Current Status of Bariatric and Metabolic Surgery in Korea

Survey of Information Acquisition and Satisfaction after Bariatric Surgery at a Tertiary Hospital in Korea

Background

To determine how patients who underwent bariatric surgery at a tertiary hospital in Korea first considered and then decided to get the surgery and identify information gaps among patients and healthcare professionals.

Methods

This study included 21 patients who underwent bariatric surgery to treat morbid obesity (body mass index [BMI] ≥35 or ≥30 kg/m2 together with obesity-related comorbidities) between August 2020 and February 2022. A telephone interview was conducted with the patients after at least 6 months had elapsed since the surgery. We asked how the patients decided to undergo bariatric surgery. We also inquired about their satisfaction with and concerns about the surgery.

Results

Seventy-one percent of the patients were introduced to bariatric surgery following a recommendation from healthcare professionals, acquaintances, or social media. Most of the patients (52%) decided to undergo bariatric surgery based on recommendations from healthcare professionals in non-surgical departments. Satisfaction with the information provided differed among the patients. Post-surgical concerns were related to postoperative symptoms, weight regain, and psychological illness.

Conclusion

Efforts are needed to raise awareness about bariatric surgery among healthcare professionals and the public. Tailored pre- and postoperative consultation may improve quality of life after bariatric surgery.

Comparison of Eastern and Western patients undergoing bariatric surgery at two US and Korean institutions: a retrospective analysis of differing bariatric patient populations

BACKGROUND

Currently, there are differences in both demographics and indications for bariatric surgery between Eastern and Western countries. We compared postoperative outcomes between Korean and American bariatric programs in order to assess how bariatric surgery differently affects these populations.

METHODS

We enrolled 540 patients who underwent bariatric surgery at University of California, Los Angeles (UCLA) and 85 patients who underwent surgery at Kosin University Gospel Hospital (KUGH) between January 2019 and December 2020. We compared demographics, complications, weight loss, and metabolic parameters between these groups.

RESULTS

There was a difference in age between the UCLA and KUGH patient groups (44.3 years vs 37.6 years, P < 0.01). Frequencies of T2DM and OSA were also different (4.2% vs 50.6%, 34.1% vs 85.9% P < 0.01. Length of hospital stay varied (1.55 days vs 6.68 days, P < 0.01), but there was no difference in operating time and complications. There was no difference in percent of excess weight loss between the two groups at 6 months (29.7 vs 33.8, P = 0.13). Hepatic steatosis index (HSI) was higher in the UCLA group both before (54.2 vs 51.5, P < 0.01) and after (44.4 vs 40.0, P = 0.02) surgery. LSG was the most frequently performed operation, and robotic surgery and revisions were performed only in the UCLA program.

CONCLUSION

There were differences in age, BMI, length of stay, and choice of operation between Korean and American bariatric patients. Also, there were differences in the degree of fatty liver disease using HSI and liver enzymes before and after surgery. There was no significant differences in operation time and complications. These findings suggest differences in bariatric practices and reactions to bariatric surgery in Eastern and Western settings.

Surgical outcomes of laparoscopic sleeve gastrectomy by a single surgeon: Before and after learning curve in a non-tertiary low-volume bariatric center

BACKGROUND

In Korea, the need for bariatric surgery (BS) is increasing because of the increasing incidence of morbid obesity. There is no special training program for BS, and most BS are conducted in non-tertiary hospitals in capital area. We evaluated the surgical outcomes of laparoscopic sleeve gastrectomy (LSG) before and after the learning curve (LC) to prove that the barrier of entry for LSG is not very high.

METHODS

We retrospectively analyzed the data of patients who underwent LSG in a secondary hospital without the supervision of an experienced surgeon between April 2019 and August 2022. We compared the surgical outcomes and changes in body measurements before the LC (BL) and after the LC (AL) after 1 year of follow-up.

RESULTS

The duration of operation for BL and AL were 118.4 and 61.9 min (p = 0.000), respectively. No mortality was observed. There were four and eight cases of morbidity; the weight loss after 1 year was 90.6 and 89.7 kg (p = 0.804); changes in body mass index (BMI) were 10.3 and 10.2 kg/m2 (p = 0.928); excess weight loss after 1 year was 93.0 and 89.3% (p = 0.762); and excess BMI loss after 1 year was 92.7 and 89.5% (p = 0.807) in the BL and AL groups, respectively. %Total weight loss was 26.8 and 23.7 in the BL and AL group. There was no statistical significance of all parameters of body measurements between two groups.

CONCLUSION

LSG can be safely and effectively performed by novice bariatric surgeons in non-tertiary hospitals if patients are cautiously selected. Surgical outcomes of BL and AL is not different, except for the operation time.

Factors Associated With Loss to Follow-up After Laparoscopic Sleeve Gastrectomy: A Single-Center Retrospective Study

Purpose

After bariatric surgery, postoperative follow-up is important for evaluating long-term outcomes, such as successful weight loss and improvement of metabolic parameters. However, many patients are lost to follow-up within 1 year. This study aimed to identify the follow-up rate of bariatric surgery and predictive factors of loss to follow-up (LTF).

