Journal Watch 5/3/2025

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 combined LSG and Nissen Fundoplication for GERD, effects of LSG on left ventricular myocardial work, BMS and the modern trends of drain placement, impact of BMS on carpal tunnel syndrome, post-op aspiration pneumonia and GLP-1ras and huge rise in obesity rates by 2050, and more (please note, log-in maybe required to access the full paper).

Efficacy of Combined Sleeve Gastrectomy and Nissen Fundoplication for Weight Loss and Prevention of Postoperative Gastroesophageal Reflux Disease in Patients with Obesity: A Systematic Review and Meta-Analysis

Laparoscopic Nissen Sleeve (LNS) seems to be a safe and effective operation with apparently better GERD-related outcomes than SG alone, according to researchers from the Hospital Alemán of Buenos Aires, Argentina.

Writing in SOARD, their systematic review and meta-analysis including five studies comprising 246 patients undergoing LNS. After a mean follow up of 27 (12-60) months, they reported a significant reduction in mean BMI (pre: 38.10 vs. post: 29.36, p<0.007) and a mean EWL of 59.10% (26%-82%).

The proportion of patients with GERD symptoms (pre: 80.16% vs. post: 11.22%, p=0.001) were significantly reduced after LNS. The use of PPIs (pre: 69% vs. post: 8.98%, p=0.10) and presence of esophagitis (pre: 69.6% vs. post: 18%, p = 0.05) also reduced after the procedure, but this was not statistically significant. Overall morbidity rate was 4% and included 2% for leaks, 2%  for strictures, 1% for bleeding and 3% for perforation.

The researchers stressed the need for further studies with longer follow-up and objective measurement of reflux are needed to confirm the successful outcomes of the procedure.

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Effects of weight loss after sleeve gastrectomy on left ventricular myocardial work in obese patients

Weight loss after LSG can improve left ventricular myocardial work (LVMW) efficiency and the associated parameter changes are related to cardiac structure, offering new clinical references, researchers from Henan Provincial People's Hospital, Zhengzhou, China, have reported.

Writing in the Frontiers in Cardiovascular Medicine, the study included 31 patients and at six-months post-LSG they reported significant reductions in body mass index, diastolic blood pressure and weight. Cardiac output, stroke volume , left ventricular end -diastolic volume, left ventricular end -systolic volume, left ventricular ejection fraction, Peak E, e', and a' decreased, while left ventricular mass index increased.

Myocardial work parameters also showed significant changes after LSG, with global longitudinal strain and global work efficiency increasing and global work index, global constructive work and global wasted work decreasing.

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Modern Trends of Drain Placement in Primary Bariatric Surgery: An MBSAQIP Analysis of 526,723 Patients

The frequency of prophylactic drain placement during primary bariatric surgical procedures has decreased in recent years and patients with drain placement seem to have increased 30-day morbidity, including longer length of stay, according to researchers from the University of Alberta, Edmonton, Canada.

Writing in Obesity Surgery and using data from the the Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database, they included two cohorts - a drain placed (DP) cohort and no drain (ND) cohort. Of 526,723 included patients, drain utilisation decreased across operative years (8.7% in 2020 to 6.1% in 2022, p<0.001).

Factors associated with drain placement included older age, higher BMI, partially dependent functional status, renal insufficiency, venous thromboembolism, hypoalbuminemia, and non-sleeve anastomotic procedures. Drain placement was also associated with increased risk of numerous complications on bivariate analysis, which was still significant in multivariate analysis, including 30-day serious complications (anastomotic leak (p<0.001), organ space infection (p<0.001), reoperation (p=0.036), and excess length of stay (p<0.001)).

“Independent predictors of drain placement include increased age and metabolic burden along with anastomotic procedures,” they concluded. “Surgeons should be judicious in selecting patients for drain placement and future prospective, controlled studies may better answer drain placement association with complications.”

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Bariatric surgery is associated with lower incidence of carpal tunnel syndrome

Israeli researchers have reported that BMS is associated with reduced incidence of developing carpal tunnel syndrome (CTS) and there is a dose-response association where greater weight loss following BMS is protective of developing CTS.

Writing in the International Journal of Obesity, they examined the outcomes from 6,124 patients who underwent BMS  and patients who developed CTS following BMS were compared to those who did not.

The incidence of CTS at the five-years prior to the surgery was significantly higher than the post BMS incidence, 8.4% versus 5.1% respectively (p<0.001). Patients who developed CTS following the BMS were older and had a higher prevalence of hypertension and diabetes mellitus prior to the BMS. They also had a higher BMI and excess body weight at every time point measured and a lower BMI reduction. However, weight regain was not associated with increased incidence of CTS and there was a direct correlation between excess weight loss to greater reduction in the incidence of CTS.

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Postoperative Aspiration Pneumonia Among Adults Using GLP-1 Receptor Agonists

There is no significant association between the preoperative use of GLP-1 RAs and short-term postoperative aspiration pneumonia - despite growing concerns about the adverse effects of these medications after surgery – researchers from Massachusetts General Hospital, Harvard Medical School, Boston, MA, have reported.

Writing in JAMA Network Open, they investigated if preoperative GLP-1 RA use is associated with postoperative aspiration pneumonia among patients undergoing common surgical procedures.

Some 366,476 patients were included of whom 5,931 patients (1.6%) had a preoperative prescription for a GLP-1 RA. Patients using GLP-1 RAs were more likely to be female (3502 [59.0%] vs 203 288 [56.4%]) and diagnosed with both obesity and diabetes (2819 [47.5%] vs 24 635 [6.8%]) compared with non-users. Adjusted analysis showed no significant differences in the odds of postoperative pneumonia (p=0.12) between GLP-1 RA users and non-users.

The study authors added that the findings suggest that it may be beneficial to reassess the preoperative withholding guidelines for GLP-1 RAs.

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Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Without urgent policy reform and action, over half the world's adult population (3.8 billion) and a third of all children and adolescents (746 million) are forecast to be living with overweight or obesity by 2050, according to an analysis from the Global Burden of Disease Study BMI Collaborators.

Writing in The Lancet, the study predicts a substantial (121%) rise in obesity among young people globally, with the total number of children and adolescents with obesity predicted to reach 360 million by 2050 (an additional 186 million from 2021). The substantial increases in obesity forecast between 2022 and 2030, underscore the urgent need for action.

The new analysis estimated the prevalence of overweight and obesity for children and young adolescents (aged 5–14 years), older adolescents (aged 15–24 years), and adults (aged 25 and older) in 204 countries and territories from 1990 to 2021 with forecasts from 2022 to 2050 (assuming continuation of past trends and patterns as well as policies and interventions) using up to 1,350 unique data sources, including all major multi-country and national survey data. Adjustments were made to correct for self-reporting bias.

The analysis found an estimated 1.69 billion additional adults living with overweight or obesity by 2050 (raising the total to 3.8 billion, of whom 1.95 billion will have obesity). While the largest number of adults with overweight and obesity are still expected in China (627 million), India (450 million) and the US (214 million) in 2050, the number in sub-Saharan Africa is forecast to rise by over 250% to 522 million, driven by population growth.

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