverse events (AEs) related to antiobesity medications (AOMs; glucagon-like peptide-1 receptor agonists [GLP-1RAs] vs. non-GLP-1RAs) after bariatric surgery. METHODS This single-centre retrospective cohort included patients (aged 16-65 years) who had undergone laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy (cohort entry date) and initiated AOMs. Participants were categorized as users of US Food and Drug Administration (FDA)-approved, off-label, or GLP-1RA AOMs if documented as receiving the medication on or after cohort entry date. Non-GLP-1RA AOMs were phentermine, orlistat, topiramate, canagliflozin, dapagliflozin, empagliflozin, naltrexone, bupropion/naltrexone and phentermine/topiramate. GLP-1RA AOMs included: semaglutide, dulaglutide, exenatide and liraglutide. The primary outcome was AE incidence. Logistic regression was used to determine the association of AOM exposure with AEs. RESULTS We identified 599 patients meeting our inclusion criteria, 83% of whom were female. Their median (interquartile range [IQR]) age was 47.8 (40.9-55.4) years. The median duration of surgery to AOM exposure was 30 months. GLP-1RAs use was not associated with higher odds of AEs: adjusted odds ratio (aOR) 1.1 (95% confidence interval [CI] 0.5-2.6) and aOR 1.1 (95% CI 0.6-2.3) for GLP-1RA versus FDA-approved and off-label AOM use, respectively. AOM initiation ≥12 months after surgery was associated with lower risk of AEs compared to <12 months (aOR 0.01 [95% CI 0.0-0.01]; p < 0.001). CONCLUSION Our results showed that GLP-1RA AOMs were not associated with an increased risk of AEs compared to non-GLP-1RA AOMs in patients who had previously undergone bariatric surgery. Prospective studies are needed to identify the optimal timeframe for GLP-1RA initiation.
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Affiliation(s)
- Jason M Samuels
- Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin D Niswender
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christianne L Roumie
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Matthew D Spann
- Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - C Robb Flynn
- Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph Blankush
- Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca Irlmeier
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Luke M Funk
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Surgery, William S. Middleton Veterans Health Administration Hospital, Madison, Wisconsin, USA
| | - Mayur B Patel
- Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Tennessee Valley VA Health Care System Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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5
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Pantelis AG. Comment on Salazar et al. Weight Regain after Metabolic Surgery: Beyond the Surgical Failure. J. Clin. Med. 2024, 13, 1143. J Clin Med 2024; 13:3608. [PMID: 38930135 PMCID: PMC11205002 DOI: 10.3390/jcm13123608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
I read the article by Salazar J. [...].
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Affiliation(s)
- Athanasios G Pantelis
- Athens Medical Group, Obesity and Metabolic Disorders Department, Psychiko Clinic, 1 Andersen Str., Psychiko, 11525 Athens, Greece
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6
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Gholizadeh B, Pazouki A, Shahsavan M, Farsi Y, Valizadeh R, Kermansaravi M. The predictive relationship between early and long-term weight loss outcomes after one anastomosis gastric bypass. Langenbecks Arch Surg 2024; 409:194. [PMID: 38937299 DOI: 10.1007/s00423-024-03371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Weight loss failure after bariatric surgery imposes great stress on patients and surgeons and great costs on healthcare systems. The literature review shows that weight loss failure is the most common cause of redo bariatric surgery. Therefore, identifying the predictors of weight loss failure in patients in the early stages can help bariatric surgeons. The present study aims to determine the association between primary weight loss and long-term weight loss outcomes. METHODS This retrospective cohort study was conducted on 329 patients undergoing OAGB who were followed for 60 months. For the prediction of short-term (24 months) and long-term (60 months) successful weight loss and weight regain, we used %TWL and BMI at any regular follow-ups. RESULTS In preoperative indices, age, sex, DLP, hypothyroidism, and HTN were not significant to predict successful short-term and long-term weight loss but %TWL at 12 months is a significant predictor of successful weight loss in short-term and long-term follow up. In the prediction of weight regain, preoperative indices (except BMI) were not significant but 12-month %TWL was a significant predictor. CONCLUSIONS This index can help surgeons find these patients early and provide helpful instructions to manage their issues more promptly to reach better weight loss outcomes.
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Affiliation(s)
- Barmak Gholizadeh
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of General Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-E Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Rasool-E Akram Hospital, Tehran, Iran
| | - Masoumeh Shahsavan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Farsi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rohollah Valizadeh
- Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-E Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Rasool-E Akram Hospital, Tehran, Iran.
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7
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Dang JT, Hider AM, Barajas-Gamboa JS, Mocanu V, Shin T, Romero-Velez G, Lee Y, Navarrete S, Rodriguez J, Kroh M. Safety of limb lengthening after Roux-en-Y gastric bypass: an analysis of the MBSAQIP database. Surg Obes Relat Dis 2024; 20:564-570. [PMID: 38316579 DOI: 10.1016/j.soard.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/29/2023] [Accepted: 12/25/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) effectively treats severe obesity, but some patients may require revisional surgery like limb lengthening (LL) for postoperative weight gain. OBJECTIVES This study aims to compare 30-day serious complications and mortality rates between LL and primary RYGB, given limited safety data on LL. METHODS Patients who underwent LL and RYGB were identified from the 2020 and 2021 MBSAQIP databases, the only years in which LL data were available. Baseline characteristics and 30-day rates of serious complications and mortality were analyzed. RESULTS A total of 86,990 patients underwent RYGB and 455 underwent LL. Patients undergoing RYGB were younger (44.4 versus 49.8 yr, P < .001), had a higher body mass index (BMI) (45.5 versus 41.8 kg/m2, P < .001) and higher rates of comorbidities including diabetes (30.0 versus 13.6%, P < .001). RYGB and LL had similar operative duration (125.3 versus 123.2 min, P = .5). There were no statistical differences between cohorts for length of stay (LOS) (1.6 RYGB versus 1.6 LL d, P = .6). After LL, there were higher 30-day rates of reoperation (3.3 versus 1.9%, P = .03) and deep surgical site infections (1.3 versus .5%, P = .03) compared to RYGB. There were no differences in overall serious complications (5.1 LL versus 5.0% RYGB, P = 1.0) and mortality (.2 LL versus .1% RYGB, P = .5). Multivariable logistic regression adjustment found that previous venous thromboembolism was associated with serious complications after LL. CONCLUSIONS When compared to primary RYGB, LL has a favorable safety profile with similar 30-day rates of serious complications and mortality.
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Affiliation(s)
- Jerry T Dang
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Ahmad M Hider
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Juan S Barajas-Gamboa
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Shin
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Yung Lee
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - John Rodriguez
- Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
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Bastos ELS, Salgado W, Dantas ACB, Onzi TR, Silva LB, Albano Á, Tristão LS, Dos Santos CL, Silvinato A, Bernardo WM. Medium and Long-Term Weight Loss After Revisional Bariatric Surgery: A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:1917-1928. [PMID: 38573390 DOI: 10.1007/s11695-024-07206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
Despite the current increase in revisional bariatric surgery (RBS), data on the sustainability of weight loss remain unclear. A systematic review and meta-analysis were performed to assess weight loss outcomes in adult patients undergoing RBS with follow-up > 2 years. Twenty-eight observational studies (n = 2213 patients) were included. The %TWL was 27.2 (95%CI = 23.7 to 30.6), and there was a drop in BMI of 10.2 kg/m2 (95%CI = - 11.6 to - 8.7). The %EWL was 54.8 (95%CI = 47.2 to 62.4) but with a high risk of publication bias (Egger's test = 0.003). The overall quality of evidence was very low. Our data reinforce that current evidence on RBS is mainly based on low-quality observational studies, and further higher-quality studies are needed to support evidence-based practice.