Materials and Methods

We retrospectively reviewed the data of 61 patients receiving bariatric surgery for obesity (laparoscopic sleeve gastrectomy; LSG group) and 872 for early gastric cancer (EGC group) from November 2018 to July 2020 in a single center. After 1:1 matching, we compared the LTF rate. In the LSG group, we analyzed the factors associated with LTF. Additionally, we collected weight data in the LTF group by a telephone survey.

Results

By 1:1 matching, 47 patients for each group were identified. The LTF rates of the LSG and EGC groups were 34.0% (16 patients) and 2.1% (one patient), respectively (P=0.0003). In the LSG group, the LTF rate increased over the postoperative month. Of the patients, 29.5% who missed a scheduled appointment within one year comprised the LTF group. In the analysis, no significant factors associated with LTF were identified. The only factor with borderline significance was dyslipidemia with medication (P=0.094).

Conclusion

The LSG group demonstrated a high LTF rate, although adherence to follow-up was closely related to postoperative outcomes. Therefore, educating patients on the significance of follow-up is important. Particularly, continuous efforts to identify the associated factors and develop a multidisciplinary management protocol after bariatric surgery are necessary.

[Weight Loss Experience of Highly Obese Young Adult Who Underwent Bariatric Surgery]

PURPOSE

This study aimed to explore the weight loss experience of highly obese young people who underwent bariatric surgery.

METHODS

Data were collected, from October 2021 to April 2022, through individual in-depth interviews with eight highly obese young adults who underwent bariatric surgery and analyzed using Colaizzi's phenomenological method.

RESULTS

The following four theme clusters were extracted. First, 'The unbearable sorrow of obese people' explains the process of choosing bariatric surgery after fluctuations and frustration despite countless repeated weight loss attempts. Second, 'The impact aftermath of bariatric surgery' revealed participants struggling in the face of unexpected changes due to bariatric surgery. Third, 'Efforts to rebuild a healthy myself' demonstrated the struggle to regain health by using the surrounding support system to overcome the difficulties of this surgical procedure. Lastly, 'Facing life by getting rid of the yoke of obesity' displayed the experiences of the participants who felt ambivalent about their changed appearance, but coping positively with the new life.

CONCLUSION

This study provides an in-depth understanding of the weight loss experiences of highly obese adolescents who underwent bariatric surgery and presents a new perspective on clinical practice. The results of this study are expected to be useful in developing and applying systematic and customized nursing interventions before and after bariatric surgery.

Restoration for the foregut surgery: bridging gaps between foregut surgery practice and academia

Foregut surgery largely involves benign diseases, and not only malignant diseases. However, for foregut surgeons in Asia, this fact has not been extensively utilized in their clinical practice due to the high burden of gastric cancer surgery. Although the prevalence of gastroesophageal reflux disease (GERD) in Eastern Asia, including Korea, is increasing, antireflux surgery (ARS) is still a fairly rare procedure in Korea. ARS is effective as proton pump inhibitors and is cost-effective compared to continuous double-dose proton pump inhibitors in patients with severe GERD. Therefore, we should focus on ARS as a treatment option for GERD also in Asian population. Similarly, although bariatric/metabolic surgery is effective in weight reduction and diabetes mellitus (DM) remission in patients with morbid obesity or DM, bariatric/metabolic surgery is only performed in a limited number of patients. Given that the prevalence of obesity and DM is continuously increasing in Korea, bariatric/metabolic surgery should become an interest among Korean foregut surgeons and should be considered a treatment for obesity and DM. Furthermore, there are new surgical fields that can control both benign and malignant diseases. Oncometabolic surgery is a field under foregut surgery that treats both malignant and benign components of a condition, an example being the control of metabolic syndrome while performing gastric cancer surgery. Therefore, in future gastric cancer treatment, oncometabolic surgery can be applied to patients with gastric cancer accompanied by obesity or metabolic syndrome.

Early Clinical Outcomes of the Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy by Gastric Cancer Surgeons: the Analysis of Fifty Consecutive Cases

Purpose

The number of bariatric surgeries performed at our tertiary hospital has gradually increased since the national health insurance began to cover their expenses in January of 2019. This study examined the early surgical outcomes of laparoscopic sleeve gastrectomy (LSG) performed by experienced gastric cancer surgeons.

Materials and Methods

We retrospectively reviewed and analyzed data from 50 patients who underwent LSG between November of 2018 and April of 2020 at the Asan Medical Center by 1 of 5 experienced surgeons each of whom performed approximately 100-300 cases of gastrectomy annually. The age, body mass index (BMI), weight, presence of comorbidities, operation time, hospital stay after surgery, postoperative complications, postoperative excess weight loss (EWL), and resolution of comorbidities were examined.

Results

The mean age, BMI, and weight were 37.29±9.77 years, 37.12 kg/m², and 102.00 kg, respectively. The mean operation time and postoperative length of hospital stay were 109.59±35.88 and 5.06±1.20 days, respectively. Two patients (4.00%) had early postoperative complications and postoperative leakage; bleeding and stenosis were not reported. The EWL after 1 and 6 months of operation was 26.55% and 60.34%, respectively. The resolution of diabetes, hypertension, and dyslipidemia after 6 months of operation was 88.89%, 54.54%, and 50.00%, respectively.

Conclusion

LSG is safe and effective when performed by an experienced gastric cancer surgeon; however, a long-term follow-up of patients is required.