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 technical Considerations for OAGB by the ISMBS collaborative group, surgeons' views on pre-op factors associated with improved HRQoL post-surgery, physiology of the weight-loss plateau post intervention, semaglutide in patients with obesity-related heart failure and T2DM, and sex disparities in surgeon ergonomics, and more (please note, log-in maybe required to access the full paper).
Technical Considerations in One Anastomosis Gastric Bypass—the Israeli Society of Metabolic and Bariatric Surgery Experience
The collaborative group of the Israeli Society of Metabolic and Bariatric Surgery (ISMBS) has reported that there are both common preferences and variations among members when performing one anastomosis gastric bypass (OAGB).
Writing in Obesity Surgery, they sought to address OAGB technical aspects using a national survey completed by members of the ISMBS via a 17-item–based questionnaire that was sent to 64 members, 47 of whom responded.
Most surgeons (74.5%) had more than ten years of MBS experience, with most (61.7%) performing more than 100 MBS a year. The majority (78.7%) perform OAGB as their most common procedure. Most surgeons fashion a 10–15cm pouch (57.4%) and use a 36Fr bougie and (38.3%). A majority (70%) use visual estimation and 10.6% routinely measure total small bowel length. The most common reasons for creating a longer biliopancreatic limb (BPL) were high body mass index (BMI) and revisional surgery (83.3% and 66%, respectively). In a primary procedure of a patient with a BMI40, most (76.6%) would create a 150–200-cm BPL. In patients with a BMI>50 or revisional cases, most (70.2% and 68.0%) would create a 175–225-cm BPL.
The authors concluded that further studies are needed in order to standardise and build a consensus on OAGB technique.
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Bariatric surgeons' views on pre-operative factors associated with improved health-related quality of life following surgery
Better than average health literacy, higher socioeconomic status, good physical and psychological health, and positive social support were predictors of improved health-related quality of life (HRQoL) following surgery, according to investigators from the University of Adelaide, Adelaide, South Australia, Australia.
Reporting in Obesity Reviews, they examined the views of 58 bariatric surgeons from Australia and New Zealand. A total of 18 factors were selected for exploration and participants rated the extent to which they thought these pre-operative factors would improve post-operative HRQoL.
The responses also noted that poor eating behaviours, smoking and the use of alcohol or other substances were deemed negative predictors.
The study authors concluded that the array of views identified suggests that there may be an opportunity for medical education and the replication of a larger survey may be useful, especially as predicted HRQoL outcomes could guide decisions regarding surgical (non) progression.
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Physiology of the weight-loss plateau in response to diet restriction, GLP-1 receptor agonism, and bariatric surgery
Both glucagon-like peptide 1 (GLP-1) receptor agonism and Roux-en-Y gastric bypass (RYGB) surgery interventions act to weaken the appetite feedback control circuit that regulates body weight and induce greater persistent effects to shift the body weight equilibrium compared with diet restriction, according to Dr Kevin Hall from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
Writing in the journal Obesity, the objective of this study was to investigate why different weight-loss interventions result in varying durations of weight loss prior to approaching plateaus. Using a validated mathematical model of energy metabolism and body composition dynamics, he simulated mean weight- and fat-loss trajectories in response to diet restriction, semaglutide 2.4mg, tirzepatide 10mg and RYGB surgery interventions.
He found that RYGB surgery resulted in a persistent intervention magnitude more than threefold greater than diet restriction and about double that of tirzepatide and semaglutide. All interventions except diet restriction substantially weakened the appetite feedback control circuit, resulting in an extended period of weight loss prior to the plateau.
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Semaglutide in Patients with Obesity-Related Heart Failure and Type 2 Diabetes
Among patients with obesity-related heart failure (HF) with preserved ejection fraction and type 2 diabetes, semaglutide led to larger reductions in heart failure–related symptoms and physical limitations and greater weight loss than placebo at one year, according to the outcomes from the STEP-HFpEF DM.
Reported by an international team of researchers, writing in the New England Journal of Medicine, they randomly assigned 616 patients who had HF with preserved ejection fraction, a body-mass index of 30 or more and T2DM to receive once-weekly semaglutide (2. mg) or placebo for 52 weeks.
The mean change in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS) was 13.7 points with semaglutide and 6.4 points with placebo (p<0.001), and the mean percentage change in body weight was −9.8% with semaglutide and −3.4% with placebo (p<0.001). The results for the confirmatory secondary end points favored semaglutide over placebo (p=0.008) and there were more serious adverse events reported in the placebo group (n=88, 28.8%) vs the semaglutide group (n=55, 17.7%).
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Overcoming Barriers: Sex Disparity in Surgeon Ergonomics
US researchers, writing on behalf of the Association of Women Surgeons Publications Committee for the American College of Surgeons, have reported that female surgeons endure more pronounced ergonomic discomfort than their male counterparts, with added ergonomic stress associated with pregnancy, and have proposed a four-fold method to overcome ergonomic barriers.
Writing in the Journal of the American College of Surgeons, they reviewed the existing literature to better understand how ergonomic stress varies between male and female surgeons.
They proposed a 4-fold method to overcome ergonomic barriers, including (1) improved education on prevention and treatment of ergonomic injury for active surgeons and trainees, (2) increased departmental and institutional support for ergonomic solutions for surgeons, (3) partnerships with industry to study innovative ergonomic solutions, and (4) additional research on the nature of surgical ergonomic challenges and the differential effects of surgical ergonomics on female surgeons.
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