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Affiliation(s)
- Eduardo L S Bastos
- Department of Gastrointestinal Surgery, Marília School of Medicine, Marília, Brazil.
| | - Wilson Salgado
- Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Anna C B Dantas
- Bariatric and Metabolic Surgery Unit, University of São Paulo, São Paulo, Brazil
| | - Tiago R Onzi
- Department of Surgery, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Lyz B Silva
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Álvaro Albano
- Bariatric and Metabolic Service, Santa Casa de Misericórdia de Itabuna, Bahia, Brazil
| | - Luca S Tristão
- Department of Evidence Based Medicine, Lusíada University Center, Santos, Brazil
| | - Clara L Dos Santos
- Department of Evidence Based Medicine, Lusíada University Center, Santos, Brazil
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Hage K, Teixeira AF, Surve A, Lind R, Jawad MA, Ghanem M, Abi Mosleh K, Kendrick ML, Cottam D, Ghanem OM. Single anastomosis duodenal switch versus Roux-en-Y gastric bypass in patients with BMI ≥ 50 kg/m 2: a multi-centered comparative analysis. Surg Endosc 2024; 38:2657-2665. [PMID: 38509391 DOI: 10.1007/s00464-024-10765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) has consistently demonstrated excellent weight loss and comorbidity resolution. However, outcomes vary based on patient's BMI. Single anastomosis duodeno-ileostomy with sleeve (SADI-S) is a novel procedure with promising short-term results. The long-term outcomes of SADI-S in patients with BMI ≥ 50 kg/m2 are not well described. We aim to compare the safety and efficacy of SADI-S with RYGB in this patient population. METHODS We performed a multicenter retrospective study of patients with a BMI ≥ 50 kg/m2 who underwent RYGB or SADI-S between 2008 and 2023. Patient demographics, peri- and post-operative characteristics were collected. Complication rates were reported at 6, 12, 24, and 60 months postoperatively. A multivariate linear regression was used to evaluate and compare weight loss outcomes between both procedures. RESULTS A total of 968 patients (343 RYGB and 625 SADI-S; 68.3% female, age 42.9 ± 12.1 years; BMI 57.3 ± 6.7 kg/m2) with a mean follow-up of 3.6 ± 3.6 years were included. Patients who underwent RYGB were older, more likely to be female, and have a higher rate of sleep apnea (p < 0.001), hypertension (p = 0.015), dyslipidemia (p < 0.001), and type 2 diabetes (p = 0.016) at baseline. The rate of bariatric surgery-specific complications was lower after SADI-S compared to RYGB. We reported no bariatric surgery related deaths after 1 year following both procedures. SADI-S demonstrated statistically higher and sustained weight loss at each time interval compared to RYGB (p < 0.001) even after controlling for multiple confounders. Lastly, the rate of surgical non-responders was lower in the SADI-S cohort. CONCLUSIONS In our cohort, SADI-S was associated with higher and sustained weight-loss results compared to RYGB. Comorbidity resolution was also higher after SADI-S. Both procedures demonstrate a similar safety profile. Further studies are required to validate the long-term safety of SADI-S compared to other bariatric procedures.
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Affiliation(s)
- Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando, FL, USA
| | - Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Romulo Lind
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando, FL, USA
| | - Muhammad A Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando, FL, USA
| | - Muhammad Ghanem
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando, FL, USA
| | | | | | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
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10
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Jamal M, Alhashemi M, Dsouza C, Al-Hassani S, Qasem W, Almazeedi S, Al-Sabah S. Semaglutide and Tirzepatide for the Management of Weight Recurrence After Sleeve Gastrectomy: A Retrospective Cohort Study. Obes Surg 2024; 34:1324-1332. [PMID: 38430320 DOI: 10.1007/s11695-024-07137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is the most effective treatment for obesity and improvement of obesity-associated comorbidities. However, a proportion of these patients may suffer from weight recurrence and recurrence of obesity-associated comorbidities. METHOD A retrospective cohort study of patients who underwent SG between January 2008 and August 2022 and sought treatment for weight recurrence with semaglutide or tirzepetide from January 2022 onwards. RESULT A total of 115 patients were included, of which 70 had SG and treated for weight recurrence with semaglutide and 45 had SG and treated with tirzepatide. The mean age of patients was 38.8 (10.4) and 80.9% of patients were female. The mean pre-treatment weight and BMI was 94.0 (23.8) kg and 35.1 (6.0) kg/m2. Following treatment with semaglutide and tirzepatide, the mean post-treatment weight at 6 months was 81.0 (19.0) kg from 90.1 (19.6) kg and 87.6 (28.3) kg from 100.2 (28.5) kg respectively, corresponding to a clinically significant mean weight loss from baseline to 6 months of 10.3 (5.9)% (p < 0.05) and 15.5 (6.3)% (p < 0.05). Weight loss in tirzepatide patients was significantly greater than the semaglutide patients at 6 months (p < 0.02). There were no reported severe adverse events to the treatment. CONCLUSION Short-term outcomes show that semaglutide and tirzepatide can be an effective treatment for managing weight recurrence after SG. Studies with longer follow-up are needed to determine the durability, as weight regain after discontinuation of the medication is highly likely, and the high cost of these medications can limit their use.
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Affiliation(s)
- Mohammad Jamal
- Department of Organ Transplant, College of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait.
- The Clinic, Kuwait City, Kuwait.
- Department of Surgery, Jaber Hospital, Kuwait City, Kuwait.
- Department of Surgery, College of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait.
| | - Mohsen Alhashemi
- Department of Surgery, Jaber Hospital, Kuwait City, Kuwait
- Department of Surgery, College of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Carol Dsouza
- Department of Surgery, College of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Sara Al-Hassani
- Department of Surgery, College of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Wafa Qasem
- The Clinic, Kuwait City, Kuwait
- Mubarak Hospital, Kuwait City, Kuwait
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11
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Marek RJ, Ben-Porath YS, Heinberg LJ. Six-year postoperative associations between the Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) and weight recurrence, eating behaviors, adherence, alcohol misuse, and quality of life. Surg Obes Relat Dis 2024; 20:391-398. [PMID: 38216363 DOI: 10.1016/j.soard.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) leads to beneficial and sustained outcomes. However, many patients evidence weight recurrence and psychosocial functioning may be associated with weight recurrence. The Minnesota Multiphasic Personality Inventory - 3 (MMPI-3) is validated for use in presurgical MBS evaluations and likely has clinical utility in understanding weight recurrence and other aspects of postoperative functioning. OBJECTIVE The objective of the current investigation is to understand how postoperative psychosocial functioning relates to weight recurrence and other behaviors and constructs 6 years after MBS. SETTING Cleveland Clinic Bariatric and Metabolic Institute. METHODS A sample of 163 participants consented to take a battery of self-report measures related to psychological functioning, eating behaviors, adherence, alcohol misuse, and quality of life along with their postoperative weight. MMPI-3 scale scores were prorated from the Minnesota Multiphasic Personality Inventory - 2 - Restructured Form (MMPI-2-RF) or scored from the Minnesota Multiphasic Personality Inventory - 2 - Restructured Form - Expanded (MMPI-2-RF-EX). RESULTS Weight recurrence was quite variable in this sample. Postoperative MMPI-3 scales related to emotional/internalizing dysfunction were modestly associated with higher weight recurrence. Postoperative MMPI-3 scale scores also demonstrated associations with other postoperative outcomes including measures of eating behaviors, adherence, alcohol misuse, and quality of life. CONCLUSIONS Postoperative psychosocial functioning as assessed by the MMPI-3 was associated with weight recurrence and a number of other problematic psychological outcomes beyond weight recurrence.
