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Gagner M, Almutlaq L, Gnanhoue G, Buchwald JN. Magnetic single-anastomosis side-to-side duodeno-ileostomy for revision of sleeve gastrectomy in adults with severe obesity: 1-year outcomes. World J Surg 2024. [PMID: 39090770 DOI: 10.1002/wjs.12304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Uncomplicated surgical approaches that minimize anastomotic complications while improving revisional metabolic/bariatric surgical (MBS) outcomes are needed. METHODS This prospective single-center study assessed the feasibility, safety, and efficacy of the novel linear magnetic anastomosis system (LMAS [3 cm]) in performing a side-to-side duodeno-ileostomy (MagDI) bipartition to revise clinically suboptimal primary sleeve gastrectomy (SG). Patients with severe obesity with/without type 2 diabetes (T2D) with suboptimal weight loss, regain, and/or T2D recurrence post SG underwent revisional MagDI. A distal and proximal magnet were delivered endoscopically to the ileum and duodenum and aligned via laparoscopic assistance. Gradual magnet fusion formed a DI bipartition. PRIMARY ENDPOINTS technical feasibility, safety (Clavien-Dindo [CD] severe adverse event classification) at 1 year. Secondary endpoints: MBS weight and T2D reduction. RESULTS July 29, 2022-March 28, 2023, 24 patients (95.8% female, mean age 44.9 ± 1.5 years, and body mass index [BMI] 39.4 ± 1.3 kg/m2) underwent MagDI. Feasibility was attained via correct magnet placement (mean operative time 63.5 ± 3.3 min), patent anastomoses created, and magnet passage per anus in 100.0% of patients. There were 4 CD-III mild or moderate severe AEs, 0.0% associated with the LMAS or MagDI: 0.0% anastomotic leakage, obstruction, bleeding, infection, reintervention, or death. Mean BMI reduction was 2.1 kg/m2 (p < 0.05); total weight loss 5.3%, excess weight loss 16.4%; and the patient with T2D improved. CONCLUSION The single-anastomosis MagDI procedure using the novel 3-cm LMAS to revise clinically suboptimal SG was technically straightforward, incurred no major complications, mitigated weight regain, and renewed clinically meaningful weight loss. CLINICALTRIALS GOV IDENTIFIER NCT05322122.
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Affiliation(s)
- Michel Gagner
- Westmount Square Surgical Center, Westmount, Quebec, Canada
| | | | | | - J N Buchwald
- Medwrite Medical Communications, Maiden Rock, Wisconsin, USA
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Gagner M, Almutlaq L, Cadiere GB, Torres AJ, Sanchez-Pernaute A, Buchwald JN, Abuladze D. Side-to-side magnetic duodeno-ileostomy in adults with severe obesity with or without type 2 diabetes: early outcomes with prior or concurrent sleeve gastrectomy. Surg Obes Relat Dis 2024; 20:341-352. [PMID: 38114385 DOI: 10.1016/j.soard.2023.10.018] [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: 06/28/2023] [Revised: 10/19/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Conventional metabolic/bariatric surgical anastomoses with sutures/staples may cause severe adverse events (AEs). OBJECTIVES The study aim was to evaluate the feasibility, safety, and effectiveness of primary and revisional side-to-side duodeno-ileostomy (DI) bipartition using a novel magnetic compression anastomosis device (Magnet Anastomosis System [MS]). SETTING Multicenter: private practices and university hospitals. METHODS In patients with body mass index ([BMI, kg/m2] ≥35.0 to ≤50.0 with/without type 2 diabetes [T2D] glycosylated hemoglobin [HbA1C > 6.5 %]), two linear MS magnets were delivered endoscopically to the duodenum and ileum with laparoscopic assistance and aligned, initiating magnet fusion and gradual DI (MagDI). The MagDI-after-SG group had undergone prior sleeve gastrectomy (SG); the MagDI + SG group underwent concurrent SG. AEs were graded by Clavien-Dindo Classification (CDC). RESULTS Between November 22, 2021 and May 30, 2023, 43 patients (88.0% female, mean age 43.7 ± 1.3 years) underwent the study procedures. The MS met feasibility criteria of magnet device placement, creation of patent anastomoses confirmed radiologically, and magnet passage in 100.0% of patients. There were 64 AEs, most were CDC grade I and II, significantly fewer in the MagDI-after-SG group (P < .001). No device-related AEs including anastomotic leakage, bleeding, obstruction, infection, or death. The MagDI-after-SG group experienced 6-month mean weight loss of 8.0 ± 2.5 kg (P < .01), 17.4 ± 5.0% excess weight loss (EWL). The MagDI + SG group had significantly greater weight loss (34.2 ± 1.6 kg, P < .001), 66.2 ± 3.4% EWL. All patients with T2D improved. CONCLUSIONS In early results of a multicenter study, the incisionless, sutureless Magnet System formed patent, complication-free anastomoses in side-to-side DI with prior or concurrent SG.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, Westmount, Quebec, Canada.
