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 the BE-CALM conversion surgery weight loss predictor, outcomes from the Ezisurg Endostapler, Delphi consensus on patient preparation for metabolic and bariatric surgery, cost drivers for robotic sleeve gastrectomy, and biologic and biosynthetic mesh for ventral hernia repair, and more (please note, log-in maybe required to access the full paper).
BE-CALM: a clinical score to predict weight loss after conversion from sleeve gastrectomy to Roux-en-Y gastric bypass
Patients who have higher starting BMI, ≥ 40% %EWL or ≤ 20% weight regain after sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) demonstrate the most effective weight loss post-conversion, according to researchers from New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, New York.
Writing in Surgical Endoscopy, they assessed weight loss outcomes and factors predictive of improved weight loss in patients undergoing RYGB after SG and create an algorithm to estimate postoperative weight loss in these patients.
The retrospective review included 114 patients (84% female, pre-SG BMI 49.3±10.2) who underwent conversion from SG to RYGB from 2015 to 2022. Post-SG, patients achieved a maximum %TBWL of 31.2% ([6.6–58.2] ± 10.1%), %EWL of 56.8%([13.3–97.3] ± 16.4%), and total body weight regain of 53.9%([0.0–144.4] ± 31.3%).
Conversion to RYGB resulted in peak %TBWL of 18.8% at 8 months, levelling off at 13.5% thereafter. Factors predictive of greater weight loss post-conversion included higher BMI at time of SG (each 5 kg/m2 increase yielded 0.8% greater %TBWL [95% CI 0.5–1%, p<0.0001]) and peak %EWL ≥ 40% after SG (yielding 5.5% more %TBWL, 95%CI 3.9–7.1%, p<0.0001).
However, those who had ≥ 20% weight regain after SG had 4.1% less %TBWL (95%CI 2.5–5.7%, p<0.0001) after conversion. These factors were used to create BE-CALM, an algorithm to predict %TBWL one year after conversion to RYGB.
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The Risk of Leakage and Bleeding After Using the Ezisurg Endostapler Technique for Bariatric Surgery
The Ezisurg endostapler results in low rates of postoperative bleeding (1.25%) and leakage (0.75%), highlighting its safety and effectiveness in laparoscopic BMS, according to study authors from the King Hussein Medical Hospital, Amman, Jordan.
The study included 400 consecutive patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRYGB). Postoperative complications occurred in ten patients (3.6%), including bleeding in five patients (1.25%) and leakage in three patients (0.75%). Five (1.25%) patients had postoperative bleeding, of which two were treated conservatively and three required surgical reoperation, two at the trocar site and one at the stapler line.
The researchers called for multi-centre studies and long-term follow-ups to confirm these findings, evaluate cost-effectiveness and explore patient-specific risk factors to further improve outcomes.
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An international Delphi consensus on patient preparation for metabolic and bariatric surgery
An international team of authors, writing in Clinical Obesity, have published an international Delphi consensus on patient preparation for BMS.
This modified Delphi study engaged 45 global experts to establish consensus on perioperative management in BMS. Experts selected from bariatric societies possessed expertise in MBS and participated in a two-round Delphi protocol. Consensus was achieved on 90 of 169 statements (53.3%), encompassing multidisciplinary team composition, patient selection criteria, preoperative testing and referral pathways. The agreement highlighted the critical role of comprehensive preoperative assessments and the integration of healthcare professionals in MBS.
“These findings offer essential insights to standardise perioperative practices and advocate for evidence-based guidelines in MBS globally,” the authors concluded. “The study underscores the need for unified protocols to optimise outcomes and guide future research in BMS.”
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Cost Drivers of Gastric Sleeve Procedures Performed Using Robotic Platform
Robotic staplers and other unspecified bedside staplers were critical cost drivers in patients undergoing robotic sleeve gastrectomy (rSG) compared to major brand bedside staplers, US researchers have reported.
Writing in SOARD, patients who underwent rSG were extracted from PINC AI Healthcare Data. There were 27,778 patient records, of which 25.6% used LBS, 10.3% used OBS, and 64.1% were RS cases. Increased costs were driven by type of stapler, patients aged 55-64, male, non-White race, non-Medicare insurance, higher comorbidity and disease severity, and hospitals in West region, rural, 500+ beds, with the lower hospital and surgeon’s volume.
After adjusting for other cost drivers, the procedures done by LBS significantly reduced variable costs by $651±$86 (mean difference ± standard error) and $564±$54 and fixed costs by $1,716±$62 and $2,297±$54 vs. OBS and RS. In total, the use of LBS significantly reduced total inpatient costs by $2,384±$118 and $2,692±$90 vs. OBS and RS, respectively.
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Postingestive reward acts through behavioral reinforcement and is conserved in obesity and after bariatric surgery
Portuguese researchers have found postingestive nutrient stimulation influences human food choices through behavioural reinforcement and is conserved in obesity and after bariatric surgery.
Writing in PLOS Biology, they tested flavour-nutrient conditioning (FNC) with maltodextrin-enriched yogurt, with maltodextrin previously optimised for concentration and dextrose equivalents (n=57) and to mask texture cues (n=102). After conditioning, healthy volunteers (n=52) increased preference for maltodextrin-paired (+102 kcal, CS+), relative to control (+1.8 kcal, CS-) flavours, as assessed according to intake, but not pleasantness.
In a clinical study (n=61), behavioural conditioning without effects on pleasantness was confirmed across pre-bariatric candidates with obesity, weight-stable post-surgery patients, and healthy controls, without significant differences between groups.
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Use of Biologic and Biosynthetic Mesh for Ventral Hernia Repair in Current Practice
Urgent or emergent repair and wound contamination were associated with increased odds of biologic or biosynthetic mesh use, nearly 90% of biologic and biosynthetic mesh use occurred in elective repairs with clean wound classifications, researchers from the Department of Surgery, University of Michigan, Ann Arbor, MI have reported.
Writing in JAMA Surgery, they sought to describe the prevalence of biologic and biosynthetic mesh use in ventral hernia repair and to identify factors associated with its use.
In total 10,838 patients who underwent mesh-based ventral hernia repair were identified: 1,174 repairs (10.8%) were performed with biologic or biosynthetic mesh and 9,664 (89.2%) were performed with synthetic mesh. Of the 1174 cases using biologic or biosynthetic mesh, 1023 (87.1%) had a clean wound classification and 1039 (88.5%) were performed electively.
In multivariable logistic regression, wound contamination was associated with increased odds of biologic or biosynthetic mesh use. Other operative factors associated with increased odds of biologic or biosynthetic mesh use included urgent or emergent surgical priority, laparoscopic or robotic approach, larger hernia width and use of myofascial release.
“These results raise questions regarding the appropriateness of its application in current practice,” the authors noted.
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