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Affiliation(s)
- Ryan J Marek
- Department of Psychology and Philosophy, Sam Houston State University, Huntsville, Texas.
| | | | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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12
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Hany M, Zidan A, Ibrahim M, Sabry A, Agayby ASS, Mourad M, Torensma B. Revisional One-Step Bariatric Surgical Techniques After Unsuccessful Laparoscopic Gastric Band: A Retrospective Cohort Study with 2-Year Follow-up. Obes Surg 2024; 34:814-829. [PMID: 38231451 PMCID: PMC10899297 DOI: 10.1007/s11695-023-07039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) has high reported rates of revision due to poor weight loss (WL) and high complication rates. Yet, there is yet to be a consensus on the best revisional procedure after unsuccessful LAGB, and studies comparing different revisional procedures after LAGB are still needed. METHODS This was a retrospective cohort study that compared the outcomes of one-step revisional Roux-en-Y gastric bypass (rRYGB), one-anastomosis gastric bypass (rOAGB), or laparoscopic sleeve gastrectomy (rLSG) after LAGB. WL, complications, resolution of associated medical conditions, and food tolerance were assessed with a post hoc pairwise comparison one-way analysis of variance (ANOVA) throughout a 2-year follow-up. RESULTS The final analysis included 102 (rRYGB), 80 (rOAGB), and 70 (rLSG) patients. After 2 years, an equal percentage of excess weight loss was observed in rOAGB and rRYGB (both >90%; p=0.998), significantly higher than that in rLSG (83.6%; p<0.001). In our study, no leaks were observed. rRYGB had higher complication rates according to the Clavien-Dindo classification (10.8% vs. 3.75% and 5.7% in rOAGB and rLSG, respectively, p=0.754), and re-operations were not statistically significant. Food tolerance was comparable between rOAGB and rRYGB (p = 0.987), and both had significantly better food tolerance than rLSG (p<0.001). The study cohorts had comparable resolution rates for associated medical problems (p>0.60). CONCLUSION rOAGB and rRYGB had better outcomes after LAGB than rLSG regarding WL, feasibility, food tolerance, and safety. rOAGB had significantly higher rates of nutritional deficiencies.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
- Consultant of Bariatric Surgery at Madina Women's Hospital, Alexandria, Egypt.
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Ahmed Sabry
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ann Samy Shafiq Agayby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Mourad
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Bart Torensma
- Clinical Epidemiologist, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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13
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Miller-Matero LR, Haley EN, Loree AM, Braciszewski JM, Maye M, Sehgal M, Carlin AM. Post-surgical psychiatric symptoms, maladaptive eating patterns, and lifestyle behaviors associated with weight recurrence after bariatric surgery. Surg Obes Relat Dis 2024; 20:297-303. [PMID: 37923621 DOI: 10.1016/j.soard.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A significant proportion of patients who undergo bariatric surgery experience weight recurrence; however, the most important areas to target to prevent weight recurrence remain unknown. OBJECTIVES The purpose was to examine whether psychiatric symptoms, maladaptive eating behaviors, and lifestyle factors were associated with weight recurrence. SETTING Single healthcare system. METHODS Individuals who underwent bariatric surgery were invited to complete a web-based survey in which they reported their current weight and completed measures of psychiatric symptoms, maladaptive eating behaviors, and lifestyle behaviors. Participants were included if they were at least 2 years postsurgery. Weight recurrence was measured from the 1-year follow-up to the survey date. RESULTS Participants (n = 169) were predominantly female and White or Black, with a mean age of 45 years. The rate of significant weight recurrence was 23.1%. Those who underwent sleeve gastrectomy were more likely to experience weight recurrence (odds ratio [OR] = 12.99; P = .01). In bivariate analyses, anxiety and depressive symptoms, emotional eating, loss of control eating, binge eating, and night eating were associated with weight recurrence (P < .05). Those who did not eat mindfully, take 20 minutes to eat, or get adequate sleep were also more likely to have weight recurrence (P < .05). In a multivariate model, only a lack of mindful eating (OR = 4.84; P = .03) and inadequate sleep (OR = 7.30; P = .02) remained statistically significant predictors. CONCLUSION Engaging in mindful eating and obtaining adequate sleep may protect against weight recurrence following bariatric surgery. Clinicians may want to screen and monitor these behaviors.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Erin N Haley
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Monica Sehgal
- Behavioral Health, Henry Ford Health, Detroit, Michigan
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14
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Wang S, Jang Q, Wang H, Yang Y, Ruan M, Yu J, Li X, Luo D. Sex differences in patients with COVID-19 after bariatric surgery: a multicenter cross-sectional study. Front Public Health 2024; 11:1293318. [PMID: 38288424 PMCID: PMC10822963 DOI: 10.3389/fpubh.2023.1293318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/21/2023] [Indexed: 01/31/2024] Open
Abstract
Objectives This multicenter, cross-sectional study aimed to investigate whether sex differences persist among patients who have undergone bariatric surgery and tested positive for the coronavirus disease (COVID-19). Methods We conducted a multicenter cross-sectional study via an online electronic questionnaire to collect data. Categorical data were presented as absolute and relative frequencies. Data for continuous variables were expressed as mean and standard deviation (SD) or median [interquartile range (IQR)]. We employed ordered logistic regression to assess whether females had higher odds of an increased self-reported duration of the most severe symptom compared to males. Using a modified Poisson regression model with robust standard errors to assess the differences in clinical characteristics among COVID-19 cases. Results Statistical analysis revealed significant differences in the prevalence rates of various comorbidities. Among participants who reported their temperature during COVID-19 infection, more than half engaged in vitamin supplementation and regular exercise, while 4.2% remained asymptomatic. The probability of females experiencing a longer duration of severe symptoms increased compared to males [adjusted Odds Ratio (aOR) = 1.92, 95% confidence interval (CI) 1.73-2.12]. In the multivariate mixed-effects Poisson regression analysis, compared to males, females exhibited a lower prevalence rate of asymptomatic infection [adjusted prevalence ratio (aPR 0.40, 95% CI 0.28-0.58), lower prevalence of infection without therapeutic medication use (aPR 0.76, 95% CI 0.70-0.82), and lower prevalence of multiple infections (aPR 0.39, 95% CI 0.20-0.74)]. Conclusion This cross-sectional study indicates the persistence of sex differences among patients with COVID-19 who have undergone bariatric surgery. Further research is needed to explore the underlying factors contributing to this disparity.
