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 an ASMBS review looing at the safety and recommendations for fasting for religious purposes after having metabolic and bariatric surgery, five-year outcomes from robotic vs. laparoscopic metabolic and bariatric surgery, two-year outcomes from a study assessing the POSE2.0, latest findings from the LOOK AHEAD study group, a paper reporting that ursodeoxycholic acid (UDCA) can effectively prevent the formation of gallstones after bariatric surgery in patients without preoperative gallstones, and investigators from Egypt have concluded that Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy (please note, log-in maybe required to access the full paper).
American Society for Metabolic and Bariatric Surgery Review on Fasting for Religious Purposes after Surgery
Writing on behalf of the American Society of Metabolic and Bariatric Surgery Integrated Health Clinical Issues Committee, US researchers have published a paper following requests made to the Society by patients, physicians, Society members, hospitals, health insurance payors, the media, and others regarding the safety and recommendations for fasting for religious purposes after having metabolic and bariatric surgery.
Published in SOARD, the review is a summary of published, peer reviewed scientific evidence spanning years from 2000 to 2020, and a recently published 2021 Delphi Consensus and expert opinion. The intent of issuing the review is to provide available objective information about this topic.
However, they acknowledge that there is lack of published research on the effects of religious fasting on metabolic and bariatric surgery (MBS), therefore, the majority of the reviewed literature covers the effects of religious fasting on adults without MBS.
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Robotic vs. Laparoscopic Metabolic and Bariatric Surgery, Outcomes over 5 Years in Nearly 800,000 Patients
US researchers have reported that both robotic SG and RYGB were found to have significantly longer operative times than laparoscopic SG and RYGB.
Reporting their findings in Obesity Surgery, they analysed data from the MBSAQIP database, which included information on 791,423 patients from 2015–2019 in the US. Within this retrospective case–control study, 13.7% of SG and 16.6% of RYGB cases were performed robotically.
They found that robotic BMS increased mean operative time by 26 min for SG and 40 min for RYGB. However, this did not increase the 30-day venous thromboembolism (VTE) or organ dysfunction complications between the two groups. Robotic SG had slightly higher risks of multiple infectious complications (OR 1.26 to 1.76) and robotic RYGB had slightly lower infectious complications and transfusion requirements. Robotic BMS had higher 30-day readmission rates and 30-day re-operative rates for both SG and RYGB.
They concluded that potential outcome benefits from robotic BMS can include a reduction in infectious complications and transfusion requirements with robotic RYGB cases. SGs were found to have slightly higher infectious complications.
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Prospective Multicenter Study of the Primary Obesity Surgery Endoluminal (POSE2.0) Procedure for Treatment of Obesity
Writing in the journal of Clinical Gastroenterology and Hepatology, an international team of researchers has report that the POSE2.0 procedure is an effective and durable endoscopic bariatric therapy which may influence physiologic pathways impacting satiety out to two years.
The prospective, multi-centre trial examined the safety, efficacy, durability and physiologic effects of POSE2.0 in adults with obesity. Primary outcomes were percent total body weight loss (%TBWL) and proportion of patients achieving >5% TBWL at 12 months. Secondary outcomes included change in obesity co-morbidities, satiety, quality of life at six-months, and durability of plications at 12 and 24-months.
In total, 44 patients (61% female, mean age 45±9.7 years, mean BMI 37±2.1 kg/m2) were enrolled. An average of 19 suture anchor pairs were used, with a mean duration of 37±11 min and the procedure was technically successful in all subjects. The mean %TBWL at 12 months was 15.7±6.8% and %TBWL >5%, >10%, and >15% was achieved in 98%, 86%, and 58% of patients at 12-months.
Improvements in lipid profile, liver biochemistries, and hepatic steatosis were seen at 6 months. Improvements in hepatic steatosis persisted for 24-months in a subgroup of patients (p<0.01).
