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 better outcomes from 30° reverse Trendelenburg position combined with the beach chair position undergoing LSG, characteristics of PCOS post-BMS, ursodeoxycholic acid is ineffective for pre-existing gallstones for LSG patients, variations in the commissioning of specialist weight management services in England and real-time forecasting of post bariatric hypoglycaemic events, and more (please note, log-in maybe required to access the full paper).
The effect of two different surgical positions on pulmonary functions in laparoscopic sleeve gastrectomies: reverse Trendelenburg vs beach chair
The 30° reverse Trendelenburg position combined with the beach chair position reduced inspiratory and peak pressures and increased dynamic compliance, compared with the 30° reverse Trendelenburg position alone, according to researchers from Istınye University Medicalpark Gaziosmanpasa Hospital, Istanbul, Turkey.
Writing in Surgical Endoscopy, 50 patients were divided into two groups; in the control group, the standard 30° reverse Trendelenburg. In the beach chair group, the feet were positioned at 30° flexion from the hips after a 30° RTP. For both positions, blood pressures, pulses, saturations, EtCO2, respiratory rate, inspiratory pressure (Pins), positive end-expiratory pressure (PEEP), minute volume, tidal volume, peak airway pressure (Ppeak), and dynamic compliance were recorded. In addition, the general surgeon was asked about his satisfaction with the intra-abdominal operation site view and whether he was uncomfortable with the position.
They reported no difference between the groups in terms of age, gender, BMI, operation time, blood pressures, heart rates, EtCO2, respiratory rate, PEEP, minute volume, tidal volume, and postoperative oxygen saturation (p>0.05). However, inspiratory and peak pressure were lower and dynamic compliance was higher in the beach chair position (p<0.05). The results showed that the beach chair position decreased inspiratory and peak pressures and increased dynamic compliances in patients with a BMI between 35.1 and 40 (p<0.05). In addition, surgical satisfaction was high for both positions and there was no discomfort with the position.
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Characteristics and Clinical Outcomes of Women with Polycystic Ovary Syndrome After Bariatric Surgery
Patients with a polycystic ovary syndrome (PCOS) diagnosis in the four years after bariatric and metabolic surgery (BMS) may be particularly susceptible to migraines, disinhibited eating behaviour and anxiety, although weight and cardiometabolic outcomes were comparable to those without a diagnosis of PCOS post-surgically, according to a study by US researchers.
Writing in Obesity Surgery, from 657 female (sex assigned at birth) participants who underwent bariatric surgery, 7% (n=46) reported having a current diagnosis of PCOS. Women with PCOS were significantly younger (p<0.001) and were more likely to endorse migraines (p<0.007) and loss of control eating episodes (p<0.001) since undergoing surgery, compared to those without a diagnosis of PCOS post-BMS.
In addition, 47.8% of women with PCOS endorsed clinically significant anxiety, compared to 25.7% of women without PCOS (p=0.03). There were no differences in other demographic, psychiatric or medical characteristics.
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Efficacy of ursodeoxycholic acid in reducing the necessity of cholecystectomy due to pre-existing and subsequently formed gallstones in patients who underwent laparoscopic sleeve gastrectomy
Ursodeoxycholic acid (UDCA) is a promising option for reducing the need for cholecystectomy in patients with post-LSG gallstones, but it appears ineffective for pre-existing gallstones, according to a study by researchers from Turkey.
Reporting in BMC Surgery, they compared the two year outcomes of 425 patients who underwent LSG in patients with pre-existing asymptomatic gallstones during preoperative evaluation, who had UDCA treatment (group A), and observation group (group B). Patients with newly formed gallstones in postoperative outpatient clinic follow-up, those with UDCA treatment (group A), and those without UDCA treatment (group B).
At the end of the first year, patients who had newly formed gallstones after LSG had a higher total weight loss percentage (39.8±6.1) vs. those who did not develop gallstones (37.9±7.4, p=0.004).
Among patients who developed gallstones postoperatively, UDCA treatment was associated with a significantly lower cholecystectomy rate in patients with newly formed gallstones postoperatively (p=0.025). There were no significant difference was shown in patients with preoperative gallstones (p=0.631).
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Variation in the commissioning of specialist weight management services and bariatric surgery across England: Results of a freedom of information-based mapping exercise across the 42 integrated Care Systems of England
There is significant geographical variation in the availability of both bariatric and specialist medical weight management services across England, with large portions of the country without local access to a service or no service at all, according to UK researchers.
Writing in Clinical Obesity, they sent Freedom of Information (FOI) requests to all 42 Integrated Care Systems (ICSs) in England asking four questions aiming to establish whether there is variation in the commissioning of specialist weight management services and the eligibility criteria for bariatric surgery across England.
Responses were received from 41 out of 42 ICSs, with 34 reporting that they provide commissioned medical weight management programmes and 38 funding bariatric surgery. Thirteen reported using criteria that were not compliant with NICE guidance. A large area of the country centred around the East of England does not have a bariatric unit reducing access to care.
“Where services are available, there is significant inconsistency in eligibility for bariatric surgery despite nationally available guidance,” the study authors concluded.
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Towards a decision support system for post bariatric hypoglycaemia: development of forecasting algorithms in unrestricted daily-life conditions
Researchers from Italy and Switzerland have reported that real-time forecasting of post bariatric hypoglycaemic (PBH) events using continuous glucose monitoring (CGM) data as a single input imposes high demands on various types of prediction algorithms, with CGM data noise and rapid postprandial glucose dynamics representing the key challenges.
Reporting in BMC Medical Informatics and Decision Making, they developed various algorithms based on linear and deep learning models to forecast PBH episodes in the short-term. Fifty patients with PBH after Roux-en-Y gastric bypass were monitored for up to 50 days under unrestricted real-life conditions. Algorithms’ performance was assessed by measuring Precision, Recall, F1-score, False-alarms-per-day and Time Gain (TG).
The run-to-run forecasting algorithm based on recursive autoregressive model (rAR) outperformed the other techniques, achieving Precision of 64.38%, Recall of 84.43%, F1-score of 73.06%, a median TG of 10 min and 1 false alarm every 6 days. More complex deep learning models demonstrated similar median TG but inferior forecasting capabilities with F1-score ranging from 54.88% to 64.10%.
Run-to-run yielded most satisfactory results with accurate PBH event predictive capacity and few false alarms, thereby indicating potential for the development of DSS for people with PBH, they concluded.
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