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Affiliation(s)
- Senlin Wang
- Center for Obesity and Metabolic Health, Department of General Surgery, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Qiubai Jang
- Department of General Surgery, Center for Obesity and Metabolic Health, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Han Wang
- Department of General Surgery, Center for Obesity and Metabolic Health, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yunning Yang
- Department of General Surgery, Center for Obesity and Metabolic Health, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Min Ruan
- Mianyang Central Hospital, Mianyang, China
| | - Juan Yu
- First Affiliated Hospital of Air Force Military Medical University, Xi’an, China
| | | | - Dan Luo
- Center for Obesity and Metabolic Health, Department of General Surgery, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
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15
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Razzak FA, Kerbage A, Brunaldi VO, Mrad R, Mahmoud T, Gala K, Vargas EJ, Storm A, Ghanem O, Dayyeh BA. Correlation Between Gastrojejunal Anastomosis Diameter, Distensibility Index, and Weight Regain After Roux-en-Y Gastric Bypass. Obes Surg 2023; 33:4042-4048. [PMID: 37922061 DOI: 10.1007/s11695-023-06918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION Gastrojejunal anastomosis (GJA) dilation is an independent predictor of weight regain (WR) after Roux-en-Y gastric bypass (RYGB). However, the role of planimetric measurements in this context remains unknown. METHODS This is a retrospective cohort study including adult RYGB patients who underwent a diagnostic endoscopy with Endoflip assessment of the GJA. We excluded patients in the early postoperative period and those with abnormal endoscopic findings (marginal ulcers and gastro-gastric fistulas). RESULTS Thirty-four patients were initially included. Endoscopic GJA diameter had a moderate positive correlation with WR (r=+0.438, p=0.011). However, after excluding the 7 patients with GJA> 30 mm, there was no significant correlation. There was a moderate agreement between the EndoFLIP-GJA diameter at 60mL and endoscopic diameter (ICC=0.576, p=0.049). The distensibility index (DI) showed a consistent moderate negative correlation with WR. Considering the maximum DI at 40 ml, we found a cutoff of DI = 7 mm2/mmHg that split the sample in two significantly different populations in terms of WR (67.4% vs. 43.2%, p=0.04). CONCLUSION Visual estimation of the GJA diameter correlates with EndoFLIP at 60mL. In the subset of patients with GJA ≤ 30 mm, more distensible GJAs are associated with lower rates of WR. Larger studies are needed to confirm this correlation and to validate its utility for clinical management.
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Affiliation(s)
- Farah Abdul Razzak
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Anthony Kerbage
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Vitor O Brunaldi
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
- Gastroenterology Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rudy Mrad
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Khushboo Gala
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Andrew Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Barham Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, Rochester, MN, 55905, USA.
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16
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Lind R, Hage K, Ghanem M, Shah M, Vierkant RA, Jawad M, Ghanem OM, Teixeira AF. Long-Term Outcomes of Sleeve Gastrectomy: Weight Recurrence and Surgical Non-responders. Obes Surg 2023; 33:3028-3034. [PMID: 37464052 DOI: 10.1007/s11695-023-06730-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is an effective procedure with remarkable weight loss and low complication rates. However, up to 30% of cases require revisional surgery in non-responders or patients who experience weight recurrence. We aim to report the rate of weight recurrence/non-responders (WR/NR) in patients who underwent SG and had more than 5 years of follow-up. METHODS We performed a multicenter retrospective study of patients who underwent initial SG from 2008 to 2017. Patient demographics and weight loss outcomes up to 12 years after SG were collected. Surgical non-responders were defined as 20% weight regain compared to maximum weight loss. A chi-square test for categorical variables and a two-sample t-test for continuous variables were used. Data are summarized as mean ± standard deviation. RESULTS From a total of 1263 patients, we included 339 patients (78% female, age 47.3 ± 11.2 years; baseline weight 125.8 ± 27.6 kg) with at least 5 years of follow-up (mean follow-up of 7.1 ± 1.8 years) (Table 1). Surgical non-response was demonstrated in 15.9% of patients (n=54) and 64.0% (n=217) had weight recurrence after SG (Fig. 1). There was a statistically significant difference in history of hypertension (p=0.046) and diabetes (p=0.032) as well as %TBWL at 1 year (p=0.005) and at longest follow-up (p<0.001) between patients who experienced WR/NR and those who did not. CONCLUSIONS Only 20% of patients who underwent SG and followed up for more than 5 years were able to maintain appropriate weight loss.
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Affiliation(s)
- Romulo Lind
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA.
| | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Ghanem
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
| | - Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Robert A Vierkant
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
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17
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Voorwinde V, Moukadem S, van Stralen MM, Janssen IM, Monpellier VM, Steenhuis IH. How to get back on track? Experiences of patients and healthcare professionals regarding weight recurrence and needs for an intervention after bariatric-metabolic surgery. OBESITY PILLARS (ONLINE) 2023; 7:100074. [PMID: 37990676 PMCID: PMC10662074 DOI: 10.1016/j.obpill.2023.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 11/23/2023]
Abstract
Background Multidisciplinary lifestyle interventions are recommended as a first step in treating weight recurrence after bariatric-metabolic surgery (BMS). However, little is known about the experience of patients and healthcare professionals (HCP) with these interventions and how they should be tailored to the patients' needs. The aim of this study was to gain more insight into the experiences and needs of patients and HCP regarding weight recurrence after BMS and an intervention to get Back on Track. In addition, attitudes towards integrating e-Health into the care program were explored. Methods A qualitative process evaluation of an intervention for weight recurrence, the Back on Track (BoT), was conducted by means of in-depth interviews and focus groups with 19 stakeholders, including patients and HCP involved in BoT. Interviews were transcribed verbatim. Data were analyzed through thematic analysis. Results Patients and HCP reported a wide array of causes of weight recurrence. Patients found it difficult to decide when weight recurrence is problematic and when they should ask for help. Patients reported feeling like the exception and ashamed, therefore experiencing a high threshold to seek help. E-Health was seen as a promising way to improve tailoring, screening, autonomy for the patient, and accessible contact. Conclusion Patients should be adequately counselled on weight recurrence after BMS and the importance of intervening early. It is important to lower the threshold for seeking help. For example by offering more long-term standard care or by adding e-Health to the intervention.
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Affiliation(s)
- Vera Voorwinde
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Sahar Moukadem
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Maartje M. van Stralen
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ignace M.C. Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
| | - Valerie M. Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, the Netherlands
| | - Ingrid H.M. Steenhuis
- VU University, Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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18
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Papasavas P, Bond D. Comment on: Bariatric surgeon perspective on revisional bariatric surgery (RBS) for weight recurrence. Surg Obes Relat Dis 2023; 19:979-980. [PMID: 37380543 DOI: 10.1016/j.soard.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/14/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut
| | - Dale Bond
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut
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19
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Johns AJ, Luce MS, Kaneski MJ, Lowery RA, Jachniewicz B, Salas A, McCreary R, Russell RM, Lyo V, Ali MR, Ahmed SM. The long weight: association between distressed communities index and long-term weight outcomes following bariatric surgery. Surg Endosc 2023; 37:7218-7225. [PMID: 37369948 PMCID: PMC10462541 DOI: 10.1007/s00464-023-10158-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Socioeconomic status (SES) is multifactorial, and its effect on post-bariatric weight recurrence is unclear. Distressed Community Index (DCI) is a composite SES score measuring community economic well-being. This study aims to evaluate the effect of DCI on long-term post-bariatric weight outcomes. METHODS Retrospective analysis of patients undergoing primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2015 and 2020 was performed. All weights in the electronic medical record (EMR), including non-bariatric visits, were captured. Patients were stratified into low tier (LT) and high tier (HT) DCI groups. RESULTS Of 583 patients, 431 (73.9%) were HT and 152 (26.1%) were LT. Average bariatric follow up was 1.78 ± 1.6 years and average postoperative weight in the EMR was 3.96 ± 2.26 years. Rates of bariatric follow up within the last year were similar (13.8% LT vs 16.2% HT, p = 0.47). LT had higher percent total body weight loss (%TWL; 26% LT vs 23% HT, p < 0.01) and percent excess weight loss (%EWL; 62% vs 57%, p = 0.04) at 1 year on univariate analysis. On multivariate linear regression adjusting for baseline characteristics and surgery type, there were no differences in %EWL between groups at 1 year (p = 0.22), ≥ 3 years (p = 0.53) or ≥ 5 years (p = 0.34) postop. While on univariate analysis LT only trended towards greater percentage of patients with > 15% increase from their 1-year weight (33.3% LT vs 21.0% HT, p = 0.06), on multivariate analysis this difference was significant (OR 2.0, LT 95%CI 1.41-2.84). There were no differences in the percentage of patients with > 15% decrease in %EWL from 1 to 3 + years postop between groups (OR 0.98, LT 95% CI 0.72-1.35). CONCLUSIONS While low tier patients had similar weight loss at 1 year, they were twice as likely to have weight recurrence at ≥ 3 years. Further studies are needed to identify factors contributing to greater weight recurrence among this population.
