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 a paper reporting that sleeve gastrectomy improves chronic kidney disease (CKD), the impact of staple line reinforcement (SLR) during laparoscopic sleeve gastrectomy (LSG), a study has reported that Roux-en-Y gastric bypass (RYGB) is the preferred treatment strategy for patients with severe obesity regardless of baseline T2D severity, international study reports patients with severe insulin-resistant diabetes (SIRD) had better outcomes after metabolic surgery, compared to patients with mild obesity-related diabetes (MOD) and severe insulin deficient diabetes (SIDD), and finally French researchers report that prophylactic mesh placement during single-port sleeve gastrectomy decreases the occurrence of postoperative incisional hernia (please note, log-in maybe required to access the full paper).
Sleeve gastrectomy in subjects with severe obesity and baseline chronic kidney disease improves kidney function independently of weight loss. A propensity score matched analysis
Researchers from the Cleveland Clinic Florida, who retrospectively reviewed the impact of sleeve gastrectomy (SG) on kidney function, have reported that there is short-term improvement of the estimated glomerular filtration rate (eGFR) in patients with severe obesity following SG.
Writing in SOARD, they calculated the estimated eGFR of 1,330 bariatric patients who underwent SG. Of these patients, 18.79% (n=250) met the criteria for CKD-EPI eGFR calculation pre-operatively and at 12 months follow-up after SG. From the 250 patients included in the analysis, 42% (n=105) were classified as CKD stage ≥2. When comparing the baseline pre-operative eGFR at 12 months follow-up after SG, they observed an improvement of 8.26 ±11.89 mL/min/1.73m2 in CKD stage ≥2 (eGFR <90 mL/min/1.73m2) vs -1.98 ±10.25 mL/min/1.73m2 in patients with eGFR >90 mL/min/1.73m2 (p=<0.001).
The researchers noted that the improvement is significant in CKD stages ≥2 and seems unrelated to weight loss.
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Staple Line Reinforcement During Laparoscopic Sleeve Gastrectomy: Systematic Review and Network Meta-analysis of Randomized Controlled Trials
Writing in Obesity Surgery, an international team of researchers examining the impact of staple line reinforcement (SLR) during laparoscopic sleeve gastrectomy (LSG), have concluded that suture oversewing seems associated with a reduced risk of bleeding, leak and overall complications, compared with no reinforcement (NR).
The study included 3,994 patients (17 RCTs) were included. Of those, 1,641 (41.1%) underwent NR, 1507 (37.7%) SR, 689 (17.2%) glue reinforcement (GR), 107 (2.7%) bioabsorbable staple line reinforcement (Gore® Seamguard®, GoR), and 50 (1.3%) clips reinforcement (CR).
Although SR was associated with a significantly reduced risk of bleeding, staple line leak and overall complications, operative time was significantly longer for SR, GR and GoR, compared to NR. Among treatments, there were no significant differences for surgical site infection (SSI), sleeve stenosis, reoperation, hospital length of stay and 30-day mortality.
The authors concluded that data for GoR and CR are limited and further trials reporting outcomes for these techniques are warranted.
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Estimated Cost-effectiveness of Medical Therapy, Sleeve Gastrectomy, and Gastric Bypass in Patients With Severe Obesity and Type 2 Diabetes
Researchers at Columbia University's Vagelos College of Physicians and Surgeons have found that Roux-en-Y gastric bypass (RYGB) is projected to be the preferred treatment strategy for patients with severe obesity regardless of baseline T2D severity.
Their study sought to estimate the cost-effectiveness of medical therapy, sleeve gastrectomy (SG), and RYGB among patients with severe obesity and T2D, stratified by T2D severity. Writing in JAMA Network, they designed a model that simulated 1,000 cohorts of 10,000 patients, of whom 16% had mild T2D, 56% had moderate T2D and 28% had severe T2D at baseline.
Compared with medical therapy over five years, RYGB was associated with the most Quality-adjusted life-years (QALYs) gained in the overall population and when stratified by baseline T2D severity. RYGB was the preferred strategy in the overall population and when stratified by baseline T2D severity. They also reported that cost-effectiveness of RYGB improved over a longer time horizon.
They concluded that the effectiveness and cost-effectiveness of bariatric surgery vary by baseline severity of T2D.
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Data-driven subgroups of type 2 diabetes, metabolic response, and renal risk profile after bariatric surgery: a retrospective cohort study
International team of researchers led by European Genomic Institute for Diabetes, Lille, France, writing in The Lancet Diabetes and Endocrinology, have reported that patients with severe insulin-resistant diabetes (SIRD) had better outcomes after metabolic surgery, both in terms of type 2 diabetes remission and renal function, with no additional surgical risk – compared to patients with mild obesity-related diabetes (MOD) and severe insulin deficient diabetes (SIDD).
They study authors retrospectively related the newly defined clusters with the response to metabolic surgery in participants with type 2 diabetes from independent cohorts in France (the Atlas Biologique de l'Obésite Sévère [ABOS] cohort, n=368) and Brazil (the metabolic surgery cohort of the German Hospital of San Paulo, n=121). The study outcomes were type 2 diabetes remission and improvement of estimated glomerular filtration rate (eGFR).
At one year, T2DM remission was reported in 26 (81%) of 32 and nine (90%) of ten patients with SIRD, 167 (55%) of 306 and 42 (51%) of 83 patients with MOD, and two (13%) of 16 and nine (36%) of 25 patients with SIDD, in the ABOS and São Paulo cohorts, respectively.
In multivariable analysis, SIRD was associated with more frequent type 2 diabetes remission (p=0·0015) and an increase in eGFR (p=0·0070).
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Prevention of incisional hernia after single-port sleeve gastrectomy (PRISM): a prospective non-randomized controlled study
French investigators have reported the impact of single-port sleeve gastrectomy (SPSG) on incisional hernia, particularly in patients with high body mass index. Writing in Surgical Endoscopy, high-risk patients (body mass index ≥ 45 kg/m2) underwent three strategies of parietal closure (suture with or without permanent or absorbable mesh) during SPSG. The primary outcome was the occurrence of radiologically defined incisional hernia during the first postoperative year. Secondary outcomes included surgical site infection rates and postoperative pain.
In total, 255 patients were included (85 in each group). At one-year, significantly more incisional hernias were observed in the no mesh group in comparison with permanent and absorbable mesh groups, respectively (20% vs. 7.1% vs. 5.1%, p=0.005). No difference was observed regarding other parietal complications.
The authors concluded that prophylactic mesh placement during SPSG decreases the occurrence of postoperative incisional hernia, and routine permanent mesh placement could be proposed in high-risk patients.
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