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 ten-year SM-BOSS outcomes, same-day discharge with remote monitoring, skeletal muscle mass post-BMS, Zoledronic acid increases spine bone mass after surgery and targeted supplementation to minimise post-op nutritional deficiencies, and more (please note, log-in maybe required to access the full paper).
Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Obesity - The SM-BOSS Randomized Clinical Trial
RYGB results in significantly higher %EBMIL in the per-protocol (PP) population compared with SG beyond ten years of follow-up, with better results for GERD.
Reporting in JAMA Surgery, the RCT was designed to compare long-term weight and metabolic outcomes, reoperation rates, and quality of life for patients undergoing SG vs RYGB at ten years and beyond.
Of the 217 patients randomised to undergo SG or RYGB, , 110 patients had a RYGB and 107 to SG. At ten years, in the intention-to-treat population, %EBMIL was 60.6% (25.9) after SG and 65.2% (26.0) after RYGB (p=0.29). Patients who underwent SG had significantly higher conversion rates because of insufficient weight reduction or reflux compared to RYGB (29.9% vs 5.5%; p<0.001). Patients undergoing RYGB had significantly higher mean (SD) %EBMIL compared to SG after ten years in the per-protocol (PP) population (65.9% [26.3] vs 56.1% [25.2]; p=0.048).
However, mean (SD) percentage total weight loss was not significantly different between groups (RYGB: 27.7% [10.8]; SG: 25.5% [15.1]; p=0.37). SG patients had significantly more de novo gastroesophageal reflux (GERD) compared with RYGB (p=0.02). Patients undergoing SG experienced a significantly higher number of conversions to different anatomy compared with RYGB.
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Remote Patient Monitoring Following Same-Day Discharge Bariatric Surgery: A Systematic Review and Meta-analysis
Same-day discharge (SDD) with remote monitoring (RM) enables a shorter hospital stay after BMS while providing a safety net for patients and clinicians, UK researchers have found.
Writing in Obesity Surgery, their systematic review included 17 studies (20,380 patients) and examined the impact of RM on postoperative readmissions and complications in patients undergoing SDD after BMS.
The incidence of readmission for patients with and without RM was 6% and 2%, respectively (p=0.01) and the overall complication rates for patients with and without RM were found to be 7% and 3% (p=0.08). Most of the patients who were readmitted had a Clavien-Dindo score of 1 or 2 (68%). There was no mortality described in studies with the use of RM.
The study authors acknowledge that readmission rate is expected marginally higher given the early discharge date and they said that future studies should reported on the reporting on cost implications.
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Meta-analysis of changes in skeletal muscle mass within 1 year after bariatric surgery
The skeletal muscle mass of patients after bariatric surgery showed a downward trend within one year after BMS, especially in the first three months, investigators from Yangzhou University, Yangzhou, China, have reported.
Writing in Surgical Endoscopy, their meta-analysis examined changes in skeletal muscle mass one year after BMS and analyse the causes of changes in skeletal muscle in postoperative patients, to provide a more comprehensive clinical basis for preserving muscle mass in patients.
They reported that skeletal muscle mass decreased significantly from preoperative to postoperative three months, and the difference was statistically significant ([WMD = 3.30kg, 95%CI (2.18, 4.41)], p<0.00001). Skeletal muscle mass was not statistically significant from three to six months after surgery and six to 12 months after surgery.
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Zoledronic acid increases spine bone mass and prevents hip bone loss after bariatric surgery: a randomized placebo-controlled study
Zoledronic acid (ZA) increases bone mass in the spine and prevents bone loss in the hip region after bariatric surgery compared with placebo, according to the outcomes of a randomised controlled trial led by researchers from Esbjerg Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark.
The aim of the RCT was to investigate the effects of ZA for the prevention of bone loss after BMS surgery and included 59 patients undergoing RYGB and LSG who were randomly assigned (1:1) to receive either zoledronic acid (5mg) or placebo preoperatively. The primary endpoint was the change in spine volumetric bone mineral density (vBMD) at 12 months after surgery.
The estimated mean treatment effects of zoledronic acid on the spine and total hip were 6.8mg/cm3 (p=0.003) and 5.0mg/cm3 (p=0.006), respectively. Bone mass in the spine increased by 2.6% in the group that received ZA, whereas no changes were observed in the placebo group.
Additionally, bone loss in the total hip was prevented in the ZA group compared with the placebo group (vBMD: −0.6% vs. −3.6%; p=0.006).
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Enhancing nutritional health and patient satisfaction five years after metabolic bariatric surgery with targeted supplementation
Type-targeted supplementation represents an innovative approach to optimising long-term nutritional support in bariatric patients as persistent iron and vitamin D deficiencies highlight the necessity of individualized supplementation and long-term monitoring, according to Italian researchers.
Reporting in the Journal of Translational Medicine, the study authors analysed the long-term outcomes of BMS of 249 patients, focusing on weight loss, nutritional deficiencies, and patient satisfaction.
They found that RYGB resulted in further weight reduction from the third year onwards and patients revised from LSG to RYGB had significantly greater weight loss (102.1%) compared to those revised to MGB (84.6%, p<0.05). Nutritional deficiencies were prevalent, with 41.2% of revised LSG patients experiencing iron deficiency and 14.3% developing new vitamin D deficiencies (p<0.05). Most patients (85%) reported improvements in quality of life and 85% expressed a willingness to undergo surgery again (p=0.0028).
Surgical revisions, especially from LSG to RYGB, were associated with greater weight loss but also increased nutritional risks and the researcher stated that future studies with larger cohorts and validated tools are needed to confirm these findings and strengthen clinical guidelines.
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