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 SG to RYGB conversion provides moderate to low complementary weight loss in the short term, SASI bypass is effective and comparable to RYGB in terms of EWL and metabolic control, surgery in older patients not associated with lower rates of obesity-related cancer and CV events, outcomes using the single use Titan Stapler and remission rate from obstructive sleep apnoea was high after metabolic and bariatric surgery, and more (please note, log-in maybe required to access the full paper).
Conversion of sleeve gastrectomy to Roux-Y laparoscopic gastric bypass: a comprehensive 14-year follow-up study on efficacy and outcomes
Researchers from Israel have reported that sleeve gastrectomy (SG) to Roux-Y gastric bypass (RYGB) conversion provides moderate to low complementary weight loss in the short term however, by years 3-4 there is a clear trend toward weight gain.
Published in SOARD, they examined the efficacy and outcomes of conversion surgery over a 14 year follow-up period in a cohort 58 patients who underwent conversion of SG to RYGB for two indications (invalidating reflux or weight recurrence during 2009-2023).
At conversion surgery, the mean weight, BMI, percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL) (calculated for intention to treat, from the weight pre-SG) were 92.2±25.2kg, 34.3±8.0kg/m2, 55.2±39.9% and 22.8±15.2% respectively. Mean nadir weight, BMI, percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL) after conversion (calculated from the weight pre-SG) were 71.1±18.4kg, 26.7±5.5kg/m2, 96.5±30.5%, 40.2±10.6%, respectively. At follow-up, the mean weight, BMI, %EWL and %TWL (calculated from the weight pre-SG) were 80.4±17.7kg, 29.6±5.4kg/m2, 78.9±26.8% and 33.3±11.2%, respectively.
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Comparison of the Effectiveness of Single Anastomosis Sleeve Ileal Bypass and Roux-en-Y Gastric Bypass in Obese Patients with Type 2 Diabetes
Single anastomosis sleeve ileal (SASI) bypass is effective and comparable to RYGB in terms of EWL and metabolic control, according to investigators from Turkey.
Writing in Obesity Surgery, they reviewed the medical records of patients who underwent RYGB and SASI bypass and compared regarding excess weight loss (EWL) and HgA1c, fasting glucose, serum iron, ferritin, haemoglobin (Hgb) and vitamin B12 levels.
The body mass index was significantly lower (p=0.003), and the %EWL was significantly higher (p=0.023) at six months postoperative in patients who underwent SASI bypass. Both groups had similar results at the other follow-up visits. The mean HgA1c levels at the six- and 12-month follow-up visits were significantly lower in SASI patients (p=0.037 and p=0.012, respectively). At the 24-month follow-up, no difference was detected in HgA1c levels between the groups (p=0.476). However, in patients who underwent RYGB, ferritin (p<0.001), plasma iron (p=0.001) and Hgb levels (p=0.001) were significantly lower at 12 months postoperatively, respectively.
The researchers added that SASI also had the advantage of not producing excluded segments and reducing nutritional deficiencies.
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Incidence of Cancer and Cardiovascular Disease After Bariatric Surgery in Older Patients
Bariatric surgery in older patients is not associated with lower rates of obesity-related cancer and cardiovascular events, but there was evidence that gastric bypass may be associated with lower risk of both outcomes, Scandinavian researchers have found.
Reporting in JAMA Network Open, they sort to determine whether bariatric surgery is associated with a decreased risk of obesity-related cancer and cardiovascular disease in patients who underwent surgery at age 60 years or older.
In total, 15,300 patients (median age, 63 [61-65] years; 10 152 female patients [66.4%]) were included, of which 2,550 (16.7%) had bariatric surgery at age 60 or older. During a median (IQR) of 5.8 (2.8-8.5) person-years of follow-up, 658 (4.3%) developed obesity-related cancer and 1436 (9.4%) developed cardiovascular disease. The risk of obesity-related cancer (HR, 0.81; 95% CI, 0.64-1.03) and cardiovascular disease (HR, 0.86; 95% CI, 0.74-1.01) were similar among who underwent surgery and those who did not.
Gastric bypass (1,930 patients) was associated with a decreased risk of obesity-related cancer (71 patients [3.7%]; HR, 0.74; 95% CI, 0.56-0.97) and cardiovascular disease (159 patients [8.2%]; HR, 0.82; 95% CI, 0.69-0.99), compared with matched controls (9650 patients; obesity-related cancer: 442 patients [4.6%]; cardiovascular disease: 859 patients [8.9%]).
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Perioperative Outcomes Using Single-Fire Stapler
A study led by researchers from the Michigan State University College of Human Medicine, Grand Rapids, MI, have reported the single fire Titan stapler during laparoscopic sleeve gastrectomy (LSG) is safe, effective and results in an improvement in length of stay, readmissions and post-operative nausea/vomiting.
Writing in Obesity Surgery, the study included 807 LSGs using the latest iteration of the Titan stapler since November 2022. Data from these patients was compared to 3,829 patients who underwent LSG using a sequential staple firing technique from September 2016–September 2021.
After propensity matching, operative duration was significantly less for the Titan. Titan patients had decreased hospital length of stay, experienced fewer 30-day readmissions, and had less post-operative nausea/vomiting. Post-op bleed rates were similar between the two cohorts. Weight loss at six months favoured the sequential fire arm, but the preliminary data shows this difference diminishes at one year.
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Remission of Obesity-Related Sleep Apnea and Its Effect on Mortality and Cardiovascular Events after Metabolic and Bariatric Surgery: A Propensity-Matched Cohort Study
Remission rate from obstructive sleep apnoea (OSA) was high after metabolic and bariatric surgery, according to Swedish researchers.
Writing in the Journal of the American College of Surgeons, the compared patients who reached remission of OSA were compared with those who did not reach remission and a propensity score-matched control group of patients without OSA at the time of operation. The main outcome was overall mortality, and secondary outcome was major cardiovascular events (MACEs).
In total, 5,892 patients with OSA and 11,552 matched patients without OSA completed a 1-year follow-up and were followed for a median of 6.8 years. Remission of OSA was seen for 4,334 patients (74%). Patients in remission had a lower risk for overall mortality (cumulative incidence 6.0% vs 9.1%; p<0.001) and MACE (cumulative incidence 3.4% vs 5.8%; p<0.001) at ten years after operation, compared with those who did not reach remission. The risk was similar to that of the control group without OSA at baseline (cumulative incidence for mortality 6%, p=0.493, for MACE 3.7%, p=0.251).
The remission rate from OSA was associated with reduced risk for death and MACE compared with patients who did not achieve remission reaching a similar risk seen among patients without OSA at baseline.
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