Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including same day discharge after RYGB, endoscopy management of sleeve gastrectomy stenosis, RYGB was associated with higher rates of dyslipidaemia remission after four years compared with VSG, hiatus hernia as a complication of gastric banding and large variations in life expectancy for type 2 diabetics across 23 high-income countries (please note, log-in maybe required to access the full paper).
Is Same-Day Discharge After Roux-en-Y Gastric Bypass Safe? A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database Analysis
Investigators at the University of Illinois at Chicago, Chicago, IL, have reported that same-day discharge (SDD) after RYGB seems to be safe and has comparable outcomes to admitted patients.
Writing in Obesity Surgery, they sought to analyse the safety of SDD after RYGB and compare its outcomes to inpatients discharged on postoperative days 1–2. They performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the period 2015–2020. Patients who underwent primary laparoscopic RYGB and were discharged the same day of the operation (SDD-RYGB) and inpatients discharged on postoperative days 1–2 (In-RYGB) were compared. Primary outcomes of interest were overall morbidity, serious morbidity, readmission, reoperation, intervention, and mortality rates.
A total of 167,188 patients were included; 2156 (1.3%) SDD-RYGB and 165,032 (98.7%) In-RYGB. Mean age, proportion of females and mean body mass index at baseline were similar between groups. Overall morbidity (SDD-RYGB: 11.3% vs. In-RYGB: 10.2%; OR: 1.2, p = 0.08), serious morbidity (SDD-RYGB: 3.1% vs. In-RYGB: 3%; OR: 1.03, p=0.81), reoperation (SDD-RYGB: 1.4% vs. In-RYGB: 1.2%; OR: 1.16, p=0.42), readmission (SDD-RYGB: 4.8% vs. In-RYGB: 4.8%; OR: 1.01, p=0.89), and mortality (SDD-RYGB: 0.04% vs. In-RYGB: 0.09%; OR: 0.53, p=0.53) were comparable between groups. SDD-RYGB had lower risk of 30-day interventions (SDD-RYGB: 1.1% vs. In-RYGB: 1.6%; OR: 0.64, p=0.04) compared to In-RYGB.
The researchers added that standardised patient selection criteria and perioperative management protocols are needed to further increase the safety of this practice.
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Endoscopy management of Sleeve Gastrectomy Stenosis. What we learned from 202 consecutive patients
French researchers have concluded that gastric sleeve stenosis (GSS) should be considered as a chronic disease and an endoscopic approach seems to be the most successful treatment with a prolonged positive outcome of 69%.
Reporting in SOARD, the paper’s authors evaluated the role of endoscopy in the management of post laparoscopic sleeve gastrectomy (LSG) stenosis, using a standardised approach according to the characteristic of stenosis.
In this retrospective, observational, single centre study on patients referred from several bariatric surgery departments to an endoscopic referral centre, 202 patients underwent endoscopy in a fluoroscopy setting, a systematic classification of type, site, and length of the GSS was performed. According to the characteristics of the stenosis, patients underwent pneumatic dilatation, Self-Expandable-Metal-Stent (SEMS) or Lumen-Apposed-Metal-Stent (LAMS) placement. Failure of endoscopic treatment was considered an indication for redo-surgery, while patients with partial or complete response were followed up for two years. In case of recurrence a different endoscopic approach was performed.
They found inflammatory strictures in 4.5%, pure narrowing in 11%, and functional stenosis in 84.5% of patients. Stenosis was in the upper tract of the stomach in 53 patients, while medium and distal stenosis was detected in 138 and 11 patients, short stenosis in 194 out of 202 patients. In total, 126 patients underwent to pneumatic dilatation, eight to SEMS placement, 64 to LAMS position and 36 to combined therapy. Overall rate of endoscopy success was 69%.
They stated that characteristics of the stenosis should guide the most suitable endoscopic approach.
