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 liver improvements after MBS, DiaRem predicting remission after OAGB, MetS and CVD, five years LSG and RYGB outcomes, barbed vs non-barbed sutures and early complications of LSG using four ports, and more (please note, log-in maybe required to access the full paper).
Rapid improvement of hepatic steatosis and liver stiffness after metabolic/bariatric surgery: a prospective study
Decreasing liver stiffness measurement (LSM) and controlled attenuation parameter [CAP), as well as liver injury markers suggest an improvement of metabolic dysfunction-associated steatotic liver disease (MASLD) and related steatohepatitis (MASH) as early as three months after metabolic/bariatric surgery (MBS), according to researchers from the Medical University of Vienna, Vienna, Austria.
Reporting in Scientific Reports, 93 patients (median age 40.9 years, 68.8% female, median baseline-BMI: 46.0 kg/m2) undergoing MBS in 2021–2022 were prospectively enrolled. LSM (via vibration-controlled transient elastography [VCTE], point [pSWE] and 2D [2DSWE] shear wave elastography) and non-invasive steatosis assessment (via CAP) were performed before (baseline [BL]) and three months after surgery.
Baseline-liver biopsy showed MASLD in 82.8% and MASH in 34.4% of patients. At three months, the median relative total weight loss (%TWL) was 20.1% and the median BMI was 36.1 kg/m2. LSM assessed by VCTE and 2DSWE, as well as median CAP all decreased significantly from baseline to three months both in the overall cohort and among patients with MASH.
There was also a decrease from baseline to three months in median levels of ALT (34.0 U/L to 31 U/L; p = 0.025), gamma glutamyl transferase (BL: 30.0 to 21.0 U/L; p<0.001) and MASLD fibrosis score (BL: − 0.97 to − 1.74; p<0.001).
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Diagnostic Value of Advanced-DiaRem for Predicting Diabetic remission after One Anastomosis Gastric Bypass/Minigastric Bypass
The diagnostic value of advanced-diabetic remission (Ad-DiaRem) for predicting diabetic remission should be specified according to race, place of residence and prevalence of diabetes in society, according to researchers from Iran University of Medical Sciences (IUMS), Shahid Hemmat Highway, Tehran, Iran.
Writing in Obesity Surgery, they sought to determine the diagnostic values of Ad-DiaRem, one of the scoring systems, in predicting diabetic remission after one anastomosis gastric bypass (OAGB) surgery.
In this retrospective cohort study, the diagnostic values of Ad-DiaRem on diabetes remission, after OAGB surgery, which consist of sensitivity (Sen), specificity (Spe), positive and negative predictive values (P/NPV), positive and negative likelihood ratios (P/NLR), accuracy, and odd ratio (OR), were determined.
The percentages of complete diabetic remission after surgery were 56.3% and 53.8% in 12th and 24th months, respectively. The remission cut-off point for Ad-DiaRem was defined 10 considering the highest Youden’s index. Among the evaluation indices, the values of Spe, PPV, accuracy, and OR were assigned a high value in both 12th and 24th months of follow-up; however, the area under curve (AUC) was 20% in both.
Presently, this model can be used cautiously until a new model is proposed by further studies, they concluded.
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Cardiovascular disease among bariatric surgery candidates: coronary artery screening and the impact of metabolic syndrome
Cardiovascular disease (CVD) is highly prevalent in patients with obesity, especially in patients living with metabolically unhealthy obesity (MUO) and increasing the number of principal metabolic syndrome (MetS) components will significantly elevate the risk of CVD, researchers from Beijing Fuxing Hospital, Beijing, China, have reported.
Reporting in Diabetology & Metabolic Syndrome, a consecutive series of bariatric 1,446 surgery candidates at two Chinese tertiary hospitals received coronary CT angiography or coronary angiography from 2017 to 2023. Patients were categorised as MUO and metabolically healthy obesity (MHO) based on the presence or absence of MetS.
The incidence of CVD and obstructive CVD were 31.7% and 9.6%. Compared with MHO patients, MUO patients had a significantly higher incidence of mild (13.7% vs. 6.1%, p<0.05), moderate (7.4% vs. 0.8%, p<0.05) and severe CVD (3.1% vs. 0%, p<0.05).