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Affiliation(s)
- Alexandra J Johns
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA
| | - M Siobhan Luce
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA
| | - Mason J Kaneski
- Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA
| | - Ryan A Lowery
- University of California, Davis Health, Sacramento, USA
| | | | - Angela Salas
- University of California, Davis Health, Sacramento, USA
| | | | | | - Victoria Lyo
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA
- Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA
- Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA
| | - Mohammed R Ali
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA
- Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA
- Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA
| | - Shushmita M Ahmed
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA.
- Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA.
- Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA.
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20
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Giannopoulos S, Kapsampelis P, Pokala B, Nault Connors JD, Hilgendorf W, Timsina L, Clapp B, Ghanem O, Kindel TL, Stefanidis D. Bariatric Surgeon Perspective on Revisional Bariatric Surgery (RBS) for Weight Recurrence. Surg Obes Relat Dis 2023; 19:972-979. [PMID: 37061437 DOI: 10.1016/j.soard.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Weight recurrence (WR) after bariatric surgery occurs in nearly 20% of patients. Revisional bariatric surgery (RBS) may benefit this population but remains controversial among surgeons. OBJECTIVES Explore surgeon perspectives and practices for patients with WR after primary bariatric surgery (PBS). SETTING Web-based survey of bariatric surgeons. METHODS A 21-item survey was piloted and posted on social media closed groups (Facebook) utilized by bariatric surgeons. Survey items included demographic information, questions pertaining to the definition of suboptimal and satisfactory response to bariatric surgery, and general questions related to different WR management options. RESULTS One hundred ten surgeons from 19 countries responded to the survey. Ninety-eight percent responded that WR was multifactorial, including behavioral and biological factors. Failure of PBS was defined as excess weight loss < 50% by 31.4%, as excess weight loss <25% by 12.8%, and as comorbidity recurrence by 17.4%. Surgeon responses differed significantly by gender (P = .036). 29.4% believed RBS was not successful, while 14.1% were unsure. Nevertheless, 73% reported that they would perform RBS if sufficient evidence of benefit existed. Most frequently performed revisional procedures included conversion of sleeve gastrectomy to Roux-en-Y gastric bypass (RYGB), adjustable gastric band to RYGB, and RYGB revision (21.9% versus 18.2% versus 15.3%, respectively). CONCLUSIONS This survey demonstrates significant variability in surgeon perception regarding causes and the effectiveness of RBS. Moreover, they disagree on what constitutes a nonsatisfactory response to PBS and to whom they offer RBS. These findings may relate to limited available clinical evidence on best management options for this patient population. Clinical trials investigating the comparative effectiveness of various treatment options are needed.
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Affiliation(s)
| | | | - Bhavani Pokala
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jill D Nault Connors
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Lava Timsina
- Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin Clapp
- Paul Foster School of Medicine, Texas Tech HSC, El Paso, Texas
| | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
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21
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Tolvanen L, Christenson A, Bonn SE, Surkan PJ, Lagerros YT. Patients' Perspectives on Dietary Patterns and Eating Behaviors During Weight Regain After Gastric Bypass Surgery. Obes Surg 2023; 33:2517-2526. [PMID: 37402891 PMCID: PMC10345057 DOI: 10.1007/s11695-023-06718-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Food quality, energy intake, and various eating-related problems have been highlighted as some of the components influencing weight after bariatric surgery. This study aimed to increase our knowledge of patients' perspectives on dietary patterns and eating behaviors during weight regain after bariatric surgery. MATERIALS AND METHODS We recruited 4 men and 12 women with obesity and the experience of weight regain after bariatric surgery at an obesity clinic in Stockholm, Sweden. Data were collected during 2018-2019. We conducted a qualitative study, carried out individual semi-structured interviews, and analyzed the recorded and transcribed interview data with thematic analysis. RESULTS Participants had regained 12 to 71% from their lowest weight after gastric bypass surgery performed 3 to 15 years before. They perceived their dietary challenges as overwhelming and had not expected weight management, meal patterns, increasing portion sizes, and appealing energy-dense foods to be problematic after surgery. In addition, difficulties with disordered eating patterns, emotional eating, and increased alcohol intake further contributed to the weight management hurdles. Insufficient nutritional knowledge and lack of support limited participants' ability to avoid weight regain, leading to restrictive eating and dieting without sustained weight loss. CONCLUSION Eating behavior and dietary factors such as lack of nutritional knowledge, emotional eating, or disorganized meal patterns contribute to difficulties with weight management after gastric bypass surgery. Improved counseling may help patients prepare for possible weight regain and remaining challenges with food and eating. The results highlight the importance of regular medical nutrition therapy after gastric bypass surgery.
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Affiliation(s)
- Liisa Tolvanen
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans gata 30A, Stockholm, SE-171 64 Sweden
- Center for Obesity, Academic Specialist Center, Stockholm, Sweden
| | - Anne Christenson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans gata 30A, Stockholm, SE-171 64 Sweden
- Center for Obesity, Academic Specialist Center, Stockholm, Sweden
| | - Stephanie E. Bonn
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans gata 30A, Stockholm, SE-171 64 Sweden
| | - Pamela J. Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Ylva Trolle Lagerros
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans gata 30A, Stockholm, SE-171 64 Sweden
- Center for Obesity, Academic Specialist Center, Stockholm, Sweden
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22
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Franken RJ, de Laar AWV. Evidence-Based Classification for Post-bariatric Weight Regain from a Benchmark Registry Cohort of 18,403 Patients and Comparison with Current Criteria. Obes Surg 2023; 33:2040-2048. [PMID: 37129789 DOI: 10.1007/s11695-023-06586-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION There is a need for a standardized, evidence-based classification of post-bariatric weight-regain, to investigate and compare revision procedures and to advice and treat patients in an evidence-based way. METHODS We used standard deviations (SD) of the highest (1-2 years) and latest (> 2 years) percentage total weight loss (%TWL) results after primary bariatric surgery from the Dutch Audit for Treatment of Obesity (DATO) bariatric registry as benchmarks for (above) average (≥ - 1SD), poor (- 1SD to - 2SD) and insufficient (< - 2SD) weight loss. Weight regain maintaining (above) average weight loss was called grade 1, weight regain towards poor weight loss grade 2, towards insufficient weight loss grade 3, with subgrades 2a/3a for below average weight loss from the start, and 2b/3b for weight regain from (above) average to below average weight loss. Patient characteristics and diabetes improvement/impairment were compared. Sensitivity and specificity of 14 existing weight regain criteria were calculated. RESULTS We analyzed 93,465 results from 38,830 patients (77.1% gastric bypass, 22.5% sleeve gastrectomy). The - 1SD thresholds for early and late weight loss approximated 25%TWL and 20%TWL, the - 2SD threshold for late weight loss 10%TWL. Weight regain could be analyzed for 18,403 patients (2.5-5.2 years follow-up). They regained mean 6.7 kg (5.4%TWL), with 66.8% grade 1 weight regain, 7.2% grade 2a, 7.4% grade 2b, 2.1% grade 3a, and 0.6% grade 3b. There were significant differences in comorbidities, gender, age, weight regain, diabetes impairment, and diabetes improvement across grades. Weight regain criteria from literature were extremely divers. None had high sensitivity. CONCLUSION The DATO classification for post-bariatric weight regain combines the extent of weight regain with evidence-based endpoints of weight loss. It differentiated weight regain maintaining (above) average weight loss, two intermediate grades, gradual weight regain with below average weight loss from the start (primary non-response) and steep weight regain towards insufficient weight loss (secondary non-response). The classification is superior to existing criteria and well supported by evidence.