POSE2.0 reduced maximum tolerated meal volume (p=0.03) and was associated with increased fullness (p<0.01) and improved eating behaviour (p<0.01) at six-months. Repeat assessment at 24-months (n=26) showed fully intact plications.
The authors stated that larger comparative studies are needed to further elucidate these initial findings.
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Weight Change During the Postintervention Follow-up of Look AHEAD
Researchers writing on behalf of the LOOK AHEAD study group, have found that steep weight loss post-intervention was associated with increased risk of mortality. Reporting in Diabetes Care, they examined weight change during the postintervention period of Look AHEAD, a randomised trial comparing intensive lifestyle intervention (ILI) with diabetes support and education (DSE) (control) in individuals with overweight/obesity with type 2 diabetes and sought to identify predictors of excessive postintervention weight loss and its association with mortality.
These secondary analyses compared postintervention weight change (year eight to final visit; median 16 years) in ILI and DSE in 3,999 Look AHEAD participants. Using empirically derived trajectory categories, they compared four subgroups: weight gainers (n=307), weight stable (n=1,561), steady losers (n=1,731) and steep losers (n = 380), on postintervention mortality, demographic variables, and health status at randomisation and year eight.
Postintervention weight change averaged −3.7 ± 9.5%, with greater weight loss in the DSE than the ILI group. The steep weight loss trajectory subgroup lost on average 17.7 ± 6.6%; 30% of steep losers died during postintervention follow-up versus 10–18% in other trajectories (p<0001).
The following variables distinguished steep losers from weight stable: baseline, older, longer diabetes duration, higher BMI, and greater multimorbidity; intervention, randomization to control group and less weight loss in years 1–8; and year eight, higher prevalence of frailty, multimorbidity, and depressive symptoms and lower use of weight control strategies.
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Effect of ursodeoxycholic acid on gallstone formation after bariatric surgery: An updated meta-analysis
Chinese investigators have reported that ursodeoxycholic acid (UDCA) can effectively prevent the formation of gallstones after bariatric surgery in patients without preoperative gallstones.
Their literature search concluded with 18 studies, including 4,827 participants who met the inclusion criteria. The statistical results showed that the incidence of gallstones in the UDCA group was significantly lower than in the control group. Furthermore, the occurrence of symptomatic gallstones and cholecystectomy was significantly reduced.
Reporting in the journal Obesity, they added that UDCA can significantly reduce the occurrence of symptomatic gallstones and the risk of postoperative cholecystectomy. Doses of 500 to 600 mg/d can be used as a measure to prevent postoperative gallstone formation.
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A Randomized Controlled Trial for Prevention of Postoperative Nausea and Vomiting after Laparoscopic Sleeve Gastrectomy: Aprepitant/Dexamethasone vs. Mirtazapine/Dexamethasone
Investigators from Egypt, writing in Anesthesiology Research and Practice, have concluded that Aprepitant/dexamethasone combination and mirtazapine/dexamethasone combination were superior to dexamethasone alone in alleviating postoperative nausea and vomiting in morbidly obese patients scheduled to undergo laparoscopic sleeve gastrectomy.
Their study included 90 patients scheduled for LSG were randomly allocated to receive 8mg dexamethasone intravenous infusion (IVI) only in the D group or in addition to 80mg aprepitant capsule in the A/D group or in addition to 30mg mirtazapine tablet in the M/D group.
The primary outcome was the complete response 0‐24 h after surgery. Collective postoperative nausea and vomiting (PONV), postoperative pain, side effects and patient satisfaction score were considered as secondary outcomes.
They found that A/D and M/D groups were superior to the D group for a complete response within 0–24 h after surgery (79.3% for the A/D group, 78.6% for the M/D group, and 20.7% for the D group). The D group was inferior to the A/D and M/D groups regarding collective PONV and use of rescue antiemetic 0–24 h after surgery (p<0.001, p<0.001, respectively).
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