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 outcomes from the BAMBINI RCT, OAGB vs sleeve gastrectomy with loop duodenojejunal bypass, bariatric surgery and inflammatory bowel disease, preoperative risk factors for early postoperative bleeding after RYGB and outcomes from a Window to Window variant technique of LSG, and more (please note, log-in maybe required to access the full paper).
Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial
Bariatric surgery is more effective than medical care for the induction of spontaneous ovulation in women with polycystic ovary syndrome (PCOS) and could therefore enhance the prospects of spontaneous fertility in this group of women, according to outcomes from the BAMBINI multicentre, open-label, randomised controlled trial.
UK researchers, writing in The Lancet, recruited 80 women with a diagnosis of PCOS who were randomly assigned at a 1:1 ratio to either vertical sleeve gastrectomy or behavioural interventions and medical therapy using a computer-generated random sequence (PLAN procedure in SAS) by an independent researcher not involved with any other aspect of the clinical trial.
The median number of ovulations was 6 (IQR 3·5–10·0) in the surgical group and 2 (0·0–4·0) in the medical group. Women in the surgical group had 2.5 times more spontaneous ovulations compared with the medical group (incidence rate ratio 2·5 [95% CI 1·5–4·2], p<0·0007). There were 24 (66.7%) adverse events in the surgical group and 12 (30%) in the medical group. There were no treatment-related deaths.
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Comparison of Sleeve Gastrectomy with Loop Duodenojejunal Bypass Versus One Anastomosis Gastric Bypass for Type 2 Diabetes: The Role of Pylorus Preservation
Both OAGB and sleeve gastrectomy with loop duodenojejunal bypass (SG + LoopDJB) show comparable, favourable outcomes in weight loss, T2DM remission, and lipidaemia improvement at the one-year follow-up, according to researchers at the First Affiliated Hospital of Nanjing Medical University, Jiangsu, China,
Writing in Obesity Surgery, the researchers explained that SG + LoopDJB bypasses an equivalent length of the foregut as OAGB while maintaining pyloric function. Therefore, they conducted a study to compare the surgical safety and one-year outcomes of OAGB and SG + LoopDJB regarding type 2 diabetes mellitus (T2DM) remission, weight loss, gastrointestinal disorders, and nutritional status in T2DM patients matched by gender, age and BMI.
SG + LoopDJB had longer operative time and length of stay (LOS) but similar major postoperative complications, compared with OAGB. At one-year follow-up, OAGB has similar diabetes remission (both 91.9%), weight loss effect (28.1 ± 7.1% vs. 30.2 ± 7.0% for %TWL), and lipidaemia improvement to SG + LoopDJB (p>0.05). OAGB presented a higher incidence of hypoalbuminemia (11.9% vs. 2.4%, p=0.026) but a low incidence of gastroesophageal reflux disease (GERD) symptoms (9.5% vs. 26.2%, p=0.046) than SG + LoopDJB. There was no statistical difference regarding other gastrointestinal disorders and nutritional deficiencies between groups.
Preservation of the pylorus preservation, while increasing surgical difficulty and the risk of de novo GERD, may reduce the risk of postoperative hypoalbuminemia, the researchers concluded.
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Bariatric Surgery in Inflammatory Bowel Disease: A Comparative Analysis of 450,000 patients
Bariatric surgery is equally effective in Inflammatory Bowel Disease (IBD) and non-IBD patients in terms of weight loss at one-year follow-up. However, IBD patients are at a higher risk of postoperative complications, micronutrient deficiency, and readmission, according to researchers from Alexandria University, Faculty of Medicine, Egypt.
Reporting in SOARD, their analysis found an insignificant difference in the change of BMI at one-year post-BS between IBD and non-IBD patients. IBD patients had a higher risk of acute renal failure, haemorrhage and readmission following surgery. However, no significant difference was observed between both groups regarding wounds, leak/intraabdominal infection, thromboembolic complications and bowel obstruction.
A higher incidence of postoperative complications was seen among IBD patients undergoing RYGB compared with SG and there was a significant decline in steroid use following surgery in IBD patients. Comparison between ulcerative colitis (UC) and Crohn’s disease (CD) found insignificant differences in treatment escalation or de-escalation, but both UC and CD reported a decline in steroid use following surgery without a preferential advantage to a particular IBD sub-type.
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Preoperative risk factors for early postoperative bleeding after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis
Age, gender, hypertension and revisional bariatric surgery are associated with early postoperative bleeding after Roux-en-Y gastric bypass (RYGB), according to a systematic review and meta-analysis by Portuguese researchers.
Writing in Langenbeck's Archives of Surgery, their review included 23 studies (232,488 patients) and reported male gender (p=0.29) and revisional surgery (p=0.21) were associated with higher risk of early postoperative bleeding. On average, patients with early postoperative bleeding were older than the remainder (MD for the mean age = 2.82 years, p=0.46). Except for hypertension (p<0.0001), comorbidities were not associated with a higher risk of EPB.
They called for additional primary studies, with higher methodological quality, to provide data to detail more risk factors.
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“Window to Window”: A Variant Technique of Laparoscopic Sleeve Gastrectomy
Window to Window technique of LSG presents many technical advantages for surgeons in terms of safety and exposure, compared with the standard technique, although with a longer learning curve, according to researchers from Lebanon.
Reporting in Obesity Surgery, the Window to Window variant LSG technique requires three trocars. Surgical steps, start by creating the paracardial window then the antral window. Subsequently, the gastric transection is performed in two phases after progressive retro-gastric liberation. Lastly, the mobilisation of greater curvature is carried out followed by specimen extraction and fascial closure.
In total, 3200 patients had this procedure and in terms of medium-term percent of excess weight loss, the outcomes were was comparable when compared with the standard technique.
“This variant technique of LSG presents many technical advantages for surgeons in terms of safety and exposure compared with the standard technique, while presenting a longer learning curve,” the researchers concluded.
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