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Affiliation(s)
- R J Franken
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134TM, Hoofddorp, Netherlands.
| | - A W Van de Laar
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134TM, Hoofddorp, Netherlands
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23
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Aleassa EM, Papasavas P, Augustin T, Khorgami Z, Benson-Davies S, Ghiassi S, Carter J, Nimeri A. American Society for Metabolic and Bariatric Surgery literature review on the effect of Roux-en-Y gastric bypass limb lengths on outcomes. Surg Obes Relat Dis 2023; 19:755-762. [PMID: 37268517 DOI: 10.1016/j.soard.2023.04.298] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/02/2023] [Indexed: 06/04/2023]
Abstract
This literature review is issued by the American Society for Metabolic and Bariatric Surgery regarding limb lengths in Roux-en-Y gastric bypass (RYGB) and their effect on metabolic and bariatric outcomes. Limbs in RYGB consist of the alimentary and biliopancreatic limbs and the common channel. Variation of limb lengths in primary RYGB and as a revisional option for weight recurrence after RYGB are described in this review.
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Affiliation(s)
- Essa M Aleassa
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | | | - Toms Augustin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma
| | - Sue Benson-Davies
- Department of Surgery, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
| | - Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, North Carolina
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24
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Bejarano CM, Gowey M, Reiter-Purtill J, Ley S, Mitchell JE, Zeller MH. Trajectories of Psychopathology and Dysregulation 2-4 Years following Adolescent Bariatric Surgery. J Pediatr Psychol 2023; 48:479-489. [PMID: 36898044 PMCID: PMC10199728 DOI: 10.1093/jpepsy/jsad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE This study examined psychopathology and weight over 4 years following bariatric surgery in adolescents with obesity, as compared to a nonsurgical group. The role of psychological dysregulation in relation to psychopathology in the 2-4 year "maintenance phase" following surgery was also examined. METHODS Adolescent participants (122 surgical and 70 nonsurgical) completed height/weight and psychopathology assessments annually for 4 years, with dysregulation assessed at Year 2. Analyses examined the association of "High" and "Low" psychopathology with weight over time using logistic regression. Mediation analyses in the surgical group examined indirect effects of dysregulation on percent weight loss through Year 4 psychopathology. RESULTS There were lower odds of "High" internalizing symptoms in the surgical group versus the nonsurgical group from baseline (presurgery) to Year 4 (OR = .39; p < .001; 42.3% "High" internalizing in surgical; 66.7% in nonsurgical) and during the 2-4 year maintenance phase (OR = .35, p < .05; 35.1% "High" internalizing in surgical; 60.8% in nonsurgical). There was a significant mediation effect in the surgical group: higher dysregulation was associated with greater Year 4 internalizing symptoms (β = .41, p < .001) which in turn was associated with less Year 4 percent weight loss (β = -.27, p < .05). CONCLUSIONS While the surgical group was less likely to experience internalizing symptoms, internalizing psychopathology was related to less percent weight loss in this group. Internalizing symptoms mediated the relationship between dysregulation and percent weight loss in the surgical group. Postoperative mental health follow-up is needed for adolescents into young adulthood.
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Affiliation(s)
- Carolina M Bejarano
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Reiter-Purtill
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sanita Ley
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James E Mitchell
- Department of Clinical Neuroscience, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Meg H Zeller
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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25
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Si Y, Zhang H, Han X, Liu W, Tu Y, Han J, Ma X, Bao Y, Yu H. Percentage of maximum weight lost as an optimal parameter of weight regain after bariatric surgery in Chinese patients with diabetes. Obesity (Silver Spring) 2023; 31:1538-1546. [PMID: 37133427 DOI: 10.1002/oby.23764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The goal of this study was to compare measures of weight regain (WR) and their association with the glucose metabolism deterioration within 3 years following bariatric surgery among Chinese patients with obesity and type 2 diabetes mellitus (T2DM). METHODS Among a retrospective cohort of 249 patients with obesity and T2DM who underwent bariatric surgery and were followed up to 3 years, WR was assessed by weight changes, BMI changes, percentage of presurgery weight, percentage of nadir weight, and percentage of maximum weight lost (%MWL). Glucose metabolism deterioration was defined as a change from an absence of antidiabetic medication use to use, or absence of insulin use to use, or an increase in glycated hemoglobin by at least 0.5% to 5.7% or greater. RESULTS A comparison of C-index of glucose metabolism deterioration indicated %MWL had better discriminatory ability versus weight change, BMI change, percentage of presurgery weight, or percentage of nadir weight (all p < 0.01). The %MWL also had the highest prediction accuracy. The optimal %MWL cutoff point was 20%. CONCLUSIONS Among Chinese patients with obesity and T2DM who underwent bariatric surgery, WR quantified as %MWL predicted 3-year postoperative glucose metabolism deterioration better than the alternatives; 20% MWL was the optimal cutoff point.
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Affiliation(s)
- Yiming Si
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Hongwei Zhang
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaodong Han
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
| | - Weijie Liu
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai, China
| | - Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Junfeng Han
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Xiaojing Ma
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
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26
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Murvelashvili N, Xie L, Schellinger JN, Mathew MS, Marroquin EM, Lingvay I, Messiah SE, Almandoz JP. Effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery weight recurrence. Obesity (Silver Spring) 2023; 31:1280-1289. [PMID: 36998152 DOI: 10.1002/oby.23736] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery (MBS) weight recurrence. METHODS A retrospective analysis of 207 adults with post-MBS weight recurrence treated with semaglutide 1.0 mg weekly (n = 115) or liraglutide 3.0 mg daily (n = 92) at an academic center from January 1, 2015, through April 1, 2021, was conducted. The primary end point was percentage body weight change at 12 months of treatment with regimens containing semaglutide or liraglutide. RESULTS The mean sample age was 55.2 years; mean BMI was 40.4 kg/m2 ; 89.9% were female; and 50% completed sleeve gastrectomy, 29% completed Roux-en-Y gastric bypass, and 21% completed adjustable gastric banding. Least-squares mean weight change at 12 months was -12.92% versus -8.77% in the semaglutide and liraglutide groups, respectively (p < 0.001). The adjusted odds ratios were 2.34 (95% CI: 1.28-4.29) for ≥10% weight loss and 2.55 (95% CI: 1.22-5.36) for ≥15% weight loss over 12 months in the semaglutide group versus liraglutide group, respectively. Weight-loss efficacy of semaglutide (vs. liraglutide) did not differ by subgroups explored, including age, sex, and MBS procedure. CONCLUSIONS These results show that treatment regimens including semaglutide 1.0 mg weekly lead to superior weight loss compared with liraglutide 3.0 mg daily for treating post-MBS weight recurrence, regardless of procedure type or the magnitude of weight recurrence.
