Evaluation of Quality of Life, Clinical Parameters, and Psychological Distress after Bariatric Surgery: Comparison of the Laparoscopic Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication

Evolution of depressive symptoms from before to 24 months after bariatric surgery: A systematic review and meta-analysis

AIMS

Depression after bariatric surgery can lead to suboptimal health outcomes. However, it is unclear how depressive symptoms evolve over the 24 months after surgery. We determined the extent depressive symptoms changed up to 24 months after bariatric surgery and how this was impacted by measurement tool and surgical procedure.

METHODS

We conducted a systematic review and meta-analysis, searching five databases from database inception to June 2021 for studies that prospectively measured depressive symptoms before and up to 24 months after bariatric surgery. Change scores were converted to Hedge's g, and analyses were performed using mixed-effects models. Subgroup analyses examined differences across time of follow-up, measurement tool, and surgical procedure.

FINDINGS

Forty-six studies met inclusion criteria (32,342 patients). Meta-analysis indicated a postsurgical reduction in depressive symptom scores that were significant (large effect, g = 0.804; 95% CI: 0.73-0.88, I²  = 95.7%). Subgroup analyses found that symptom reductions did not differ between the timing of follow-up periods, measurement tool, and surgical procedure.

CONCLUSIONS

Depressive symptom scores reduced substantially following surgery; comparable decreases occurred 6 through 24 months after surgery. These findings can help inform practitioners of the typical evolution of depressive symptoms following surgery and where deviations from this may require additional intervention.

Quality of Life After Bariatric Surgery-a Systematic Review with Bayesian Network Meta-analysis

OBJECTIVE

Comprehensive analysis and comparison of HRQoL following different bariatric interventions through systematic review with network meta-analysis.

BACKGROUND

Different types of bariatric surgeries have been developed throughout the years. Apart from weight loss and comorbidities remission, improvement of health-related quality of life (HRQoL) is an important outcome of metabolic surgery.

METHODS

MEDLINE, EMBASE, and Scopus databases have been searched up to April 2020. Inclusion criteria to the analysis were (1) study with at least 2 arms comparing bariatric surgeries; (2) reporting of HRQoL with a validated tool; (3) follow-up period of 1, 2, 3, or 5 years. Network meta-analysis was conducted using Bayesian statistics. The primary outcome was HRQoL.

RESULTS

Forty-seven studies were included in the analysis involving 26,629 patients and 11 different surgeries such as sleeve gastrectomy (LSG), gastric bypass (LRYGB), one anastomosis gastric bypass (OAGB), and other. At 1 year, there was significant difference in HRQoL in favor of LSG, LRYGB, and OAG compared with lifestyle intervention (SMD: 0.44; 95% CrI 0.2 to 0.68 for LSG, SMD: 0.56; 95% CrI 0.31 to 0.8 for LRYGB; and SMD: 0.43; 95% CrI 0.06 to 0.8 for OAGB). At 5 years, LSG, LRYGB, and OAGB showed better HRQoL compared to control (SMD: 0.92; 95% CrI 0.58 to 1.26, SMD: 1.27; 95% CrI 0.94 to 1.61, and SMD: 1.01; 95% CrI 0.63 to 1.4, respectively).

CONCLUSIONS

LSG and LRYGB may lead to better HRQoL across most follow-up time points. Long-term analysis shows that bariatric intervention results in better HRQoL than non-surgical interventions.

Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review

Obesity is a leading global epidemic. Bariatric surgery is the only treatment demonstrating substantial long-term weight loss and medical benefits. However, there is limited research on the psychological outcomes following surgery. Therefore, the primary aim of this study was to systematically review depression, anxiety, and binge eating outcomes at different time points following bariatric surgery and identify whether bariatric surgery significantly reduces psychological symptoms over time. These outcomes were also examined among endoscopic bariatric procedures as a secondary aim. Forty-eight studies met inclusion criteria. Findings suggested that most patients experience a short-term reduction in anxiety and depression symptoms from pre-surgery. Over time, however, these symptoms increase and may even return to pre-surgery levels. Furthermore, while binge eating was uncommon after surgery, other disordered eating patterns may emerge. Binge eating may also restart over time as the stomach enlarges again. Overall, the complex psychological difficulties faced by individuals with obesity continue after surgery and may contribute to longer-term weight recidivism. More comprehensive and standardised psychological assessment procedures, including clinical interviews and longer-term follow-up, may provide insight into the psychological mechanisms maintaining weight management issues, and may serve as a starting point for improving the long-term success of patients with obesity.

Laparoscopic Gastric Plication versus Laparoscopic Sleeve Gastrectomy: An Up-to-Date Systematic Review and Meta-Analysis

Introduction

A meta-analysis was conducted in order to provide an up-to-date comparison of laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric plication (LGP) for morbid obesity.

Materials and Methods

The PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were used for the conduction of this study. A systematic literature search was performed in the electronic databases (MEDLINE, CENTRAL, and Web of Science and Scopus). The fixed effects or random effects model was used according to the Cochran Q test.

Results

Totally, 12 eligible studies were extracted. LSG displayed a statistically significant lower rate of overall complications (OR: 0.35; 95% CI: 0.17, 0.68; p=0.002) and a sustainable higher %EWL through all time endpoints (OR: 4.86, p=0.04; OR: 7.57, p < 0.00001; and OR: 13.74; p < 0.00001). There was no difference between the two techniques in terms of length of hospital stay (p=0.16), operative duration (p=0.81), reoperation rate (p=0.51), and cost (p=0.06).

Conclusions

LSG was demonstrated to have a lower overall complications and a higher weight loss rate, when compared to LGP. Further RCTs of a higher methodological quality level, with a larger sample size, are required in order to validate these findings.