| | - Lamees Almutlaq
- Department of Surgery, Westmount Square Surgical Center, Westmount, Quebec, Canada
| | | | - Antonio J Torres
- Department of Surgery, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Jane N Buchwald
- Medwrite Medical Communications, Maiden Rock, Wisconsin, USA
| | - David Abuladze
- Department of Surgery, Innova Medical Center, Tbilisi, Republic of Georgia
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Mela V, Agüera Z, Alvarez-Bermudez MD, Martín-Reyes F, Granero R, Sánchez-García A, Oliva-Olivera W, Tomé M, Moreno-Ruiz FJ, Soler-Humanes R, Fernández-Serrano JL, Sánchez-Gallegos P, Martínez-Moreno JM, Sancho-Marín R, Fernández-Aranda F, García-Fuentes E, Tinahones FJ, Garrido-Sánchez L. The Relationship between Depressive Symptoms, Quality of Life and miRNAs 8 Years after Bariatric Surgery. Nutrients 2023; 15:4109. [PMID: 37836393 PMCID: PMC10574314 DOI: 10.3390/nu15194109] [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: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: There are conflicting results on whether weight loss after bariatric surgery (BS) might be associated with quality of life (QoL)/depressive symptomatology. We aim to determine whether BS outcomes are associated with QoL/depressive symptomatology in studied patients at the 8-year follow-up after BS, as well as their relationship with different serum proteins and miRNAs. (2) Methods: A total of 53 patients with class III obesity who underwent BS, and then classified into "good responders" and "non-responders" depending on the percentage of excess weight lost (%EWL) 8 years after BS (%EWL ≥ 50% and %EWL < 50%, respectively), were included. Basal serum miRNAs and different proteins were analysed, and patients completed tests to evaluate QoL/depressive symptomatology at 8 years after BS. (3) Results: The good responders group showed higher scores on SF-36 scales of physical functioning, role functioning-physical, role functioning-emotional, body pain and global general health compared with the non-responders. The expression of hsa-miR-101-3p, hsa-miR-15a-5p, hsa-miR-29c-3p, hsa-miR-144-3p and hsa-miR-19b-3p were lower in non-responders. Hsa-miR-19b-3p was the variable associated with the response to BS in a logistic regression model. (4) Conclusions: The mental health of patients after BS is limited by the success of the intervention. In addition, the expression of basal serum miRNAs related to depression/anxiety could predict the success of BS.
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Affiliation(s)
- Virginia Mela
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Zaida Agüera
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
- Departament d’Infermeria de Salut Pública, Salut Mental i Maternoinfantil, Escola d’Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
| | - Maria D. Alvarez-Bermudez
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Flores Martín-Reyes
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
| | - Roser Granero
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Ana Sánchez-García
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Wilfredo Oliva-Olivera
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Monica Tomé
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - Francisco J. Moreno-Ruiz
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Regional Universitario de Málaga, 29010 Malaga, Spain;
| | - Rocío Soler-Humanes
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain; (R.S.-H.); (J.L.F.-S.)
| | - Jose L. Fernández-Serrano
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain; (R.S.-H.); (J.L.F.-S.)
| | - Pilar Sánchez-Gallegos
- Department of Surgical Specialities, Biochemistry and Immunology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain; (P.S.-G.); (J.M.M.-M.); (R.S.-M.)
| | - Jose M. Martínez-Moreno
- Department of Surgical Specialities, Biochemistry and Immunology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain; (P.S.-G.); (J.M.M.-M.); (R.S.-M.)
| | - Raquel Sancho-Marín
- Department of Surgical Specialities, Biochemistry and Immunology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain; (P.S.-G.); (J.M.M.-M.); (R.S.-M.)
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge, 08907 Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
| | - Eduardo García-Fuentes
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Francisco J. Tinahones
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Lourdes Garrido-Sánchez
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
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