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Affiliation(s)
- Natia Murvelashvili
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Luyu Xie
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - M Sunil Mathew
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
| | - Elisa Morales Marroquin
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
| | - Ildiko Lingvay
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
- Department of Pediatrics, John P. and Kathrine G. McGovern School of Medicine at UTHealth, Houston, Texas, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
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27
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Pereira SE, Rossoni C, Cambi MPC, Faria SL, Mattos FCC, De Campos TBF, Petry TBZ, Da Silva SA, Pereira AZ, Umeda LM, Nogueira C, De Araújo Burgos MGP, Magro DO. Brazilian guide to nutrition in bariatric and metabolic surgery. Langenbecks Arch Surg 2023; 408:143. [PMID: 37039877 DOI: 10.1007/s00423-023-02868-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.
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Affiliation(s)
- Silvia Elaine Pereira
- Postgraduate Program in Nutritional Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Carina Rossoni
- Faculty of Medicine (ISAMB), Instituto of Environmental Health, Universidade de Lisboa, Lisbon, Portugal.
| | | | - Silvia Leite Faria
- Postgraduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | | | | | | | - Silvia Alves Da Silva
- Postgraduate Program in Nutritional in Bariatric Surgery, Federal University of Pernambuco, Recife, Brazil
| | | | - Luciana Mela Umeda
- Medical Residency Program in Endrocrinology and Metabology, Ipiranga Hospital, São Paulo, Brazil
| | - Carla Nogueira
- Postgraduate Program in Human Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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28
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Kerver GA, Engel SG, Gunstad J, Crosby RD, Steffen KJ. Deficits in cognitive control during alcohol consumption after bariatric surgery. Surg Obes Relat Dis 2023; 19:344-349. [PMID: 36443210 PMCID: PMC10040420 DOI: 10.1016/j.soard.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND While bariatric surgery results in substantial weight loss, one negative side effect of surgery is that patients often experience more rapid and intense intoxication effects after consuming alcohol. OBJECTIVES Given that alcohol use has been associated with impaired cognitive functioning in the general population, this study examined whether acute alcohol consumption after bariatric surgery immediately led to impaired cognitive control, and whether this effect was impacted by baseline levels of cognitive control. SETTING Nonprofit teaching hospital, United States. METHODS Participants were 34 adults who attended a laboratory visit before and 1 year after Roux-en-Y gastric bypass surgery, wherein they consumed a weight-based dose of alcohol and completed cognitive testing over the course of 3 hours. RESULTS A series of generalized mixed-effect models demonstrated that performance on the cognitive task generally improved over time, likely due to practice effects. However, following bariatric surgery, individuals with impaired cognitive control before consuming alcohol experienced greater commission errors immediately afterward. CONCLUSIONS These findings suggest that alcohol use after bariatric surgery may produce immediate deficits in inhibitory control among individuals who are already vulnerable to impaired cognitive control. Clinicians should seek to educate bariatric surgery candidates on this possible effect, as deficits in inhibitory control may ultimately lead to risky behaviors and poor adherence with postsurgical medical recommendations.
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Affiliation(s)
- Gail A Kerver
- Sanford Center for Biobehavioral Research, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota.
| | - Scott G Engel
- Sanford Center for Biobehavioral Research, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota
| | - Kristine J Steffen
- Sanford Center for Biobehavioral Research, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
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29
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Fehervari M, Banh S, Varma P, Das B, Al-Yaqout K, Al-Sabah S, Khwaja H, Efthimiou E, Ashrafian H. Weight loss specific to indication, remission of diabetes, and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:384-395. [PMID: 36581551 DOI: 10.1016/j.soard.2022.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Long-term complications such as insufficient weight loss (IWL) and gastroesophageal reflux disease (GERD) may necessitate SG conversion to Roux-en-Y gastric bypass (RYGB). The aim of this review was to determine the indication-specific weight loss and diabetes remission after SG conversion to RYGB (STOBY). Our objective was to extract all available published data on indication for conversion, weight loss, remission of diabetes, and short-term complications after STOBY. A systematic literature search was conducted to identify studies reporting outcomes following STOBY. A random effects model was used for meta-analysis. The search identified 44 relevant studies. Overall short-term (12-mo) excess weight loss (EWL) was 54.6% (95% confidence interval [CI], 46%-63%) in 23 studies (n = 712) and total weight loss (TWL) was 19.9% (95% CI, 14%-25%) in 21 studies (n = 740). For IWL, short-term (12-mo) pooled weight loss outcomes were 53.9% EWL (95% CI, 48%-59%) in 14 studies (n = 295) and 22.7% TWL (95% CI, 17%-28%) in 12 studies (n = 219), and medium-term (2-5 yr) outcomes were 45.8% EWL (95% CI, 38%-53%) in 7 studies (n = 154) and 20.6% TWL (95% CI, 15%-26%) in 9 studies (n = 206). Overall diabetes remission was 53% (95% CI, 33%-72%), and the perioperative complication rate was 8.2% (95% CI, 7.6%-8.7%). Revisional SG conversion to RYGB for IWL can achieve good weight loss outcomes and diabetes remission.
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Affiliation(s)
- Matyas Fehervari
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Serena Banh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Piyush Varma
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | | - Haris Khwaja
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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30
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Dang JT, Kim GJ, Kroh M. Bariatric endoscopy: from managing complications to primary metabolic procedures. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:1-8. [PMID: 36936036 PMCID: PMC10020740 DOI: 10.7602/jmis.2023.26.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/09/2023] [Indexed: 03/18/2023]
Abstract
Obesity is a worldwide epidemic and is the second leading cause of preventable death. The approach to treating obesity involves a multidisciplinary approach including lifestyle interventions, pharmacological therapies, and bariatric surgery. Endoscopic interventions are emerging as important tools in the treatment of obesity with primary and revisional bariatric endoscopic therapies. These include intragastric balloons, aspiration therapy, suturing and plication, duodenal-jejunal bypass liners, endoscopic duodenal mucosal resurfacing, and incisionless magnetic anastomosis systems. Endoscopic interventions have also demonstrated efficacy in treating complications of bariatric surgery. Approaches include stenting, endoscopic internal drainage, and endoscopic vacuum-assisted closure. This review aimed to discuss the current endoscopic procedures used as primary and revisional bariatric therapy including those used for managing bariatric surgical complications.