Following complete adjustment, compared with zero or one component, two principal MetS components was found to be associated with a notable increase in the risk of CVD (OR 2.05, 95% CI 1.18–3.58, p<0.05); three principal MetS components were observed to have a higher risk of CVD and obstructive CVD (OR 2.68, 95% CI 1.56–4.62, p<0.001; OR 3.93, 95% CI 1.19–12.93, p<0.05). Each increase in the number of principal MetS components correlated with a 1.47-fold (95% CI 1.20–1.81, p<0.001) and 1.78-fold (95% CI 1.24–2.55, p<0.05) higher risk of CVD and obstructive CVD, respectively.
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Update on comparison of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis of weight loss, comorbidities, and quality of life at 5 years
At five years after surgery, laparoscopic Roux-en-Y gastric bypass (LRYGB) resulted in greater weight loss and achieved better remission rate of T2D and dyslipidaemia than laparoscopic sleeve gastrectomy (LSG) however, LSG has a lower morbidity rate than that of LRYGB, researchers from the Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, China, have reported.
Writing in BMC Surgery, this meta-analysis included 18 eligible studies (1,776 patients in the LSG group and 1,679 patients in the LRYGB group) and they found LRYGB resulted in greater weight loss compared with LSG at five years [WMD= -7.65 kg/m², 95% confidence interval (CI) -11.54 to -3.76, p=0.0001], but there exists high heterogeneity with I²=84%. Resolution rate of type 2 diabetes mellitus (T2D) (OR = 0.60, 95%Cl 0.41–0.87, p=0.007) and dyslipidaemia (OR = 0.44, 95%Cl 0.23–0.84, p=0.01) was higher in the LRYGB group than that in the LSG group at five years. There was no difference between LRYGB and LSG for remission of hypertension and obstructive sleep apnoea. No differences were observed in the QoL after LRYGB or LSG.
Morbidity was lower in the LSG group (WMD = -0.07, 95% CI: -0.13, -0.02, p=0.01) than in the LRYGB group. No statistically significant difference was found in mortality between the two procedures.
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Safety and Efficacy of Barbed Sutures Compared to Non-barbed Sutures in Bariatric Surgery: An Updated Systematic Review and Meta-analysis
Barbed sutures have the potential to be an alternative for laparoscopic intracorporeal suturing in bariatric surgery, according to authors writing on behalf of Global Obesity Collaborative.
Reporting in Obesity Surgery, they explored the potential of barbed sutures through a meta-analysis that compared outcomes to those of conventional non-barbed sutures in bariatric surgery.
Using data from 11 studies (27,442 patients, including 3,516 in the barbed suture group across various bariatric surgeries), the analysis demonstrated a significant reduction in suturing time (mean difference -4.87; 95% CI -8.43 to -1.30; p<0.01; I2 = 99%) associated with the use of barbed sutures.
In Roux-en-Y gastric bypass, they found a significant decrease in operative time (mean difference -12.11; 95% CI -19.27 to -4.95; p<0.01; I2 = 93%). Interestingly, they identified that the mean body mass index did not significantly predict the mean difference in operative time outcome. There were no significant differences emerged in hospital stay or postoperative complications, including leak, bleeding, stenosis, and bowel obstruction (p>0.05).
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Frequency of Early Complications of Laparoscopic Sleeve Gastrectomy Using Four Ports
The four-port technique in LSG is associated with an 18% early complication rate with significant risk factors being higher BMI and longer surgery duration, researchers from the Bacha Khan Medical Complex, Swabi, Pakistan, have found.
Writing in Cureus, they investigated the frequency and types of early complications following LSG using four ports. In total, 369 patients (aged 25-65 years with a BMI of 35-55 kg/m2) were included.
The average surgery duration was 92 minutes (SD = 22) and the mean intraoperative blood loss was 100 mL (SD = 50). Early complications occurred in 18% of patients with bleeding, infection, and leakage each accounting for 5%, 4%, and 3%, respectively. Reoperation was required in 5% of patients due to these complications. Higher BMI (45.2 vs. 41.8 kg/m2, p=0.04) and longer surgery duration (105 vs. 88 minutes, p=0.03) were significantly associated with increased complication rates. Comorbidities were present in 60% of patients with complications compared to 34% without complications (p=0.03).
Careful patient selection, standardised surgical techniques and robust postoperative care are essential to minimize complications and improve outcomes in LSG, they concluded.
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