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 OAGB betters RYGB as revision surgery, acute pancreatitis following IGB insertion, Stent-Over-Sponge a rescue technique for leaks, sleeve betters Ozempic for out-of pocket costs at two years and Obesity Medicine Association updates bariatric surgery guidance, and more (please note, log-in maybe required to access the full paper).
One Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass as a Revisional Bariatric Procedure: Comparing one-year postoperative outcomes
Patients who underwent conversion from either sleeve gastrectomy (SG) or laparoscopic adjustable gastric band (LAGB) to one anastomosis gastric bypass (OAGB) experienced a greater total body weight loss (TBWL) at one-year postop compared with those who underwent conversion to Roux-en-Y gastric bypass (RYGB) without differences in nutritional deficiencies, according to researcher from NYU Grossman School of Medicine.
Published in SOARD, the study sought to assess OAGB and RYGB as revision surgery and report the differences in weight loss and nutritional status at about one year. In total, 113 patients with either a primary SG or LAGB were included in the study, 58 converted to OAGB and 55 were converted to RYGB.
The OAGB cohort had a higher TBWL compared to the RYGB. There were no significant differences in post-operative nutritional values between the groups, except for decreased vitamin B12 levels in the RYGB cohort.
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Risk Factors for Acute Pancreatitis Following Intragastric Balloon Insertion: A 7-Year Retrospective Cohort Study
Investigators from the Hamad Medical Corporation, Doha, Qatar, have reported that acute pancreatitis (AP) following intragastric balloon (IGB) insertion is uncommon but may be underreported, with substantial variability in onset time.
Reporting in Obesity Surgery, this retrospective time-to-event study was conducted over seven years, encompassing 450 patients who received IGBs between January 2017 and 2024. Cox regression analyses were performed to identify risk factors and the incidence of AP was evaluated as a secondary outcome, with patients categorised into the AP and non-AP groups at a 1:3 ratio (the Revised Atlanta Classification was used to diagnose AP).
Among 450 patients with IGB, 25 developed AP, yielding an incidence of 5.56%. The Orbera balloon was associated with a lower AP risk (HR 0.29, 95% CI: 0.09–0.96; p=0.042). The median time to AP onset was 40 days. Higher preprocedural BMI and age > 30 years showed a trend toward reduced AP risk, though not statistically significant.
The authors concluded that the findings underscore the importance of balloon selection and the need for further prospective studies to confirm these results and optimise AP risk management in IGB patients.
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Stent-Over-Sponge (SOS) as a Rescue Technique for Leak Post-Bariatric Surgery: Experience From Hôpital du Sacré-Coeur, Canada
In a case study, stent-over-sponge (SOS) technique demonstrates its safety and efficacy in dealing with post-operative leaks in patients having undergone bariatric surgery, which would justify performing more extended evaluative studies - researchers from Saudi Arabia and Canada have reported.
Writing in Cureus, their case study presents the case of a 60-year-old female patient who underwent revisional bariatric surgery and developed a leak post-operation. Initial management included endoscopic debridement and the placement of an Endo-VAC system.
Due to technical difficulties, the sponge was left in an endoluminal position, leading to migration. A partially covered stent was placed to prevent further migration and facilitate healing. The patient experienced complications, including hematemesis, but ultimately achieved complete leak closure and is asymptomatic six months post-treatment.
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Out-of-Pocket Costs Among Commercially Insured Individuals With Type 2 Diabetes and Obesity - Comparison Between Ozempic and Sleeve Gastrectomy
US researchers have found out-of-pocket (OOP) health care costs were significantly lower among individuals who had a sleeve gastrectomy (SG) versus those treated with Ozempic for patients with type 2 diabetes (T2D) and obesity.
Writing in the Annals of Surgery, 302 SGs were propensity matched on demographics, obesity-related comorbidities and baseline OOP costs in the year before treatment to 302 Ozempic patients (mean age: 50, mean baseline body mass index: 40, 41% males). OOP costs were compared in the two years after treatment using paired t tests.
OOP health care costs were similar for the SG ($2267) and Ozempic ($2131) cohorts 1 year after the index date (difference = $136, p=0.19). However, at two years the OOP health care costs were significantly lower in the SG cohort ($1155 vs $2,084, p<0.01).
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Bariatric nutrition and evaluation of the metabolic surgical patient: Update to the 2022 Obesity Medicine Association (OMA) bariatric surgery, gastrointestinal hormones, and the microbiome clinical practice statement (CPS)
A new evidence-based review from the the Obesity Medicine Association (OMA) includes an overview of current bariatric nutrition recommendations, which is intended to provide clinicians with more advanced knowledge and skills in nutrition assessment and management of the preoperative and post-surgical MBS patients.
Written by US researchers and published in the Annals of Surgery, this Clinical Practice Statement is an update to the 2022 OMA CPS. In particular, the section on macronutrients, micronutrients, and bariatric surgery has been updated, highlighting practical approaches to nutrient deficiencies typically encountered in the bariatric surgery patient.
Also included is a section on how to envision and develop an interdisciplinary team of medical providers with evidence-based nutrition knowledge and consistent information that improves the quality of nutrition care provided to BMS patients.
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