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Affiliation(s)
- Jerry T Dang
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grace J Kim
- Digestive Disease & Surgery Institute, Cleveland Clinic - South Pointe Hospital, Warrensville Heights, OH, USA
| | - Matthew Kroh
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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31
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Akpinar EO, Liem RSL, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ. Weight recurrence after Sleeve Gastrectomy versus Roux-en-Y gastric bypass: a propensity score matched nationwide analysis. Surg Endosc 2023:10.1007/s00464-022-09785-8. [PMID: 36745232 DOI: 10.1007/s00464-022-09785-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/27/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Literature remains scarce on patients experiencing weight recurrence after initial adequate weight loss following primary bariatric surgery. Therefore, this study compared the extent of weight recurrence between patients who received a Sleeve Gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) after adequate weight loss at 1-year follow-up. METHODS All patients undergoing primary RYGB or SG between 2015 and 2018 were selected from the Dutch Audit for Treatment of Obesity. Inclusion criteria were achieving ≥ 20% total weight loss (TWL) at 1-year and having at least one subsequent follow-up visit. The primary outcome was ≥ 10% weight recurrence (WR) at the last recorded follow-up between 2 and 5 years, after ≥ 20% TWL at 1-year follow-up. Secondary outcomes included remission of comorbidities at last recorded follow-up. A propensity score matched logistic regression analysis was used to estimate the difference between RYGB and SG. RESULTS A total of 19.762 patients were included, 14.982 RYGB and 4.780 SG patients. After matching 4.693 patients from each group, patients undergoing SG had a higher likelihood on WR up to 5-year follow-up compared with RYGB [OR 2.07, 95% CI (1.89-2.27), p < 0.01] and less often remission of type 2 diabetes [OR 0.69, 95% CI (0.56-0.86), p < 0.01], hypertension (HTN) [OR 0.75, 95% CI (0.65-0.87), p < 0.01], dyslipidemia [OR 0.44, 95% CI (0.36-0.54), p < 0.01], gastroesophageal reflux [OR 0.25 95% CI (0.18-0.34), p < 0.01], and obstructive sleep apnea syndrome (OSAS) [OR 0.66, 95% CI (0.54-0.8), p < 0.01]. In subgroup analyses, patients who experienced WR after SG but maintained ≥ 20%TWL from starting weight, more often achieved HTN (44.7% vs 29.4%), dyslipidemia (38.3% vs 19.3%), and OSAS (54% vs 20.3%) remission compared with patients not maintaining ≥ 20%TWL. No such differences in comorbidity remission were found within RYGB patients. CONCLUSION Patients undergoing SG are more likely to experience weight recurrence, and less likely to achieve comorbidity remission than patients undergoing RYGB.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
- Dutch Obesity Clinic, The Hague & Gouda, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
- Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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Conversion of gastric sleeve to Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch: safe and viable options. Surg Obes Relat Dis 2023; 19:131-135. [PMID: 36414524 DOI: 10.1016/j.soard.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/19/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) remains the most performed bariatric surgery. As numbers of SG increase, so do the numbers of patients requiring conversion for insufficient weight loss or weight regain. However, the literature has cited complication rates as high as 30% for reoperative bariatric surgery. OBJECTIVE With the recent inclusion of conversion surgery variables in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we compared the safety and efficacy of SG conversion to Roux-en-Y gastric bypass (RYGB) versus biliopancreatic diversion and duodenal switch (BPD/DS). SETTING MBSAQIP database. METHODS Analysis of the 2020 MBSAQIP Participant Use Files revealed 6020 patients who underwent SG conversion to RYGB (5348) and BPD/DS (672). We examined 30-day outcomes including death, anastomotic leak, readmission, any complication, dehydration, and weight loss. RESULTS There was no statistically significant difference in mortality (.12% versus 0%) or; complication rate (6.5% versus 5.1%) with SG conversion to RYGB or BPD/DS. There was a statistically significant difference in anastomotic leak (.5% versus 1.2%, P = .024). Interestingly, BPD/DS was less likely to require dehydration treatments (4.2% versus 2.2%, P = .009) and had fewer readmissions within 30 days (7.3% versus 5.4%, P = .043). CONCLUSIONS Complication rates after conversion of SG to RYGB or BPD/DS may be significantly lower than previously reported and only slightly higher than after primary weight loss surgery. SG conversion to either RYGB or BPD/DS remain safe, viable options for patients who had insufficient weight loss or regain, and BPD/DS may be the better option in the appropriate patient.
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Park JH, Kim SM. High-rate of long-term revision surgery due to weight regain after Laparoscopic Gastric Greater Curvature Plication (LGGCP). Asian J Surg 2023; 46:850-855. [PMID: 36155163 DOI: 10.1016/j.asjsur.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To present the long-term clinical outcomes of laparoscopic gastric greater curvature plication (LGGCP) in terms of weight loss and revision surgery rate. MATERIAL AND METHODS This single-center study involved a retrospective analysis of patients that underwent revision surgery after LGGCP due to weight regain. Demographic and anthropometric data, comorbidities, operation time, hospital stays, mortalities, and immediate and long-term postoperative complications were analyzed. Postoperative Body Mass Index (BMI), %total weight loss (TWL), and complications were collected during follow-up. RESULTS Of the 75 patients that underwent LGGCP at our hospital from March 2013 to February 2016, 13 (13/75, 17.3%) underwent revision surgery. All patients except one opted for sleeve gastrectomy. The mean interval between LGGCP and revision surgery was 71.0 ± 12.0 months (range, 54.8-93.6), and mean body weight, BMI, and TWL at revision were 89.2 ± 11.3 kg, 33.9 ± 4.2 kg/m2, and 4.7 ± 9.3%, respectively. The main reason for revision was weight regain. Additional problems were chronic intermittent GERD (4/13, 30.8%), dyspepsia (4/13,30.8%), and chronic relapsing melena (1/13, 7.7%). Two patients experienced immediate postoperative complications (Clavien-Dindo II and III). At one year after revision surgery, the mean body weight, BMI, and additional %TWL from revision surgery were 63.0 ± 5.3 kg, 24.0 ± 2.9 kg/m2, and 28.7 ± 8.0%, respectively. One of four patients (1/4, 25%) that complained of GERD before revision surgery, was still on PPI medication at 1 year after revision surgery. CONCLUSION Although LGGCP showed initial acceptable weight loss outcomes, long term (>5 years) follow-up showed that LGGCP is associated with a high rate of revision surgery (17.3%) due to weight regain.
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Affiliation(s)
- Ji-Hyeon Park
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Seong-Min Kim
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, South Korea.
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Kennedy C, Podkameni D, King WC. Letter to the Editor. Surg Obes Relat Dis 2022; 18:1254-1255. [DOI: 10.1016/j.soard.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
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Abboud DM, Yao R, Rapaka B, Ghazi R, Ghanem OM, Abu Dayyeh BK. Endoscopic Management of Weight Recurrence Following Bariatric Surgery. Front Endocrinol (Lausanne) 2022; 13:946870. [PMID: 35909531 PMCID: PMC9329792 DOI: 10.3389/fendo.2022.946870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Metabolic and bariatric surgery is the most effective therapy for weight loss and improving obesity-related comorbidities, comprising the Roux-en-Y gastric bypass (RYGB), gastric banding, sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch. While the effectiveness of weight loss surgery is well-rooted in existing literature, weight recurrence (WR) following bariatric surgery is a concern. Endoscopic bariatric therapy presents an anatomy-preserving and minimally invasive option for managing WR in select cases. In this review article, we will highlight the endoscopic management techniques for WR for the most commonly performed bariatric surgeries in the United States -RYGB and SG. For each endoscopic technique, we will review weight loss outcomes in the short and mid-terms and discuss safety and known adverse events. While there are multiple endoscopic options to help address anatomical issues, patients should be managed in a multidisciplinary approach to address anatomical, nutritional, psychological, and social factors contributing to WR.
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Affiliation(s)
- Donna Maria Abboud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Rebecca Yao
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Babusai Rapaka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Rabih Ghazi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Omar M. Ghanem
- Department of Surgery Mayo Clinic, Rochester, MN, United States
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Barham K. Abu Dayyeh,
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