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Remission and Relapse of Dyslipidemia After Vertical Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass in a Racially and Ethnically Diverse Population
US researchers have reported that racially and ethnically diverse cohort of patients who underwent bariatric and metabolic surgery in clinical practices, RYGB was associated with higher rates of dyslipidaemia remission after four years compared with vertical sleeve gastrectomy (VSG).
Writing in JAMA Network Open, they compared four-year outcomes associated with VSG vs RYGB for remission and relapse of dyslipidaemia. The study included patients with dyslipidaemia at the time of surgery who underwent VSG (4,142 patients) or RYGB (2,853 patients).
Dyslipidaemia outcomes at four years were discovered in 2,168 patients (75.9%) undergoing RYGB and 3,999 (73.9%) undergoing VSG. Remission was significantly higher for those who underwent RYGB (824 [38.0%]) compared with VSG (1120 [28.0%]), with no differences in relapse (455 [21.0%] vs 960 [24.0%]). Without accounting for relapse, remission of dyslipidaemia after four years was 58.9% (1,279) for those who underwent RYGB and 51.9% (2,079) for those who underwent VSG. Four-year differences between operations were most pronounced for patients 65 years or older, those with cardiovascular disease or non-Hispanic Black patients and White patients.
Although RYGB was associated with higher rates of dyslipidaemia remission after four years compared with VSG, the authors noted that almost one-quarter of all patients experienced relapse, suggesting that patients should be monitored closely throughout their postoperative course to maximize the benefits of these operations for treatment of dyslipidaemia.
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Hiatus Hernia as a Complication of Gastric Banding: A Systematic Review and Meta-Analysis
An international team of researchers have reported that laparoscopic adjustable gastric banding (LAGB) could play in a role in the creation of symptomatic hiatal hernias (HHs) however, further research is needed to underpin the mechanism and confirm causation.
Writing in Cureus, their systematic review identified five studies (7,033 patients) that met all eligibility criteria and were included in the meta-analysis.
The included studies show a comparable rate of post-operative HH; the fact that HHs can become symptomatic following the adjustable gastric banding (AGB) procedure indicates that AGB plays a role in creating symptomatic hiatal hernias at the very least.
“Further research is needed to underpin the mechanism and confirm causation,” they concluded. “However, this complication should potentially be discussed with patients opting for this kind of operation as it can be a reason for re-operation.”
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Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study
A team of international researchers have reported large variations in life expectancy for type 2 diabetics across 23 high-income countries with the lifetime risk of type 2 diabetes ranging from 16.3% for Scottish women to 59.6% for Singaporean men.
In the study, published in The Lancet Diabetes and Endocrinology, the investigators sought to estimate lifetime risk, life expectancy and years of life lost for type 2 diabetes in the high-income setting.
For people with T2DM, the highest life expectancies were found for both sexes in Japan in 2017–18, where life expectancy at age 20 years was 59.2 years (95% CI 59·2–59·3) for men and 64.1 years (64.0–64.2) for women. Lithuania had the lowest life expectancy at age 20 years with T2DM observed in 2013–14 for (437 years [42.7–44.6]) for men and in 2010–11 in Latvia (54.2 years [53.4–54.9]) for women. Life expectancy in people with T2DM increased with time for both sexes in all countries, apart from for Spain and Scotland.
The authors also reported that the life expectancy gap between those with and without T2DM declined substantially in Latvia from 2010–11 to 2015–16 and in the USA from 2009–10 to 2014–15.Years of life lost to T2DM ranged from 2.5 years (Latvia; 2015–16) to 12.9 years (Israel Clalit Health Services; 2015–16) for 20-year-old men and from 3.1 years (Finland; 2011–12) to 11.2 years (Israel Clalit Health Services; 2010–11 and 2015–16) for 20-year-old women. The greatest decrease in years of life lost to T2DM was found in the USA between 2009–10 and 2014–15 for 20-year-old men (a decrease of 2.7 years).
They noted that despite declining lifetime risk and improvements in life expectancy for type 2 diabetics, the burden of type 2 diabetes “remains substantial”.
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